International Journal of Social Science Research (IJSSR)

Household Biomass Smoke Exposure and Chronic Obstructive Pulmonary Disease among Rural Indian Women: A Systematic Review Integrating Environmental, Nutritional, and Policy Perspectives.

Introduction: Household air pollution from biomass/solid-fuel cooking remains a major risk factor for COPD and related chronic respiratory outcomes, with women bearing disproportionate exposure due to gendered household roles. [1] India continues to face substantial rural reliance on polluting fuels, and NFHS-5 documents markedly lower rural clean-fuel adoption than urban, suggesting continued high exposure among rural women. [2]This systematic review synthesizes epidemiological evidence from India (2000–2026) linking household biomass/solid-fuel cooking to chronic obstructive pulmonary disease (COPD) or closely related spirometric endpoints (airflow obstruction/abnormal pulmonary function), and integrates (i) environmental exposure metrics (PM levels, ventilation, cooking duration), (ii) nutritional vulnerabilities (low BMI, anemia, antioxidant-related pathways), and (iii) policy context (clean-cooking scale-up, NCD programme integration) Objectives: To systematically review i) The association between household biomass/solid-fuel smoke exposure among rural Indian women ii) How environmental, nutritional, and policy factors modify risk and inform interventions. Methods: Following PRISMA principles, we searched PubMed/MEDLINE, Scopus, Web of Science, Embase (search strings provided), Google Scholar, IMedIND, and grey-literature repositories (WHO/UNICEF/Government of India/NFHS) for English-language records from January 2000 to February 2026. Eight India-based empirical studies met inclusion criteria for women-focused COPD/airflow obstruction outcomes and/or adjacent mechanistic evidence (inflammation/oxidative stress biomarkers), spanning southern (Tamil Nadu, Karnataka), eastern (Odisha), and northern (Uttar Pradesh/Delhi-NCR) settings. Across the most comparable spirometry-based studies with a clean-fuel comparator, solid biomass/biomass fuel use was strongly associated with airflow obstruction or abnormal pulmonary function, with adjusted odds ratios (OR) in the range of approximately 5–8 in rural women. A small random-effects meta-analysis (k=2) pooling these spirometry-proxy outcomes produced a pooled OR of 6.55 (95% CI 4.58–9.36), interpreted as a “signal estimate” rather than a definitive national effect due to heterogeneity in outcome definitions and age bands. Eligible studies were India-based, included women (rural or rural-stratified), measured household biomass/solid-fuel use and/ pollutant metrics), and reported COPD while diagnosis. Risk of bias was assessed using adapted Newcastle–Ottawa Scale (cross-sectional/case–control) and ROBINS-I domains for non-randomized exposures. Results: A rural Tamil Nadu study (January–May 2007) reported COPD prevalence 2.44% in non-smoking rural women >30 years and higher prevalence among biomass users (OR 1.24; wide CI). A large Indian multi-centre-linked screening study reported COPD prevalence 18.4% among biomass-exposed women, with strong dose–response by exposure duration (e.g., OR 2.9 for >25 years vs lower exposure categories) and underdiagnosis driven by limited spirometry access and low awareness. In Odisha, never-smoking women (18–49 years) using solid biomass had higher odds of chronic bronchitis (OR 1.96) and airflow obstruction (OR 5.55) than LPG users. In western Uttar Pradesh, biomass use was strongly associated with abnormal pulmonary function compared with LPG (OR 8.01). A random-effects meta-analysis pooling the two most comparable spirometric proxy outcomes yielded OR 6.55 (95% CI 4.58–9.36). Conclusions: Evidence from multiple Indian regions supports a strong association between household chulha induced cooking exposure and spirometry airflow obstruction/abnormal pulmonary function among rural women, with exposure intensity, ventilation, and socioeconomic disadvantage acting as important modifiers. Integration with nutrition and anemia reduction strategies, and alignment with clean cooking and NCD programme implementation, are likely to improve effectiveness and equity.