Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa

Melissa Lygizos, Sheela V. Shenoi, Ralph P. Brooks, Ambika Bhushan, James C.M. Brust, Daniel Zelterman, Yanhong Deng, Veronika Northrup, Anthony P. Moll, Gerald H. Friedland

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: 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.Methods: 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.Results: 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.Conclusions: 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.

Original languageEnglish (US)
Article number300
JournalBMC Infectious Diseases
Volume13
Issue number1
DOIs
StatePublished - Jul 1 2013

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South Africa
Ventilation
Air
Health Facilities
Carbon Dioxide
Pharmaceutical Preparations
Multivariate Analysis
HIV
Delivery of Health Care

Keywords

  • Household
  • Infection control
  • MDR/XDR TB
  • South Africa
  • Tuberculosis transmission
  • Ventilation

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa. / 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.

In: BMC Infectious Diseases, Vol. 13, No. 1, 300, 01.07.2013.

Research output: Contribution to journalArticle

Lygizos, M, Shenoi, SV, Brooks, RP, Bhushan, A, Brust, JCM, Zelterman, D, Deng, Y, Northrup, V, Moll, AP & Friedland, GH 2013, 'Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa', BMC Infectious Diseases, vol. 13, no. 1, 300. https://doi.org/10.1186/1471-2334-13-300
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. / Natural ventilation reduces high TB transmission risk in traditional homes in rural KwaZulu-Natal, South Africa. In: BMC Infectious Diseases. 2013 ; Vol. 13, No. 1.
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AU - Lygizos, Melissa

AU - Shenoi, Sheela V.

AU - Brooks, Ralph P.

AU - Bhushan, Ambika

AU - Brust, James C.M.

AU - Zelterman, Daniel

AU - Deng, Yanhong

AU - Northrup, Veronika

AU - Moll, Anthony P.

AU - Friedland, Gerald H.

PY - 2013/7/1

Y1 - 2013/7/1

N2 - Background: 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.Methods: 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.Results: 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.Conclusions: 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.

AB - Background: 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.Methods: 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.Results: 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.Conclusions: 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.

KW - Household

KW - Infection control

KW - MDR/XDR TB

KW - South Africa

KW - Tuberculosis transmission

KW - Ventilation

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JO - BMC Infectious Diseases

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