The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana. Source: The International Journal of Tuberculosis and Lung Disease, March 2015.

Authors: Kelly, M. S.; Wirth, K. E. et al.

SETTING: Tertiary hospital in Gaborone, Botswana.

OBJECTIVE: To examine whether exposure to wood smoke worsens outcomes of childhood pneumonia.

DESIGN: Prospective cohort study of children aged 1–23 months meeting clinical criteria for pneumonia. Household use of wood as a cooking fuel was assessed during a face-to-face questionnaire with care givers. We estimated crude and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for treatment failure at 48 h by household use of wood as a cooking fuel. We assessed for effect modification by age (1–5 vs. 6–23 months) and malnutrition (none vs. moderate vs. severe).

RESULTS: The median age of the 284 enrolled children was 5.9 months; 17% had moderate or severe malnutrition. Ninety-nine (35%) children failed treatment at 48 h and 17 (6%) died. In multivariable analyses, household use of wood as a cooking fuel increased the risk of treatment failure at 48 h (RR 1.44, 95%CI 1.09–1.92, P = 0.01). This association differed by child nutritional status (P = 0.02), with a detrimental effect observed only among children with no or moderate malnutrition.

CONCLUSIONS: Exposure to wood smoke worsens outcomes for childhood pneumonia. Efforts to prevent exposure to smoke from unprocessed fuels may improve pneumonia outcomes among children.

Children’s Health in Latin America: The Influence of Environmental Exposures. Environ Health Perspect, March 2015, DOI:10.1289/ehp.1408292

Authors: Amalia Laborde, Fernando Tomasina, et al.

Specific Environmental Health Threats to Children in Latin America
Indoor air pollution. Indoor air pollution is the leading environmental threat to health in the Americas, being responsible for nearly 5% of healthy years of life lost and 7% of premature deaths (WHO 2014c). WHO estimates that in 2012, 7,500 deaths were attributable to indoor air pollution in children < 5 years of age in low- and middle-income countries of the Americas (WHO 2014c). In 2010, indoor air pollution ranked eighth among risk factors for chronic disease in Latin America (Lim et al. 2012).

Solid and biomass fuels are the major source of indoor air pollution, especially in rural areas. WHO estimates that in 2010, 10% of the population of Latin America relied on solid and biomass fuels for cooking and heating, largely in open fires or unvented stoves (WHO 2014b). The rural/urban ratio in use of solid fuels is 2.3 in countries in the lowest and, 11.7 in the highest quartile of the Human Development Index (​elopment-index-hdi). The Living Standards Measurement Survey (World Bank 2012) conducted in Guatemala demonstrated the highest reliance on solid fuel—up to 95% in some regions—among indigenous populations in rural areas.

Ten-fold disparities in death rates attributable to indoor air pollution are seen across Latin American countries and range from a high of 14 in the least developed countries, down to 0.3 for high-income countries (WHO 2014b). Thus in 2012, ≥ 50% of the populations of Guatemala, Haiti, Honduras, and Nicaragua used solid fuels as their main energy source (WHO 2014b). Even in urban areas of the less-developed countries of the Americas, a high percentage of the population relies on solid fuels (Soares da Silva et al. 2013; WHO 2014b).

Since 1990 the region has experienced a steady decline in the percentage of the population using solid fuels and the size of the population exposed (Bonjour et al. 2013). Some countries can make the transition to cleaner fuels, but others will likely continue to use solid fuels because of lack of infrastructure and the high costs associated with transition to gas and electricity.

Interventions are underway, especially in areas of the Americas, to introduce new cookstoves that use solid fuels more efficiently and are less polluting. A major study of this intervention in Guatemala found that using clean stoves was associated with a 30% reduction in severe pneumonia among children < 18 months of age (Smith et al. 2011). A study in Peru found that using the new cookstoves significantly reduced sleep and respiratory symptoms in children 2–14 years of age, but only in households that used the less-polluting stoves exclusively and with adequate maintenance (Accinelli et al. 2014).

Patterns of Stove Use in the Context of Fuel–Device Stacking: Rationale and Implications. EcoHealth, February 2015

Authors: Ilse Ruiz-Mercado, Omar Masera

In this paper we explain that stacking and, specifically, the residual use of traditional fires have strong implications for two agendas critical to the cookstove sector: the implementation of fuel-stove programs that deliver tangible and sustained benefits and the design of evaluation and monitoring schemes that effectively and realistically assess these benefits.
The rationale and implications of stacking hinge on three key aspects: end uses, cooking tasks and livelihood strategies. For example, traditional fires satisfy energy uses that extend beyond cooking and therefore, most of the times, introducing a single clean fuel-stove will not be a perfect substitution of the traditional fires and their residual use will persist.
It is by looking at the interactions of these three aspects with habits, culture, preferences, and household dynamics that the patterns of fuel-stove use can be understood and that the actual benefits from clean fuels and stoves can be assessed.
Thus, addressing stacking, displacement and residual use of traditional fires requires that we:
  • Move from introducing a single fuel-stove to the promotion of a portfolio or “stack” of options(fuels, stoves and practices) to fully displace the negative health and environmental effects of traditional open fires.
  • Design stoves that target the most critical traditional cooking tasks (the most frequent, most culturally relevant or those with the greatest negative effects -not necessarily the same) and stoves specifically aimed at covering residual end uses.
  • Evaluate the effects of introducing a clean fuel-device and its levels of usage in terms of the niche of tasks that the stove can actually cover. Characterize the redistribution of tasks among new and existing stoves and consider the weight that each task has (for health, fuel or emissions) to assess the impacts of stacking and displacement.
  • Complement fuel-stove dissemination with strategies to provide cost-effective alternatives to fuel processing, storage and drying as well as sustainable mechanisms to secure spare parts and stove repairs.

[click to continue…]

Bookmark and Share

A Household-Based Study of Contact Networks Relevant for the Spread of Infectious Diseases in the Highlands of Peru. PLoS ONE, Mar 2015.

Authors: Carlos G. Grijalva , Nele Goeyvaerts, Hector Verastegui, Kathryn M. Edwards, Ana I. Gil, Claudio F. Lanata, Niel Hens

Background - Few studies have quantified social mixing in remote rural areas of developing countries, where the burden of infectious diseases is usually the highest. Understanding social mixing patterns in those settings is crucial to inform the implementation of strategies for disease prevention and control. We characterized contact and social mixing patterns in rural communities of the Peruvian highlands.

Methods and Findings - This cross-sectional study was nested in a large prospective household-based study of respiratory infections conducted in the province of San Marcos, Cajamarca-Peru. Members of study households were interviewed using a structured questionnaire of social contacts (conversation or physical interaction) experienced during the last 24 hours. We identified 9015 reported contacts from 588 study household members. The median age of respondents was 17 years (interquartile range [IQR] 4–34 years). The median number of reported contacts was 12 (IQR 8–20) whereas the median number of physical (i.e. skin-to-skin) contacts was 8.5 (IQR 5–14). Study participants had contacts mostly with people of similar age, and with their offspring or parents. The number of reported contacts was mainly determined by the participants’ age, household size and occupation. School-aged children had more contacts than other age groups. Within-household reciprocity of contacts reporting declined with household size (range 70%-100%). Ninety percent of household contact networks were complete, and furthermore, household members’ contacts with non-household members showed significant overlap (range 33%-86%), indicating a high degree of contact clustering. A two-level mixing epidemic model was simulated to compare within-household mixing based on observed contact networks and within-household random mixing. No differences in the size or duration of the simulated epidemics were revealed.

Conclusion - This study of rural low-density communities in the highlands of Peru suggests contact patterns are highly assortative. Study findings support the use of within-household homogenous mixing assumptions for epidemic modeling in this setting.

Field Testing of Alternative Cookstove Performance in a Rural Setting of Western India. International Journal of Environmental Research and Public Health, Feb 2015.

Authors: Veena Muralidharan , Thomas E. Sussan, et al.

Nearly three billion people use solid fuels for cooking and heating, which leads to extremely high levels of household air pollution and is a major cause of morbidity and mortality. Many stove manufacturers have developed alternative cookstoves (ACSs) that are aimed at reducing emissions and fuel consumption. Here, we tested a traditional clay chulha cookstove (TCS) and five commercially available ACSs, including both natural draft (Greenway Smart Stove, Envirofit PCS-1) and forced draft stoves (BioLite HomeStove, Philips Woodstove HD4012, and Eco-Chulha XXL), in a test kitchen in a rural village of western India.

Compared to the TCS, the ACSs produced significant reductions in particulate matter less than 2.5 µm (PM2.5) and CO concentrations (Envirofit: 22%/16%, Greenway: 24%/42%, BioLite: 40%/35%, Philips: 66%/55% and Eco-Chulha: 61%/42%), which persisted after normalization for fuel consumption or useful energy. PM2.5 and CO concentrations were lower for forced draft stoves than natural draft stoves. Furthermore, the Philips and Eco-Chulha units exhibited higher cooking efficiency than the TCS. Despite significant reductions in concentrations, all ACSs failed to achieve PM2.5 levels that are considered safe by the World Health Organization.

Consequence of indoor air pollution in rural area of Nepal: a simplified measurement approach. Frontiers in Public Health, Jan 2015.

Authors: Chhabi Lal Ranabhat, Chun-Bae Kim, et al.

People of developing countries especially from rural area are commonly exposed to high levels of household pollution for 3–7 h daily using biomass in their kitchen. Such biomass produces harmful smoke and makes indoor air pollution (IAP). Community-basedcross-sectional study was performed to identify effects of IAP by simplified measurement approach in Sunsari District of Nepal. Representative samples of 157 housewives from household, involving more than 5 years in kitchen were included by cluster sampling. Datawere analyzed by SPSS and logistic regression was applied for the statistical test. Most(87.3%) housewives used biomass as a cooking fuel. Tearing of eyes, difficulty in breathing,and productive cough were the main reported health problems and traditional mudstoves and use of unrefined biomass were statistically significant (p < 0.05) and more risk(AOR > 2) with health problems related to IAP. The treatment cost and episodes of acuterespiratory infection was >2 folders higher in severe IAP than mild IAP. Simplified measurement approach could be helpful to measure IAP in rural area. Some effective intervention is suggested to reduce the severe level of IAP considering women and children.


Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana (REACCTING): study rationale and protocol. BMC Public Health (2015) 15:126.

Authors: Katherine L Dickinson, Ernest Kanyomse, et al.

Background: Cooking over open fires using solid fuels is both common practice throughout much of the world and widely recognized to contribute to human health, environmental, and social problems. The public health burden of household air pollution includes an estimated four million premature deaths each year. To be effective and generate useful insight into potential solutions, cookstove intervention studies must select cooking technologies that are appropriate for local socioeconomic conditions and cooking culture, and include interdisciplinary measurement strategies along a continuum of outcomes.

Methods/Design: REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in NorthernGhana) is an ongoing interdisciplinary randomized cookstove intervention study in the Kassena-Nankana District ofNorthern Ghana. The study tests two types of biomass burning stoves that have the potential to meet local cooking needs and represent different “rungs” in the cookstove technology ladder: a locally-made low-tech rocket stove and the imported, highly efficient Philips gasifier stove. Intervention households were randomized into four different groups,three of which received different combinations of two improved stoves, while the fourth group serves as a control for the duration of the study. Diverse measurements assess different points along the causal chain linking the interventionto final outcomes of interest. We assess stove use and cooking behavior, cooking emissions, household air pollutionand personal exposure, health burden, and local to regional air quality. Integrated analysis and modeling will tackle arange of interdisciplinary science questions, including examining ambient exposures among the regional population,assessing how those exposures might change with different technologies and behaviors, and estimating the comparativeimpact of local behavior and technological changes versus regional climate variability and change on local air quality andhealth outcomes.

Discussion: REACCTING is well-poised to generate useful data on the impact of a cookstove intervention on a wide rangeof outcomes. By comparing different technologies side by side and employing an interdisciplinary approach to study thisissue from multiple perspectives, this study may help to inform future efforts to improve health and quality of life forpopulations currently relying on open fires for their cooking needs.

The carbon footprint of traditional woodfuels. Nature Climate Change, Jan 2019.

Authors: Robert Bailis, Rudi Drigo,, Adrian Ghilardi and Omar Masera

Over half of all wood harvested worldwide is used as fuel, supplying ∼9% of global primary energy. By depleting stocks of woody biomass, unsustainable harvesting can contribute to forest degradation, deforestation and climate change. However, past efforts to quantify woodfuel sustainability failed to provide credible results. We present a spatially explicit assessment of  pan-tropical woodfuel supply and demand, calculate the degree to which woodfuel demand exceeds regrowth, and estimate woodfuel-related greenhouse-gas emissions for the year 2009.

We estimate 27–34% of woodfuel harvested was unsustainable, with large geographic variations. Our estimates are lower than estimates from carbon offset projects, which are probably overstating the climate benefits of improved stoves. Approximately 275 million people live in woodfuel depletion‘hotspots’—concentrated in South Asia and East Africa—where most demand is unsustainable.

Emissions from woodfuels are 1.0–1.2 Gt CO2e yr−1(1.9–2.3% of global emissions). Successful deployment and utilization of 100 million improved stoves could reduce this by 11–17%. At US$11 per tCO2e, these reductions would be worth over US$1 billion yr−1 in avoided greenhouse-gas emissions if black carbon were integrated into carbon markets. By identifying potential areas of woodfuel-driven degradationor deforestation, we inform the ongoing discussion about REDD-based approaches to climate change mitigation.


Clean, Affordable and Sustainable Cooking Energy for India: Possibilities and Realities beyond LPG, 2015.

Authors: Abhishek Jain, Poulami Choudhury, and Karthik Ganesan. Council on Energy, Environment and Water.

There is a dearth of research and studies which compare different cooking energy options,especially using a multi-dimensional approach. Thus, with the objective of promoting clean,affordable and sustainable cooking energy for all, this study analysed the potential of thealternatives, going beyond LPG. The options which were assessed include the centrally distributed commodities like LPG, PNG, electricity and the decentralised options such as biogas and improved biomass cookstoves.

A multi-criteria comparative analysis was conducted, incorporating various dimensions such as economics, fuel supply assurance,technology resilience, cooking convenience, environmental impacts, etc. The analysis utilised the existing wealth of literature and secondary data, while tapping into the knowledge and experience of technology experts through online surveys and interviews.

Experimentation in Product Evaluation: The Case of Solar Lanterns in Uganda, Africa, 2015. MIT; USAID.

Evaluating solar lanterns in Uganda

In summer 2013, a team of MIT faculty and students set off for western Uganda to conduct CITE’s evaluation of solar lanterns. Researchers conducted hundreds of surveys with consumers, suppliers, manufacturers, and nonprofits to evaluate 11 locally available solar lantern models.

To assess each product’s suitability, researchers computed a ratings score from 0 to 100 based on how the product’s attributes and features fared. “Attributes” included characteristics inherent to solar lanterns, such as brightness, run time, and time to charge.

“Features” included less-central characteristics, such as a lantern’s ability to charge a cellphone.

The importance of cellphone charging was a surprising and noteworthy finding, Sanyal says.

“One of the things that stuck with me was that [consumers] were most concerned with whether or not the solar lantern charged their cellphone. It was a feature we never expected would be so important,” Sanyal says. “For some, having connections may be more valuable than having light.”

[click to continue…]

Bookmark and Share