Benefits and Costs of the Air Pollution Targets for the Post-2015 Development Agenda, December 2014.

Marc Jeuland, Sanford School of Public Policy Duke Global Health Institute , Duke University

The assessment paper “Benefits and Costs of Air Pollution Targets for the Post-2015 Development Agenda: Post 2015 Consensus” provides an accessible entry into a problem of major global importance for both global health and environmental sustainability, that of household air pollution. It presents data on the magnitude and scope of the negative effectsof pollution from household use of solid fuels. The assessment paper then addresses some of the complications associated with specifying pollution targets in this domain, and proposes that technology-based targets (concerning specific fuels or stoves) are likely most appropriate. In line with this recommendation of appropriate targets, it closes by demonstrating the economic case for higher-efficiency cookstoves, which are receiving increasing attention and support from the global community. Indeed, replacement of traditional stoves with cleaner cooking technologies has been called “low hanging fruit”(Rosenthal 2009), in part because they would deliver a diverse set of benefits – to health and well-being, local environmental quality, and mitigation of global climate change (GACC2010, World Bank 2013).


Indonesia has made great strides in moving toward clean cooking solutions, beginning with the highly successful government supported Kerosene-to-LPG Conversion Program (2007–12) and the ongoing BIRU Biogas Program. However, some 24.5 million households in Indonesia continue to depend on traditional biomass as their primary cooking fuel.  The momentum and lessons learned from these successful programs present a significant opportunity to promote and scale up high-quality biomass cookstoves in Indonesia.

In 2012, the World Bank, in collaboration with Indonesia’s Directorate of Bioenergy, Ministry of Energy and Mineral Resources (Indonesia Stove Alliance), launched the Indonesia Clean Stove Initiative (CSI). The broad aim of this initiative is to scale up access to clean cooking solutions for the 40 percent of households who will likely continue using solid fuels beyond 2030.
Join the Winrock and U.S. EPA “Indonesia Clean Stoves Initiative ” webinar on Thursday, January 15, 2015 at 9:00am Eastern Standard Time (EST) to hear results from Phase 1 and to discuss CSI’s integrated approach, using a results-based financing mechanism, to overcome supply- and demand-side barriers and institutional constraints.

About the speakers:

Ms. Christina Aristanti
Christina Aristanti is the manager of the Indonesia Stove Alliance. The Indonesia Stove Alliance is hosted by Yayasan Dian Desa, a local NGO working on appropriate technology, which has been addressing the need for clean stoves since the early 1980’s. Christina was the Asia Regional Cookstove Program (ARECOP) manager from 1991 – 2010.

[click to continue…]

Bookmark and Share

Increased risk of respiratory illness associated with kerosene fuel use among women and children in urban Bangalore, India. Occup Environ Med 2015;72:114-122 doi:10.1136/oemed-2014-102472.

Authors: Jae-Young Choi, Jill Baumgartner, et al.

Correspondence to - Dr Gurumurthy Ramachandran, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, 420 Delaware Street SE, MMC 807, Minneapolis, MN 55455, USA;

Background – Kerosene is a widely used cooking and lighting fuel in developing countries. The potential respiratory health effects of cooking with kerosene relative to cooking with cleaner fuels such as liquefied petroleum gas (LPG) have not been well characterised.

Methods – We sampled 600 households from six urban neighbourhoods in Bangalore, India. Each household’s primary cook, usually the woman of the house, was interviewed to collect information on current domestic fuel use and whether there was any presence of respiratory symptoms or illness in her or in the children in the household. Our analysis was limited to 547 adult females (ages 18–85) and 845 children (ages 0–17) in households exclusively cooking with either kerosene or LPG. We investigated the associations between kerosene use and the likelihood of having respiratory symptoms or illness using multivariate logistic regression models.

Results – Among adult women, cooking with kerosene was associated with cough (OR=1.88; 95% CI 1.19 to 2.99), bronchitis (OR=1.54; 95% CI 1.00 to 2.37), phlegm (OR=1.51; 95% CI 0.98 to 2.33) and chest illness (OR=1.61; 95% CI 1.02 to 2.53), relative to cooking with LPG in the multivariate models. Among children, living in a household cooking with kerosene was associated with bronchitis (OR=1.91; 95% CI 1.17 to 3.13), phlegm (OR=2.020; 95% CI 1.29 to 3.74) and chest illness (OR=1.70; 95% CI 0.99 to 2.90) after adjusting for other covariates. We also found associations between kerosene use and wheezing, difficulty breathing and asthma in adults and cough and wheezing in children, though these associations were not statistically significant.

Conclusions – Women and children in households cooking with kerosene were more likely to have respiratory symptoms and illnesses compared with those in households cooking with LPG. Transitioning from kerosene to LPG for cooking may improve respiratory health among adult women and children in this population.


Interactions between household air pollution and GWAS-identified lung cancer susceptibility markers in the Female Lung Cancer Consortium in Asia (FLCCA). Hum Genet. 2015 Jan 8.

Hosgood HD 3rd, Song M, Hsiung CA, Yin Z, et al.
Author information – 1Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave. Belfer 1309, 10461, Bronx, NY, USA,

We previously carried out a multi-stage genome-wide association study (GWAS) on lung cancer among never smokers in the Female Lung Cancer Consortium in Asia (FLCCA) (6,609 cases, 7,457 controls) that identified novel susceptibility loci at 10q25.2, 6q22.2, and 6p21.32, and confirmed two previously identified loci at 5p15.33 and 3q28. Household air pollution (HAP) attributed to solid fuel burning for heating and cooking, is the leading cause of the overall disease burden in Southeast Asia, and is known to contain lung carcinogens. To evaluate the gene-HAP interactions associated with lung cancer in loci independent of smoking, we analyzed data from studies participating in FLCCA with fuel use information available (n = 3; 1,731 cases; 1,349 controls). Coal use was associated with a 30 % increased risk of lung cancer (OR 1.3, 95 % CI 1.0-1.6).

Among the five a priori SNPs identified by our GWAS, two showed a significant interaction with coal use (HLA Class II rs2395185, p = 0.02; TP63 rs4488809 (rs4600802), p = 0.04). The risk of lung cancer associated with coal exposure varied with the respective alleles for these two SNPs. Our observations provide evidence that genetic variation in HLA Class II and TP63 may modify the association between HAP and lung cancer risk. The roles played in the cell cycle and inflammation pathways by the proteins encoded by these two genes provide biological plausibility for these interactions; however, additional replication studies are needed in other non-smoking populations.

Household air pollution:a call to action. Lancet Respiratory Medicine, Jan 2015.

Authors: Alison Lee, Paul R O C Adobamen, et al.

Without any intervention,2·7 billion people will be reliant on biomass fuels by 2030.In view of the enormous burden of disease and the crucial need for quality exposure data,we call on the international scientific biomedical community, along with potential funders, to convene and form partnerships with these and other promising African researchers. Existing research centres, such as those in Ghana and Malawi, should be leveraged to build centres of excellence to train and supervise burgeoning African research sites. Provision of monitoring equipment and on-the-ground technical training and support would build desperately needed capacity and allow African researchers to lead research and public health efforts to combat the devastating health effects of household air pollution.

Construction of solar cookers and driers, 2014.

The Technical Centre for Agricultural and Rural Cooperation (CTA)

Although improved techniques for using solar energy are not that well-known,they nevertheless provide better results in terms of economy, ecology, quality and simple usage. Solar cookers and driers capture the sun’s rays to heat and dry food.This guide presents simple methods for construction and use of solar cookers and driers: a box cooker, a solar panel cooker, a direct solar drier and an indirect solar drier. Easy to make and use independently, they provide an economical way to meet the food processing needs of diverse populations.The solar cooker saves time, money and energy at no risk for the environment.It can be used to cook all types of food (vegetables, fruits, meat, cereals,bread, etc.).

Envirofit – Launch of Econochar and Econofire cookstoves in Kenya and Nigeria

“Envirofit is excited to announce the official launch of the EconocharTM and EconofireTM cookstoves in Kenya and Nigeria this holiday season. We spent over 18 months conducting extensive consumer research and user acceptance studies to create a line of affordable cookstoves that safely support large cooking pots while cooking quickly and efficiently.  The arrival of the econoline marks the first low-cost products to compete with traditional stoves on the market without requiring carbon subsidies.  The other major break-through is that these stoves can be assembled very easily in the field. This enables remote distribution partners as well aid/relief channels alike to create skilled labor jobs at the last mile.”

” To ensure stoves are accessible to both urban and rural populations Envirofit is working in partnership with Tower Brand Nigeria and Kaluworks Kenya to create greater access for our dealers and small business owners region-wide. This partnership represents the first major scalable solution for both wood and charcoal users with the potential to impact people that cook over an open fire or use inefficient charcoal stoves – saving them money, time and lives.”


Is mom energy efficient? A study of gender, household energy consumption and family decision making in Indonesia. Energy Research & Social Science, Volume 6, March 2015, Pages 78–86

Authors: Ariva Sugandi Permana, Norsiah Abd. Aziz, Ho Chin Siong

This study highlights gender-related factors and attempts to understand their influence in residential energy consumption. This pilot study was done in Bandung City, Indonesia. It employed a questionnaire survey and face to face interviews. Questionnaires were randomly distributed to the households in Bandung City.

In this study, energy consumption included household uses of power for lighting, entertainment, thermal comfort and cooking. Energy consumption was estimated based upon electrical and liquefied petroleum gas (LPG) consumption. The results showed that when the decisions about energy expenditure and control of energy consumption in the household were solely made by a woman, energy consumption tended to be the lowest.

There are three possible ways decision can be made, by the wife, husband and a joint decision. This evidence suggests several things. They are that (1) women are good household energy managers, (2) men may be careless with respect to energy consumption, (3) women may be more cautious about household expenditures, and (4) when joint decisions were made the husband and wife relied-upon-each-other in reaching agreement. This suggests useful entry points for energy efficient initiatives.

Protocol – Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control. JMIR Res Proto, OCt-Dec 2-014.

Authors: Ellen A Boamah1, MPH ; KP Asante1, BSc, MPH, PhD ; KA Ae-Ngibise1, BEd, MSc ; Patrick L Kinney2, ScD ; Darby W Jack2, PhD ; Grace Manu1, BA ; Irene T Azindow1, BSc ; Seth Owusu-Agyei1, BSc, MSc, PhD ; Blair J Wylie3, MD, MPH

Corresponding Author: Blair J Wylie, MD, MPHMassachusetts General Hospital Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Harvard Medical School, Email:

Background: Four million premature deaths occur yearly as a result of smoke from cooking fires. The Ghana Randomized Air Pollution and Health Study (GRAPHS) is underway in the Kintampo North municipality and South district of rural Ghana to evaluate the impact of improved cook stoves introduced during pregnancy on birth weight and childhood pneumonia. These hypotheses are being tested in a cluster-randomized intervention trial among 1415 maternal-infant pairs within 35 communities assigned to a control arm (traditional cooking) or one of two intervention arms (cooking with an improved biomass stove; cooking with liquefied petroleum gas stoves).

Objective: The trial is designed to ensure delivery of the stove intervention prior to the period of maximal fetal growth. To answer questions about the impact of household air pollution on pregnancy outcome, accurate gestational age assessment is critical. This manuscript describes in detail the development of the gestational dating protocol, intensive ultrasound training involved, ultrasound capacity building, and ultrasound quality control program.

Methods: Ultrasound training occurred in several phases over the course of 2 years. Training included a basic obstetric ultrasound course offered to all midwives performing antenatal care at the two study hospitals, followed by a more intense period of hands-on training focused on fetal biometry for a select group of providers demonstrating aptitude in the basic course. A standard operating procedure was developed describing how to obtain all fetal biometric measurements. Consensus was obtained on how biometric images are used in the trial to establish gestational age and estimate the delivery date. An ongoing ultrasound quality control program including the use of an image scorecard was also designed.

Results: Publication of trial results is anticipated in late 2016.

Conclusions: Use of ultrasound should be strongly considered in field-based trials involving pregnant women to accurately establish gestational age, as menstrual dates may be incorrect or unknown. The inclusion of ultrasound in areas where ultrasound capacity does not previously exist requires a significant investment of time and resources. Such investment ensures appropriate training, high quality images, and accurate dating pregnancies. We outline our ultrasound training, image acquisition, quality control, and dating protocols in detail.
Trial Registration: NCT01335490; (Archived by WebCite at

Study protocol: Designs of Two randomized, community-based trials to assess the impact of alternative cookstove installation on respiratory illness among young children and reproductive outcomes in rural Nepal. BMC Public Health, Dec 2014, 14:1271 doi:10.1186/1471-2458-14-1271

Authors: James M Tielsch, Joanne Katz, Scott L Zeger, Subarna K Khatry, Laxman Shrestha, Patrick Breysse, William Checkley, Luke C Mullany and Steven C LeClerq

Background – Acute lower respiratory infections (ALRI) are a leading cause of death among young children in low and middle income countries. Low birthweight is highly prevalent in South Asia and is associated with increased risks of mortality, morbidity, and poor motor and cognitive development. High levels of indoor household air pollution caused by open burning of biomass fuels such as wood, animal dung, and crop waste are common in these settings and are associated with high rates of ALRI and low birthweight. Alternative stove designs that burn biomass fuel more efficiently have been proposed as one method for reducing these high exposures and lowering the rates of these disorders. We designed two randomized trials to test this hypothesis.

Methods – We conducted a pair of community-based, randomized trials of alternative cookstove installation a rural district in southern Nepal. Phase one was a cluster randomized, modified step-wedge design using an alternative biomass stove with a chimney to vent smoke to the exterior. A pre-installation period of morbidity assessment and household environmental assessment was conducted for six months in all households. This was followed by a one year step-wedge phase with 12 monthly steps for clusters of households to receive the alternative stove. The timing of alternative stove introduction was randomized. This step-wedge phase was followed in all households by another six month follow-up phase. Eligibility criteria for phase one included household informed consent, the presence of a married woman of reproductive age (15-30 yrs) or a child < 36 months. Children were followed until 36 months of age or the end of the trial and then discharged. Pregnancies were identified and followed until completion or end of the trial.

Phase two was an individually randomized trial of the same alternative biomass stove versus liquid propane gas stove installation in a subset of households that participated in phase one. Follow-up for phase two was 12 months following stove installation. Eligibility criteria included the same components as phase one except children were only enrolled for morbidity follow-up if they were less than 24 months are the start.

The primary outcomes included: the incidence of ALRI in children and birthweight among newborn infants.

Conclusions – We have presented the design and methods of two randomized trials of alternative cookstoves on rates of acute lower respiratory infection and birthweight in a rural population in southern Nepal.