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Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa
Transmission of drug susceptible and drug resistant TB occurs in health care facilities, and community and households settings, particularly in highly prevalent TB and HIV areas. There is a paucity of data regarding factors that may affect TB transmission risk in household settings. We evaluated air...
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Published in: | BMC infectious diseases 2013-07, Vol.13 (1), p.300-300, Article 300 |
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description | Transmission of drug susceptible and drug resistant TB occurs in health care facilities, and community and households settings, particularly in highly prevalent TB and HIV areas. There is a paucity of data regarding factors that may affect TB transmission risk in household settings. We evaluated air exchange and the impact of natural ventilation on estimated TB transmission risk in traditional Zulu homes in rural South Africa.
We utilized a carbon dioxide decay technique to measure ventilation in air changes per hour (ACH). We evaluated predominant home types to determine factors affecting ACH and used the Wells-Riley equation to estimate TB transmission risk.
Two hundred eighteen ventilation measurements were taken in 24 traditional homes. All had low ventilation at baseline when windows were closed (mean ACH = 3, SD = 3.0), with estimated TB transmission risk of 55.4% over a ten hour period of exposure to an infectious TB patient. There was significant improvement with opening windows and door, reaching a mean ACH of 20 (SD = 13.1, p |
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We utilized a carbon dioxide decay technique to measure ventilation in air changes per hour (ACH). We evaluated predominant home types to determine factors affecting ACH and used the Wells-Riley equation to estimate TB transmission risk.
Two hundred eighteen ventilation measurements were taken in 24 traditional homes. All had low ventilation at baseline when windows were closed (mean ACH = 3, SD = 3.0), with estimated TB transmission risk of 55.4% over a ten hour period of exposure to an infectious TB patient. There was significant improvement with opening windows and door, reaching a mean ACH of 20 (SD = 13.1, p < 0.0001) resulting in significant decrease in estimated TB transmission risk to 9.6% (p < 0.0001). Multivariate analysis identified factors predicting ACH, including ventilation conditions (windows/doors open) and window to volume ratio. Expanding ventilation increased the odds of achieving ≥12 ACH by 60-fold.
There is high estimated risk of TB transmission in traditional homes of infectious TB patients in rural South Africa. Improving natural ventilation may decrease household TB transmission risk and, combined with other strategies, may enhance TB control efforts.</description><identifier>ISSN: 1471-2334</identifier><identifier>EISSN: 1471-2334</identifier><identifier>DOI: 10.1186/1471-2334-13-300</identifier><identifier>PMID: 23815441</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Acquired immune deficiency syndrome ; AIDS ; Air flow ; Air Movements ; Analysis ; Analysis of Variance ; Carbon dioxide ; Charitable foundations ; Community ; Disease transmission ; Ferries ; Health facilities ; HIV ; Households ; Housing - standards ; Human immunodeficiency virus ; Humans ; Medicine ; Mortality ; Multivariate Analysis ; Public health ; Risk ; Risk Factors ; Rural areas ; South Africa - epidemiology ; Temperature ; Tuberculosis ; Tuberculosis - epidemiology ; Tuberculosis - prevention & control ; Tuberculosis - transmission ; Ventilation ; Ventilation - methods ; Windows & doors</subject><ispartof>BMC infectious diseases, 2013-07, Vol.13 (1), p.300-300, Article 300</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Lygizos et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2013 Lygizos et al.; licensee BioMed Central Ltd. 2013 Lygizos et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b619t-25353682f3b585fb6ed5c80f43f53eeaff7b28c0861c575dd8b4ccd8f41883dd3</citedby><cites>FETCH-LOGICAL-b619t-25353682f3b585fb6ed5c80f43f53eeaff7b28c0861c575dd8b4ccd8f41883dd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716713/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1406089536?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23815441$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lygizos, Melissa</creatorcontrib><creatorcontrib>Shenoi, Sheela V</creatorcontrib><creatorcontrib>Brooks, Ralph P</creatorcontrib><creatorcontrib>Bhushan, Ambika</creatorcontrib><creatorcontrib>Brust, James C M</creatorcontrib><creatorcontrib>Zelterman, Daniel</creatorcontrib><creatorcontrib>Deng, Yanhong</creatorcontrib><creatorcontrib>Northrup, Veronika</creatorcontrib><creatorcontrib>Moll, Anthony P</creatorcontrib><creatorcontrib>Friedland, Gerald H</creatorcontrib><title>Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa</title><title>BMC infectious diseases</title><addtitle>BMC Infect Dis</addtitle><description>Transmission of drug susceptible and drug resistant TB occurs in health care facilities, and community and households settings, particularly in highly prevalent TB and HIV areas. There is a paucity of data regarding factors that may affect TB transmission risk in household settings. We evaluated air exchange and the impact of natural ventilation on estimated TB transmission risk in traditional Zulu homes in rural South Africa.
We utilized a carbon dioxide decay technique to measure ventilation in air changes per hour (ACH). We evaluated predominant home types to determine factors affecting ACH and used the Wells-Riley equation to estimate TB transmission risk.
Two hundred eighteen ventilation measurements were taken in 24 traditional homes. All had low ventilation at baseline when windows were closed (mean ACH = 3, SD = 3.0), with estimated TB transmission risk of 55.4% over a ten hour period of exposure to an infectious TB patient. There was significant improvement with opening windows and door, reaching a mean ACH of 20 (SD = 13.1, p < 0.0001) resulting in significant decrease in estimated TB transmission risk to 9.6% (p < 0.0001). Multivariate analysis identified factors predicting ACH, including ventilation conditions (windows/doors open) and window to volume ratio. Expanding ventilation increased the odds of achieving ≥12 ACH by 60-fold.
There is high estimated risk of TB transmission in traditional homes of infectious TB patients in rural South Africa. Improving natural ventilation may decrease household TB transmission risk and, combined with other strategies, may enhance TB control efforts.</description><subject>Acquired immune deficiency syndrome</subject><subject>AIDS</subject><subject>Air flow</subject><subject>Air Movements</subject><subject>Analysis</subject><subject>Analysis of Variance</subject><subject>Carbon dioxide</subject><subject>Charitable foundations</subject><subject>Community</subject><subject>Disease transmission</subject><subject>Ferries</subject><subject>Health facilities</subject><subject>HIV</subject><subject>Households</subject><subject>Housing - standards</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Medicine</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Public health</subject><subject>Risk</subject><subject>Risk Factors</subject><subject>Rural areas</subject><subject>South Africa - epidemiology</subject><subject>Temperature</subject><subject>Tuberculosis</subject><subject>Tuberculosis - epidemiology</subject><subject>Tuberculosis - prevention & control</subject><subject>Tuberculosis - transmission</subject><subject>Ventilation</subject><subject>Ventilation - methods</subject><subject>Windows & doors</subject><issn>1471-2334</issn><issn>1471-2334</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNqNkktv1DAUhS0Eog_Ys0KR2IBEih3bsWdTaRgVqKioRAsLNpbjx8QliYsdF_j3OJ0yNKhIyItY937n-ObYADxB8AAhXr9ChKGywpiUCJcYwntgd1u6f2u_A_ZivIAQMV4tHoKdCnNECUG7wH-QYwqyK67MMLpOjs4PRTA6KROL1q3b4vx1MQY5xN7FeN108Wvhhqmo3YRncev7jOdiuPZ6_11-SV0qs7fsXhZnPo1tsbTBKfkIPLCyi-bxzXcffHpzdL56V56cvj1eLU_KpkaLsawoprjmlcUN5dQ2tdFUcWgJthQbI61lTcUV5DVSlFGteUOU0twSxDnWGu-Dw43vZWp6o1X-uzyZuAyul-Gn8NKJeWdwrVj7K4EZqhnC2WC1MWic_4fBvKN8L6bAxRS4QFjk-8guz2_GCP5bMnEUOUZluk4OxqeYBbBGjHHEMvrsL_TCp5DT3VCQL3Iif6i17Ixwg_X5cDWZiiXFpIaMk2n4gzuovLTpnfKDsS7XZ4IXM0FmRvNjXMsUozg--_j_7OnnOQs3rAo-xmDsNkAExfSE74rs6e2b2wp-v1n8C2hU6pc</recordid><startdate>20130701</startdate><enddate>20130701</enddate><creator>Lygizos, Melissa</creator><creator>Shenoi, Sheela V</creator><creator>Brooks, Ralph P</creator><creator>Bhushan, Ambika</creator><creator>Brust, James C M</creator><creator>Zelterman, Daniel</creator><creator>Deng, Yanhong</creator><creator>Northrup, Veronika</creator><creator>Moll, Anthony P</creator><creator>Friedland, Gerald H</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QL</scope><scope>7T2</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20130701</creationdate><title>Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa</title><author>Lygizos, Melissa ; Shenoi, Sheela V ; Brooks, Ralph P ; Bhushan, Ambika ; Brust, James C M ; Zelterman, Daniel ; Deng, Yanhong ; Northrup, Veronika ; Moll, Anthony P ; Friedland, Gerald H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b619t-25353682f3b585fb6ed5c80f43f53eeaff7b28c0861c575dd8b4ccd8f41883dd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>AIDS</topic><topic>Air flow</topic><topic>Air Movements</topic><topic>Analysis</topic><topic>Analysis of Variance</topic><topic>Carbon dioxide</topic><topic>Charitable foundations</topic><topic>Community</topic><topic>Disease transmission</topic><topic>Ferries</topic><topic>Health facilities</topic><topic>HIV</topic><topic>Households</topic><topic>Housing - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lygizos, Melissa</au><au>Shenoi, Sheela V</au><au>Brooks, Ralph P</au><au>Bhushan, Ambika</au><au>Brust, James C M</au><au>Zelterman, Daniel</au><au>Deng, Yanhong</au><au>Northrup, Veronika</au><au>Moll, Anthony P</au><au>Friedland, Gerald H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa</atitle><jtitle>BMC infectious diseases</jtitle><addtitle>BMC Infect Dis</addtitle><date>2013-07-01</date><risdate>2013</risdate><volume>13</volume><issue>1</issue><spage>300</spage><epage>300</epage><pages>300-300</pages><artnum>300</artnum><issn>1471-2334</issn><eissn>1471-2334</eissn><abstract>Transmission of drug susceptible and drug resistant TB occurs in health care facilities, and community and households settings, particularly in highly prevalent TB and HIV areas. There is a paucity of data regarding factors that may affect TB transmission risk in household settings. We evaluated air exchange and the impact of natural ventilation on estimated TB transmission risk in traditional Zulu homes in rural South Africa.
We utilized a carbon dioxide decay technique to measure ventilation in air changes per hour (ACH). We evaluated predominant home types to determine factors affecting ACH and used the Wells-Riley equation to estimate TB transmission risk.
Two hundred eighteen ventilation measurements were taken in 24 traditional homes. All had low ventilation at baseline when windows were closed (mean ACH = 3, SD = 3.0), with estimated TB transmission risk of 55.4% over a ten hour period of exposure to an infectious TB patient. There was significant improvement with opening windows and door, reaching a mean ACH of 20 (SD = 13.1, p < 0.0001) resulting in significant decrease in estimated TB transmission risk to 9.6% (p < 0.0001). Multivariate analysis identified factors predicting ACH, including ventilation conditions (windows/doors open) and window to volume ratio. Expanding ventilation increased the odds of achieving ≥12 ACH by 60-fold.
There is high estimated risk of TB transmission in traditional homes of infectious TB patients in rural South Africa. Improving natural ventilation may decrease household TB transmission risk and, combined with other strategies, may enhance TB control efforts.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>23815441</pmid><doi>10.1186/1471-2334-13-300</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Acquired immune deficiency syndrome AIDS Air flow Air Movements Analysis Analysis of Variance Carbon dioxide Charitable foundations Community Disease transmission Ferries Health facilities HIV Households Housing - standards Human immunodeficiency virus Humans Medicine Mortality Multivariate Analysis Public health Risk Risk Factors Rural areas South Africa - epidemiology Temperature Tuberculosis Tuberculosis - epidemiology Tuberculosis - prevention & control Tuberculosis - transmission Ventilation Ventilation - methods Windows & doors |
title | Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa |
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