BACKGROUND: Household air pollution from biomass fuels burning in traditional cookstoves currently appeared as one of the most serious threats to public health with a recent burden estimate of 2.6 million premature deaths every year worldwide, ranking highest among environmental risk factors and one of the major risk factors of any type globally. Improved cookstove interventions have been widely practiced as potential solutions. However, studies on the effect of improved cookstove interventions are limited and heterogeneous which suggested the need for further research. METHODS: A cluster randomized controlled trial study was conducted to assess the effect of biomass-fuelled improved cookstove intervention on the concentration of household air pollution compared with the continuation of an open burning traditional cookstove. A total of 36 clusters were randomly allocated to both arms at a 1:1 ratio, and improved cookstove intervention was delivered to all households allocated into the treatment arm. All households in the included clusters were biomass fuel users and relatively homogenous in terms of basic socio-demographic and cooking-related characteristics. Household air pollution was determined by measuring the concentration of indoor fine particulate, and the effect of the intervention was estimated using the Generalized Estimating Equation. RESULTS: A total of 2031 household was enrolled in the study across 36 randomly selected clusters in both arms, among which data were obtained from a total of 1977 households for at least one follow-up visit which establishes the intention-to-treat population dataset for analysis. The improved cookstove intervention significantly reduces the concentration of household air pollution by about 343 μg/m CONCLUSIONS: The biomass-fuelled improved cookstove intervention significantly reduces the concentration of household air pollution compared to the traditional method. This suggests that the implementation of these cookstove technologies may be necessary to achieve household air pollution exposure reductions. TRIAL REGISTRATION The trial project was retrospectively registered on August 2, 2018, at the clinical trials.gov registry database ( https://clinicaltrials.gov/ ) with the NCT03612362 registration identifier number.
Air Pollutants/analysis* ; Air Pollution, Indoor/prevention & control* ; Biomass ; Cluster Analysis ; Cooking/methods* ; Ethiopia

BACKGROUND: Food safety and hygiene are currently a global health apprehension especially in unindustrialized countries as a result of increasing food-borne diseases (FBDs) and accompanying deaths. This study aimed at assessing knowledge, attitude, and hygiene practices (KAP) of food safety among street-cooked food handlers (SCFHs) in North Dayi District, Ghana. METHODS: This was a descriptive cross-sectional study conducted on 407 SCFHs in North Dayi District, Ghana. The World Health Organization's Five Keys to Safer Food for food handlers and a pretested structured questionnaire were adapted for data collection among stationary SCFHs along principal streets. Significant parameters such as educational status, average monthly income, registered SCFHs, and food safety training course were used in bivariate and multivariate logistic regression models to calculate the power of the relationships observed. RESULTS: The majority 84.3% of SCFHs were female and 56.0% had not attended a food safety training course. This study showed that 67.3%, 58.2%, and 62.9% of SCFHs had good levels of KAP of food safety, respectively. About 87.2% showed a good attitude of separating uncooked and prepared meal before storage. Good knowledge of food safety was 2 times higher among registered SCFHs compared to unregistered [cOR=1.64, p=0.032]. SCFHs with secondary education were 4 times good at hygiene practices of food safety likened to no education [aOR=4.06, p=0.003]. Above GHc1500 average monthly income earners were 5 times good at hygiene practices of food safety compared to below GHc500 [aOR=4.89, p=0.006]. Registered SCFHs were 8 times good at hygiene practice of food safety compared to unregistered [aOR=7.50, p<0.001]. The odd for good hygiene practice of food safety was 6 times found among SCFHs who had training on food safety courses likened to those who had not [aOR=5.97, p<0.001]. CONCLUSIONS Over half of the SCFHs had good levels of KAP of food safety. Registering as SCFH was significantly associated with good knowledge and hygiene practices of food safety. Therefore, our results may present an imperative foundation for design to increase food safety and hygiene practice in the district, region, and beyond.
Adult ; Attitude ; Cooking/methods* ; Cross-Sectional Studies ; Female ; Food Safety ; Ghana ; Health Knowledge, Attitudes, Practice ; Humans ; Hygiene ; Male ; Middle Aged ; Socioeconomic Factors ; Young Adult

BACKGROUND: Among the environmental risk factors, household air pollution exposure from traditional cooking practices is one of the biggest killers globally, which mainly impacts developing countries where many families rely on traditional cooking practices. Although improved cookstove adoption is central to tackle this public health issue, the efforts to disseminate cookstove technologies have faced challenges, and the adoption rates are reported to be very low in many developing countries including Ethiopia. Therefore, this study aimed to determine the magnitude and identify potential factors that may act as facilitators or barriers to adoption from users' point of view. METHODS: As part of the wider stove trial project, a cross-sectional study was conducted among a total of 5830 households under randomly selected clusters. The required data were collected through face-to-face interviews, and a backward stepwise logistic regression analysis technique was applied to evaluate the effect of potential predictor variables on adoption using adjusted odds ratio (AOR) as measures of effect. RESULTS: The prevalence of adoption was found to be 12.3% (95% CI 11.5-13.2), and households headed by females (AOR 1.96; 95% CI 1.24-3.10), private house ownership (AOR 4.58; 95% CI 3.89-6.19), separate cooking location (AOR 1.84; 95% CI 1.49-2.78), fuel purchasing (AOR 2.13; 95% CI 1.64-2.76), health benefit (AOR 1.76; 95% CI 1.15-2.70), optimistic social interaction (AOR 1.81; 95% CI 1.46-2.26), traditional suitability (AOR 1.58; 95% CI 1.28-1.95), stove use demonstration experience (AOR 2.47; 95% CI 1.98-3.07), cheap price (AOR 2.48; 95% CI 1.91-3.21), availability (AOR 1.81; 95% CI 1.5-1, 2.17), fuel-saving benefit (AOR 1.63; 95% CI 1.18-2.24), and more durable stove (AOR 1.71; 95% CI 1.30-2.26) of cookstove played a significant role as facilitators to adoption. In addition, lower educational level of head (AOR 0.31; 95% CI 0.23-0.42) and fuel processing requirement (AOR 0.55; 95% CI 0.44-0.70) of cookstove were found to be barriers for adoption. CONCLUSIONS Extremely lower improved cookstove adoption was observed due to household- and setting-related, cookstove technology-related, user knowledge- and perception-related, and financial- and market development-related factors. Therefore, to gain successful adoption, implementers and policymakers should consider those important factors in the implementation of clean cooking solutions to the community.
Air Pollution, Indoor ; Cooking ; methods ; Cross-Sectional Studies ; Environmental Health ; Ethiopia ; Household Articles ; statistics & numerical data

A 59-year-old woman presented with abdominal pain. Abdominal computerized tomography was suggestive of biliary stones. During endoscopic retrograde cholangiopancreatography, adult worms resembling Clonorchis sinensis (C. sinensis) were drained. Eggs were detected in stool using the formalin-ether concentration method and C. sinensis-specific antibody was detected in the serum. A diagnosis of C. sinensis infection was made. The symptoms of the patient gradually resolved after treatment with anti-parasite medication. The patient lived in a non-endemic region for C. sinensis infection and had no history of intake of raw or undercooked freshwater fishes. South Korea is one of the endemic countries for C. sinensis infection and people can be infected via indirect routes of transmission such as cooking utensils. Therefore, the possibility of C. sinensis infection should be considered in patients presenting with biliary diseases in South Korea. We describe the clinical findings of this case with a review of literature.
Abdominal Pain ; Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Cholecystitis ; Cholecystitis, Acute ; Clonorchis sinensis ; Cooking and Eating Utensils ; Diagnosis ; Eggs ; Female ; Fishes ; Fresh Water ; Humans ; Korea ; Methods ; Middle Aged ; Ovum

BACKGROUND: Polycyclic aromatic hydrocarbons (PAHs) produced by incomplete combustion have negative effects on human health due to their carcinogenicity and teratogenicity. Indoor sources of PAHs include tobacco smoke, heating sources, and cooking. This study evaluated the relationship between human PAH exposure and residence characteristics. METHOD: This study was based on the second Korean National Environmental Health Survey (2012–2014). Non-smoking housewives were included in the analyses (n = 1269). The concentrations of urinary PAH metabolites (2-naphthol, 2-hydroxyfluorene, 1-hydroxyphenanthrene, and 1-hydroxypyrene) were adjusted by urine creatinine level. The geometric mean concentrations of urinary PAH metabolites by residential factors were examined. Logistic regression models were used to evaluate associations between residential variables and PAH exposures. RESULTS: The adjusted geometric mean concentrations of urinary 2-hydroxyfluorene and 1-hydroxyphenanthrene were significantly higher in the group residing within 100 m of a major road (p < 0.05) than in those residing > 100 m from a major road. In logistic regression analyses, the odds ratio (OR) for exceeding the third quartile of urinary 1-hydroxypyrene concentration was significantly higher in the group using coal or wood fuel for residential heating than in the group using gas (OR = 2.745, 95% confidence interval [CI] = 1.295–5.819). The detached house group had a significantly higher OR for 1-hydroxyphenanthrene compared with the apartment group (OR = 1.515, 95% CI = 1.023–2.243). CONCLUSION: Our study shows the evidence of associations between some urinary PAH metabolite levels (1-hydroxyphenanthrene and 1-hydroxypyrene) and residence characteristics. Additional studies are needed to clarify these associations.
Coal ; Cooking ; Creatinine ; Environmental Health ; Heating ; Hot Temperature ; Humans ; Logistic Models ; Methods ; Odds Ratio ; Polycyclic Hydrocarbons, Aromatic ; Residence Characteristics ; Smoke ; Tobacco ; Wood

Objective: To analyze the status and distribution characteristics of household polluting fuel use in China. Methods: The data were collected from the adults aged ≥40 years who were recruited through multi-stage stratified cluster sampling in 2014-2015 COPD surveillance conducted in 31 provinces (autonomous regions and municipalities) in China. A total of 75 107 adults aged ≥40 years in 125 surveillance points were surveyed in face to face interview. Polluting fuels included biomass fuels (wood, dung, crop residues and charcoal), coal (including coal dust and lignite) and kerosene. The weighted percentage of family using polluting fuels, combustion method for cooking or heating and ventilation installation with 95%CI were estimated by complex sampling design. Results: According to the survey results from 75 075 adults, the percentage of family using polluting fuels for cooking or heating was 59.9% (95%CI: 54.2%-65.7%), the percentage in rural areas was significantly higher than that in urban areas (P<0.001). As for different polluting fuels, the percentage of using only biomass fuels for cooking or heating was 25.9% (95%CI:20.5%-31.3%), the percentage of using only coal (including kerosene) was 18.9% (95%CI: 13.2%-24.7%), and the percentage of using both biomass fuels and coal was 15.1% (95%CI: 10.8%-19.4%). Among seven geographic areas in China, the percentages of using biomass fuels ranged from 53.8% in southern China to 23.0% in northern China (P=0.039), the percentages of using coal (including kerosene) ranged from 59.5% in northwestern China to 22.3% in southern China (P=0.001). Among the families using polluting fuels, the percentages of mainly using traditional open fires and stoves were 21.3% (95%CI: 16.9%-25.8%) and 31.5% (95%CI: 25.8%-37.2%), respectively; the percentage of having ventilation installation was72.7% (95%CI: 66.9%-78.5%). Conclusions: Household polluting fuel use is common in China, but differs with area, traditional fuel combustion method is widely used, the coverage of ventilation installation need to be improved. In order to promote COPD prevention and control, it is necessary to develop strategies on fuels and fuel combustion method improvement to reduce indoor air pollution resulted from household fuel combustion.
Adult ; Aged ; Air Pollution, Indoor/prevention & control* ; Biomass ; China/epidemiology* ; Coal/adverse effects* ; Cooking ; Environmental Pollutants/adverse effects* ; Family Characteristics ; Female ; Heating/methods* ; Humans ; Male ; Middle Aged ; Wood

Objective: To understand the prevalence of biomass fuel exposure in women aged ≥40 years in China during 2014-2015, and provide evidence for the prevention and control of bio-fuel exposure. Methods: All participants were selected from a national representative cross-sectional survey during 2014-2015 in the mainland of China. A multi-stage stratified cluster sampling strategy was used. A total of 37 795 women aged ≥40 years received a face-to-face questionnaire survey at 125 surveillance points in 31 provinces. The level of biomass fuel exposure was analyzed after complex sample weighting to represent the overall Chinese women aged ≥40 years. Results: A total of 37 777 women were included in the analysis. With complex weighting, the rate of biomass fuel exposure in Chinese women aged ≥40 years was 35.8% (95%CI: 29.6%-42.1%), the exposure rate was higher in rural women than in urban women (P<0.001). The biomass fuel exposure rate was highest in northeastern and lowest in northern areas of China (χ(2)=17.03, P=0.009). The estimated biomass fuel exposure rate decreased with the increase of educational level (P<0.001). Conclusion: The prevalence of biomass fuel exposure is high in women aged ≥40 years in China, especially in those in rural areas. The exposure level differs with age and area. Appropriate measures should be taken to reduce the level of biomass fuel exposure in Chinese women.
Adult ; Aged ; Air Pollutants/toxicity* ; Air Pollution, Indoor/statistics & numerical data* ; Asian People ; Biomass ; China/epidemiology* ; Cooking/methods* ; Cross-Sectional Studies ; Female ; Fossil Fuels/toxicity* ; Humans ; Inhalation Exposure/statistics & numerical data* ; Middle Aged ; Prevalence ; Risk Factors ; Rural Population ; Surveys and Questionnaires

PURPOSE: This study analyzed iodine intake by establishing an iodine database of general Korean foods eaten by Korean adults based on the data from the 1998 ~ 2014 KNHANES (Korea National Health and Nutrition Examination Survey). METHODS: Data on 56,818 subjects aged 19 years and older were obtained from health behavior interviews and a 24-hour dietary recall survey. Iodine intake of subjects was analyzed according to general characteristics, dietary lifestyle, food groups, and cooking method. RESULTS: An iodine database was established for 312 food items. The mean iodine intake of Korean adults decreased from 641.6 μg in 1998 to 236.2 μg in 2014 per day. Iodine intake of women was higher than that of men. For age distribution, those aged 30 ~ 49 years constituted more than 39 ~ 46% of subjects by survey year. Regarding iodine intake according to dietary lifestyle, the highest iodine intake was 29.4 ~ 34.4% for lunch while that of breakfast decreased. The highest iodine contribution by food group was seaweed such as kelp, sea mustard, and laver. CONCLUSION: The results of this study indicate that iodine intake of Korean adults has been decreasing, and iodine intake is associated with the prevalence of thyroid disease. This study provides basic data for the estimation of iodine intake in Korean adults.
Adult* ; Age Distribution ; Breakfast ; Cooking ; Female ; Functional Food ; Health Behavior ; Humans ; Iodine* ; Kelp ; Korea* ; Life Style ; Lunch ; Male ; Methods ; Mustard Plant ; Nutrition Surveys* ; Prevalence ; Seaweed ; Thyroid Diseases

BACKGROUND: Histamine in food is known to cause food poisoning and allergic reactions. We usually ingest histamine in cooked food, but there are few studies about the influence of cooking method on the histamine level. OBJECTIVE: The purpose of this study was to determine the influence of cooking methods on the concentration of histamine in foods. METHODS: The foods chosen were those kinds consumed frequently and cooked by grilling, boiling, and frying. The histamine level of the food was measured using enzyme-linked immunosorbent assay. RESULTS: Grilled seafood had higher histamine levels than raw or boiled seafood. For meat, grilling increased the histamine level, whereas boiling decreased it. For eggs, there was not much difference in histamine level according to cooking method. Fried vegetables had higher histamine levels than raw vegetables. And fermented foods didn't show much difference in histamine level after being boiled. CONCLUSION: The histamine level in food has changed according to the cooking method used to prepare it. Frying and grilling increased histamine level in foods, whereas boiling had little influence or even decreased it. The boiling method might be helpful to control the effect of histamine in histamine-sensitive or susceptible patients, compared with frying and grilling.
Biogenic Amines ; Cooking* ; Eggs ; Enzyme-Linked Immunosorbent Assay ; Foodborne Diseases ; Histamine* ; Humans ; Hypersensitivity ; Meat ; Methods* ; Ovum ; Seafood ; Vegetables

OBJECTIVES: This study aims to investigate the married female immigrants' experience on Korean dietary life adaptation, especially identifying the symbolic meaning and nature of experiences. METHODS: This study was conducted with six married female immigrants through an analysis of the qualitative materials which consisted of in-depth interviews, field notes and materials. Data was analyzed using Giorgi's phenomenological research methods. RESULTS: The results were deduced as 116 significant statements, 17 formulated meanings (sub-theme), and 6 theme clusters. Six theme clusters comprised of lack of preliminary knowledge and information, conflict and support in relationships, Korean food culture which is different from homeland, adaptation attitudes of Korean food culture according to situation, sharing of homeland food culture, and practical difficulty and expectative service. The participants started Korean life in the dark about Korea and Korean food culture, so they were subjected to trial and error. The conflict between Korean mother-in-law and foreign daughter-in-law came from lack of consideration of daughter-in-law's cultural background. Some participants were hurt because of misunderstanding and nitpicking. They were learning about cooking method, ingredient, seasoning, table setting and manner. Some participants integrated Korean food culture and their homeland food culture. Some of them assimilated with Korean food culture. One of them maintained homeland food culture. The participants who adapted Korean food culture well could share homeland food amicably. They sometimes didn't apply the services which were offered by the government, because the services did not fit their needs. Some of them didn't know the usage route of the services or information. They had resistance about home teaching and it showed that outreach service was not always effective. CONCLUSIONS: This study suggested that it is necessary to develop a practical support plan which covers married female immigrants' real needs and system improvement measures.
Cooking ; Emigrants and Immigrants* ; Female* ; Humans ; Korea ; Learning ; Methods ; Seasons