Are Randomized Trials Necessary to Advance Epidemiologic Research on Household Air Pollution? Curr Epidemiol Rep, Sept 2015.

Authors: Jennifer L. Peel & Jill Baumgartner & Gregory A. Wellenius & Maggie L. Clark & Kirk R. Smith

Nearly three billion people burn solid fuels in inefficient stoves for cooking and space heating. The resulting household air pollution is the third leading risk factor for mortality globally, responsible for an estimated 3.9 million premature deaths each year. Important gaps remain in our knowledge regarding the full characterization of diseases impacted by household air pollution as well as the health benefits associated with specific interventions.

Although policy makers and funding agencies often call for more randomized trials of interventions to reduce household air pollution, randomized trials for household air pollution are not feasible for certain health endpoints, may not provide the information that is needed for advancing policy, and may even lead to improper causal inference. A variety of study designs, both observational and randomized, may be useful if they include quantitative exposure measurements and appropriately track and measure stove use and other important confounders over time.

WHO calls to protect health from climate change, October 6, 2015.

WHO calls on the global health community to add its voice to the call for a strong and effective climate agreement at the United Nations Climate Change Conference (COP-21), that will save lives, both now and in the future. Changes to weather patterns result in extreme weather events that threaten lives and cause changes to infectious disease transmission patterns resulting in more outbreaks.

Beer, Wood, and Welfare ‒ The Impact of Improved Stove Use Among Dolo-Beer Breweries. PLoS One. Aug 2015.

Authors: Michael Grimm and Jörg Peters

Local beer breweries in Burkina Faso absorb a considerable amount of urban woodfuel demand. We assess the woodfuel savings caused by the adoption of improved brewing stoves by these micro-breweries and estimate the implied welfare effects through the woodfuel market on private households as well as the environmental effect. We find substantial wood savings among the breweries, 36% to 38% if they fully switch to an improved stove.

In absolute amounts, they save about 0.176 kg of fuelwood per litre of dolo brewed. These savings imply huge reductions in CO2-emissions and reduce the overall demand for woodfuel, which is predominantly used by the poorer strata for cooking purposes. We provide estimates for the price decrease that might result from this and show that the urban poor are likely to benefit. Thus, the intervention under study is an example for a green growth intervention with pro-poor welfare gains – something green growth strategies should look for.

2015 Service to America Medal Winner – Detailee at State Department Jacob Moss

U.S State Dept, October 7, 2015.

Jacob Moss, an Environmental Protection Agency employee who was on detail to the Department of State, will receive the prestigious 2015 Service to America Medal from the Partnership for Public Service at tonight’s Samuel J. Heyman Service to America Medal Awards Gala. While at the Department of State, Mr. Moss forged a coalition of federal and international agencies, countries, and corporations to bring more efficient cook stoves and cleaner burning fuels to homes in developing nations, which is protecting the environment and the health of millions of people worldwide.

The Service to America Science and Environment medal won by Mr. Moss recognizes a federal employee for a significant contribution to the nation in activities related to aerospace engineering, astronomy, biomedicine, economics, energy, engineering, information technology, meteorology, physics, and resource conservation. Further information on Mr. Moss’s contributions is available at:

Mr. Moss will be honored along with seven other award recipients and finalists, including Department of State “Call to Service” finalist Bridget Roddy and “Management Excellence” finalist Edward Ramotowski, at a dinner and awards ceremony this evening at the Andrew W. Mellon Auditorium in Washington, DC.

Biogas Cook Stoves for Healthy and Sustainable Diets? A Case Study in Southern India. Front Nutr. 2015 Sep 16;2:28. doi: 10.3389/fnut.2015.00028. eCollection 2015.

Authors: Anderman TL, DeFries RS, Wood SA, Remans R, Ahuja R, Ulla SE.

Alternative cook stoves that replace solid fuels with cleaner energy sources, such as biogas, are gaining popularity in low-income settings across Asia, Africa, and South America. Published research on these technologies focuses on their potential to reduce indoor air pollution and improve respiratory health. Effects on other cooking-related aspects, such as diets and women’s time management, are less understood. In this study, in southern India, we investigate if using biogas cook stoves alters household diets and women’s time management.

We compare treatment households who are supplied with a biogas cook stove with comparison households who do not have access to these stoves, while controlling for several socio-economic factors. We find that diets of treatment households are more diverse than diets of comparison households. In addition, women from treatment households spend on average 40 min less cooking and 70 min less collecting firewood per day than women in comparison households.

This study illustrates that alongside known benefits for respiratory health, using alternative cook stoves may benefit household diets and free up women’s time. To inform development investments and ensure these co-benefits, we argue that multiple dimensions of sustainability should be considered in evaluating the impact of alternative cook stoves.

Financing Sustainable Development: Ideas for Action, 2015. World Bank.

Access to clean cookstove technology for citizens at the bottom of the economic pyramid can be directly improved through a participatory model of Development Impact Bonds (DIBs). This proposed bond model enhances the current structureof DIBs financially, while also building in an innovative component that supports local training, education, and knowledge sharing. Unlike previous versions of DIBs, our model not only provides enhancedfinancial access to clean cookstove technology, but also furnishes the resources Financing Sustainable Development: Ideas for Action 51to train local individuals on the maintenance, distribution, and sales of the cookstoves. This structure enables adoption to occur in a culturally sensitive,sustainable way that empowers citizen involvement and adoption. In addition,the model funds the training of local NGO workers on impact measurementto demonstrate to investors the impact of their investment.

Global Alliance for Clean Cookstoves: Five Years of Impact 2010 – 2015.

In just five years, the Alliance and its partners have made significant strides toward developing a clean cookstoves and fuels sector that is poised to scale and built for sustainable growth.

The Alliance leverages a market-based approach to build a more cohesive sector, strengthening existing actors and attracting new ones to eliminate fragmentation and establish a sustainable, healthy market capable of enabling 100 million households to adopt clean and efficient cookstoves and fuels by 2020.

Ghana randomized air pollution and health study (GRAPHS): study protocol for a randomized controlled trial. Trials. 2015; 16: 420. Published online 2015 Sep 22.

Authors: Darby W. Jack, Kwaku Poku Asante, Blair J. Wylie, et al.

Background – Household air pollution exposure is a major health risk, but validated interventions remain elusive.

Methods/Design – The Ghana Randomized Air Pollution and Health Study (GRAPHS) is a cluster-randomized trial that evaluates the efficacy of clean fuels (liquefied petroleum gas, or LPG) and efficient biomass cookstoves in the Brong-Ahafo region of central Ghana. We recruit pregnant women into LPG, efficient cookstove, and control arms and track birth weight and physician-assessed severe pneumonia incidence in the first year of life. A woman is eligible to participate if she is in the first or second trimester of pregnancy and carrying a live singleton fetus, if she is the primary cook, and if she does not smoke. We hypothesize that babies born to intervention mothers will weigh more and will have fewer cases of physician-assessed severe pneumonia in the first year of life. Additionally, an extensive personal air pollution exposure monitoring effort opens the way for exposure-response analyses, which we will present alongside intention-to-treat analyses. Major funding was provided by the National Institute of Environmental Health Sciences, The Thrasher Research Fund, and the Global Alliance for Clean Cookstoves.

Discussion – Household air pollution exposure is a major health risk that requires well-tested interventions. GRAPHS will provide important new evidence on the efficacy of both efficient biomass cookstoves and LPG, and will thus help inform health and energy policies in developing countries.

Chronic Household Air Pollution Exposure Is Associated with Impaired Alveolar Macrophage Function in Malawian Non-Smokers. PLoS One, Sept 2015.

Authors: Jamie Rylance , Chikondi Chimpini, Sean Semple, David G. Russell, Malcolm J. Jackson, Robert S. Heyderman, Stephen B. Gordon

Background – Household air pollution in low income countries is an important cause of mortality from respiratory infection. We hypothesised that chronic smoke exposure is detrimental to alveolar macrophage function, causing failure of innate immunity. We report the relationship between macrophage function and prior smoke exposure in healthy Malawians.

Methods – Healthy subjects exposed daily to cooking smoke at home volunteered for bronchoalveolar lavage. Alveolar macrophage particulate content was measured as a known correlate of smoke exposure. Phagocytosis and intraphagosomal function (oxidative burst and proteolysis) were measured by a flow cytometric assay. Cytokine responses in macrophages were compared following re-exposure in vitro to wood smoke, before and after glutathione depletion.

Results – Volunteers had a range of alveolar macrophage particulate loading. The macrophage capacity for phagosomal oxidative burst was negatively associated with alveolar macrophage particulate content (n = 29, r2 = 0.16, p = 0.033), but phagocytosis per se and proteolytic function were unaffected. High particulate content was associated with lower baseline CXCL8 release (ratio 0.51, CI 0.29–0.89) and lower final concentrations on re-exposure to smoke in vitro (ratio 0.58, CI 0.34–0.97). Glutathione depletion augmented CXCL8 responses by 1.49x (CI 1.02–2.17) compared with wood smoke alone. This response was specific to smoke as macrophages response to LPS were not modulated by glutathione.

Conclusion – Chronic smoke exposure is associated with reduced human macrophage oxidative burst, and dampened inflammatory cytokine responses. These are critical processes in lung defence against infection and likely to underpin the relationship between air pollution and pneumonia.

Improved cookstoves in Central America: health impacts and uptake, 2015.

Authors: Fiona Lambe (SEI) and Caroline Ochieng (SEI)

Approximately 20 million people in Central America  – more than half the region’s population – continue to rely on traditional biomass to meet their household energy needs. 86% of these are located in Guatemala, Honduras, Nicaragua and El Salvador.

This discussion brief summarizes a desk study carried out by SEI and commissioned by the World Bank. The study distils recent research linking cleaner cookstoves to health gains at the household level and offers in sights into what type of technical solutions can have an impact in Central America. It also provides a snapshot of the sector in terms of technologies being adopted and their potential for improving household health.

Every year 37,000 people in the region die prematurely – most of them women and children – because of exposure to household air pollution. As in other parts of the world there is a long history of improved cookstove programmes in the region. However, many of these initiatives have not been adopted in a sustained way, mainly because of poor performance of cookstoves in the field, the availability of free wood, the absence of quality standards in improved cookstoves, and the lack of attention to the needs of the end user and specific socio-cultural contexts.

In a preliminary effort to fill these gaps, the authors review cookstove options in the region in terms of the potential emission reductions and health benefits they can offer, in light of the 2014 World Health Organization’s guidelines on indoor air quality.

They also identify the improved cookstoves that households are actually taking up, and analyze the factors that appear to support uptake. A summary of the results is followed by a discussion of the challenges involved in introducing improved cookstoves, both in terms of the behavioural shifts needed at the household level to do so and in establishing sustainable local markets for them.