Effectiveness of interventions to reduce indoor air pollution and/or improve health in homes using solid fuel in lower and middle income countries: protocol for a systematic review

March 6, 2015 · 0 comments

Effectiveness of interventions to reduce indoor air pollution and/or improve health in homes using solid fuel in lower and middle income countries: protocol for a systematic review. Systematic Reviews, March 2015, 4:22 doi:10.1186/s13643-015-0012-8

Authors: Reginald Quansah, Caroline A Ochieng, Sean Semple, Sanjar Juvekar, Jacques Emina, Frederick Ato Armah and Isaac Luginaah

Background – Indoor air pollution (IAP) interventions are widely promoted as a means of reducing indoor air pollution/health from solid fuel use; and research addressing impact of these interventions has increased substantially in the past two decades. It is timely and important to understand more about effectiveness of these interventions. We describe the protocol of a systematic review to (i) evaluate effectiveness of IAP interventions to improve indoor air quality and/or health in homes using solid fuel for cooking and/or heating in lower- and middle-income countries, (ii) identify the most effective intervention to improve indoor air quality and/or health, and (iii) identify future research needs.

Methods – This review will be conducted according to the National Institute for Health and Care Excellence (NICE) guidelines and will be reported following the PRISMA statement. Ovid MEDLINE, Ovid Embase, SCOPUS, and PubMed searches were conducted in September 2013 and updated in November 2014 (and include any further search updates in February 2015). Additional references will be located through searching the references cited by identified studies and through the World Health Organization Global database of household air pollution measurements. We will also search our own archives. Data extraction and risk of bias assessment of all included papers will be conducted independently by five reviewers.

Discussion – The study will provide insights into what interventions are most effective in reducing indoor air pollution and/or adverse health outcomes in homes using solid fuel for cooking or heating in lower- or middle-income countries. The findings from this review will be used to inform future IAP interventions and policy on poverty reduction and health improvement in poor communities who rely on biomass and solid fuels for cooking and heating.

WHO indoor air quality guidelines on household fuel combustion: Strategy implications of new evidence on interventions and exposure–risk functions

March 6, 2015 · 0 comments

WHO indoor air quality guidelines on household fuel combustion: Strategy implications of new evidence on interventions and exposure–risk functions. Atmospheric Environment,  April 2015.

Authors: Nigel Bruce, Dan Pope, Eva Rehfuess, Kalpana Balakrishnan, Heather Adair-Rohani, Carlos Dora

Highlights

  • New WHO air quality guidelines will address household air pollution (HAP).
  • Action on HAP could lower risk of multiple child and adult diseases by 20–50%.
  • New evidence shows levels at or below 35 μg/m3 PM2.5 (WHO IT-1) are needed.
  • Most improved solid fuel stoves result in PM2.5 levels well above IT-1.
  • Intervention strategy must shift towards accelerating access to clean fuels.

Background: 2.8 billion people use solid fuels as their primary cooking fuel; the resulting high levels of household air pollution (HAP) were estimated to cause more than 4 million premature deaths in 2012. The people most affected are among the world’s poorest, and past experience has shown that securing adoption and sustained use of effective, low-emission stove technologies and fuels in such populations is not easy. Among the questions raised by these challenges are (i) to what levels does HAP exposure need to be reduced in order to ensure that substantial health benefits are achieved, and (ii) what intervention technologies and fuels can achieve the required levels of HAP in practice? New WHO air quality guidelines are being developed to address these issues.

Aims: To address the above questions drawing on evidence from new evidence reviews conducted for the WHO guidelines.

Methods: Discussion of key findings from reviews covering (i) systematic reviews of health risks from HAP exposure, (ii) newly developed exposure–response functions which combine combustion pollution risk evidence from ambient air pollution, second-hand smoke, HAP and active smoking, and (iii) a systematic review of the impacts of solid fuel and clean fuel interventions on kitchen levels of, and personal exposure to, PM2.5 and carbon monoxide (CO).

Findings: Evidence on health risks from HAP suggest that controlling this exposure could reduce the risk of multiple child and adult health outcomes by 20–50%. The new integrated exposure–response functions (IERs) indicate that in order to secure these benefits, HAP levels require to be reduced to the WHO IT-1 annual average level (35 μg/m3 PM2.5), or below. The second review found that, in practice, solid fuel ‘improved stoves’ led to large percentage and absolute reductions, but post-intervention kitchen levels were still very high, at several hundreds of μg/m3 of PM2.5, although most solid fuel stove types met the WHO 24-hr average guideline for CO of 7 mg/m3. Clean fuel user studies were few, but also did not meet IT-1 for PM2.5, likely due to a combination of continuing multiple stove and fuel use, other sources in the home (e.g. kerosene lamps), and pollution from neighbours and other outdoor sources.

Conclusions: Together, this evidence implies there needs to be a strategic shift towards more rapid and widespread promotion of clean fuels, along with efforts to encourage more exclusive use and control other sources in and around the home. For households continuing to rely on solid fuels, the best possible low-emission solid fuel stoves should be promoted, backed up by testing and in-field evaluation.

Reductions in Indoor Black Carbon Concentrations from Improved Biomass Stoves in Rural India

March 6, 2015 · 0 comments

Reductions in Indoor Black Carbon Concentrations from Improved Biomass Stoves in Rural India. Environ Sci Technol. 2015 Mar 4.

Authors: Patange OS, Ramanathan N, Rehman H, Tripathi SN, Misra A, Kar A, Graham E, Singh L, Bahadur R, Ramanathan V.

Deployment of improved biomass burning cookstoves is recognized as a black carbon (BC) mitigation measure that has the potential to achieve health benefits and climate co-benefits. Yet, few field based studies document BC concentration reductions (and resulting human exposure) resulting from improved stove usage. In this paper, data are presented from 277 real-world cooking sessions collected during two field studies to document the impacts on indoor BC concentrations inside village kitchens as a result of switching from traditional stoves to improved forced draft (FD) stoves. Data collection utilized new low-cost cellphone methods to monitor BC, cooking duration, and fuel consumption.

A cross sectional study recorded a reduction of 36% in BC during cooking sessions. An independent paired sample study demonstrated a statistically significant reduction of 40% in 24-hour BC concentrations when traditional stoves were replaced with FD stoves. Reductions observed in these field studies differ from emission factor reductions (up to 99%) observed under controlled conditions in laboratory studies. Other non-stove sources (e.g. kerosene lamps, ambient concentrations) likely offset the reductions. Health exposure studies should utilize reductions determined by field measurements inside village kitchens, in conjunction with laboratory data, to assess the health impacts of new cooking technologies.

The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana

March 4, 2015 · 0 comments

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

March 4, 2015 · 0 comments

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 (http://hdr.undp.org/en/content/human-dev​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

March 4, 2015 · 0 comments

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.

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A Household-Based Study of Contact Networks Relevant for the Spread of Infectious Diseases in the Highlands of Peru

March 4, 2015 · 0 comments

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

February 26, 2015 · 0 comments

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

February 26, 2015 · 0 comments

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

February 26, 2015 · 0 comments

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.

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