CO levels in waterpipe cafes of Karachi, Pakistan

Background The dangers of water-pipe smoking have been documented, but data from water-pipe (WP) cafés is lacking. Assessing carbon monoxide (CO) levels in the air inside WP cafés may aid the understanding of the toxins and exposure of the employees. The results can provide novel information regarding WP's effect on air quality which may help generate regulatory efforts to protect the café employees against WP smoke. We wanted determine the air quality through measurement of CO levels in closed room cafés and restaurants of Karachi, Pakistan. Methods It was a cross sectional study design. 3 WP cafes in the city of Karachi, Pakistan were surveyed during June 2015. All cafés were indoors and air-conditioned. Carbon Monoxide (CO) air samples were collected from the included cafés using CO USB Data logger. The Sampling device was left with café admin managers and was left for 30 hours at venue #1, for almost 7 hours at venue #2, and for 70 hours at venue #3 to measure the CO levels in cafés. The average sampling duration was around 36 hours. The graphs were automatically generated by the device. Results Overall, readings of the CO monitoring samples from all included venues were within / lower than threshold limit value (TLV) of 25 ppm, and MAK maximum workplace value of 30 ppm. Conclusions The findings of this study provide evidence that the air quality in water-pipe cafes is potentially hazardous to the health of its employees, which is critical to inform tobacco control policies and regulations for such venues. The study findings indicate a clear need to extend research to not only focus on the indoor air quality of water-pipe cafes, but also the biological monitoring of employees in water-pipe cafes. Key messages Employees working in waterpipe cafes are exposed to toxic substances that can potentially manifest adverse health effects. Air quality of indoor waterpipe cafes should be assessed to protect employees.