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Abstract
Air pollution is a grave risk to human health that affects nearly everyone in the world and nearly every organ in the body. Fortunately, it is largely a preventable risk. Reducing pollution at its source can have a rapid and substantial impact on health. Within a few weeks, respiratory and irritation symptoms, such as shortness of breath, cough, phlegm, and sore throat, disappear; school absenteeism, clinic visits, hospitalizations, premature births, cardiovascular illness and death, and all-cause mortality decrease significantly. The interventions are cost-effective. Reducing factors causing air pollution and climate change have strong cobenefits. Although regions with high air pollution have the greatest potential for health benefits, health improvements continue to be associated with pollution decreases even below international standards. The large response to and short time needed for benefits of these interventions emphasize the urgency of improving global air quality and the importance of increasing efforts to reduce pollution at local levels.
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Pillarisetti A, Roy S, Diamond-Smith N, Ghorpade M, Dhongade A, Balakrishnan K, Sambandam S, Patil R, Levine DI, Juvekar S, Smith KR. Marriage-based pilot clean household fuel intervention in India for improved pregnancy outcomes. BMJ Open 2020; 10:e044127. [PMID: 33020110 PMCID: PMC7537452 DOI: 10.1136/bmjopen-2020-044127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Health interventions often target pregnant women and their unborn children. Interventions in rural India targeting pregnant women, however, often do not cover the critical early windows of susceptibility during the first trimester and parts of the second trimester. This pilot seeks to determine if targeting newlyweds could protect entire pregnancies with a clean stove and fuel intervention. METHODS We recruited 50 newlywed couples who use biomass as a cooking fuel into a clean cooking intervention that included a liquefied petroleum gas (LPG) stove, two gas cylinders, a table to place the stove on and health education. We first evaluated whether community health workers in this region could identify and recruit couples at marriage. We quantified how many additional days of pregnancy could be covered by an intervention if we recruited at marriage versus recruiting after detection of pregnancy. RESULTS On average, we identified and visited newlywed couples within 40 (SD 21) days of marriage. Of the 50 couples recruited, 25 pregnancies and 18 deliveries were identified during this 1-year study. Due to challenges securing fuel from the LPG supply system, not all couples received their intervention prior to pregnancy. Regardless, couples recruited in the marriage arm had substantially more days with the intervention than couples recruited into a similar arm recruited at pregnancy (211 SD 46 vs 120 SD 45). At scale, a stove intervention targeting new marriages would cover about twice as many weeks of first pregnancies as an intervention recruiting after detection of pregnancy. CONCLUSIONS We were able to recruit in early marriage using existing community health workers. Households recruited early in marriage had more days with clean fuel coverage than those recruited at pregnancy. Our findings indicate that recruitment at marriage is feasible and warrants further exploration for stove and other interventions targeting pregnancy-related outcomes.
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Affiliation(s)
- Ajay Pillarisetti
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Sudipto Roy
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | | | - Makarand Ghorpade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Arun Dhongade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kalpana Balakrishnan
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sankar Sambandam
- ICMR Center for Advanced Research on Air Quality, Climate and Health, Department of Environmental Health Engineering, Faculty of Public Health, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rutuja Patil
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - David I Levine
- Haas School of Business, University of California, Berkeley, California, USA
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
- Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Kirk R Smith
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA
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Katz J, Tielsch JM, Khatry SK, Shrestha L, Breysse P, Zeger SL, Kozuki N, Checkley W, LeClerq SC, Mullany LC. Impact of Improved Biomass and Liquid Petroleum Gas Stoves on Birth Outcomes in Rural Nepal: Results of 2 Randomized Trials. GLOBAL HEALTH, SCIENCE AND PRACTICE 2020; 8:372-382. [PMID: 32680912 DOI: 10.9745/ghsp-d-2000011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/26/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Few randomized trials have assessed the impact of reducing household air pollution from biomass stoves on adverse birth outcomes in low-income countries. METHODS Two sequential trials were conducted in rural low-lying Nepal. Trial 1 was a cluster-randomized step-wedge trial comparing traditional biomass stoves and improved biomass stoves vented with a chimney. Trial 2 was a parallel household-randomized trial comparing vented biomass stoves and liquid petroleum gas (LPG) stoves with a year's supply of gas. Kitchen particulate matter of 2.5 μm or less (PM2.5) and carbon monoxide (CO) were assessed before and after stove installation. Prevalent and incident pregnancies were enrolled at baseline and throughout the trials. Birth anthropometry was compared across differing exposure times in pregnancy. RESULTS In trial 1, the mean 20-hour kitchen PM2.5 concentration was reduced from 1380 µg/m3 to 936 µg/m3. Among infants born before the intervention, mean birth weight and gestational age were 2627 g (SD=443) and 38.8 weeks (SD=3.1), and 39% were low birth weight (LBW), 22% preterm, and 55% small for gestational age (SGA). Adverse birth outcomes were not significantly different with increasing exposure to improved stoves during pregnancy. In trial 2, the mean 20-hour PM2.5 concentration was 885 µg/m3 in households with vented biomass and 442 µg/m3 in those with LPG stoves. Mean birth weight was 2780 g (SD=427) and 2742 g (SD=431), among households with vented and LPG stoves, respectively. Respective percentages for LBW, SGA, and preterm were 23%, 13%, and 42% in the vented stove group and not statistically different from 31%, 17%, and 42% in the LPG group. CONCLUSIONS Improved biomass or LPG stoves did not reduce adverse birth outcomes. PM2.5 and CO following improved stove installation remained well above the World Health Organization indoor air standard of 25 µg/m3 or intermediate air quality guideline of 37.5 µg/m3. Trials that lower indoor air pollution further are needed.
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Affiliation(s)
- Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Laxman Shrestha
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Patrick Breysse
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott L Zeger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William Checkley
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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54
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Katz J, Tielsch JM, Khatry SK, Shrestha L, Breysse P, Zeger SL, Kozuki N, Checkley W, LeClerq SC, Mullany LC. Impact of Improved Biomass and Liquid Petroleum Gas Stoves on Birth Outcomes in Rural Nepal: Results of 2 Randomized Trials. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:372-382. [PMID: 32680912 PMCID: PMC7541104 DOI: 10.9745/ghsp-d-20-00011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/26/2020] [Indexed: 01/10/2023]
Abstract
Improved biomass stoves may not reduce indoor air pollution as much as is needed to have an impact on adverse birth outcomes. Background: Few randomized trials have assessed the impact of reducing household air pollution from biomass stoves on adverse birth outcomes in low-income countries. Methods: Two sequential trials were conducted in rural low-lying Nepal. Trial 1 was a cluster-randomized step-wedge trial comparing traditional biomass stoves and improved biomass stoves vented with a chimney. Trial 2 was a parallel household-randomized trial comparing vented biomass stoves and liquid petroleum gas (LPG) stoves with a year’s supply of gas. Kitchen particulate matter of 2.5 μm or less (PM2.5) and carbon monoxide (CO) were assessed before and after stove installation. Prevalent and incident pregnancies were enrolled at baseline and throughout the trials. Birth anthropometry was compared across differing exposure times in pregnancy. Results: In trial 1, the mean 20-hour kitchen PM2.5 concentration was reduced from 1380 µg/m3 to 936 µg/m3. Among infants born before the intervention, mean birth weight and gestational age were 2627 g (SD=443) and 38.8 weeks (SD=3.1), and 39% were low birth weight (LBW), 22% preterm, and 55% small for gestational age (SGA). Adverse birth outcomes were not significantly different with increasing exposure to improved stoves during pregnancy. In trial 2, the mean 20-hour PM2.5 concentration was 885 µg/m3 in households with vented biomass and 442 µg/m3 in those with LPG stoves. Mean birth weight was 2780 g (SD=427) and 2742 g (SD=431), among households with vented and LPG stoves, respectively. Respective percentages for LBW, SGA, and preterm were 23%, 13%, and 42% in the vented stove group and not statistically different from 31%, 17%, and 42% in the LPG group. Conclusions: Improved biomass or LPG stoves did not reduce adverse birth outcomes. PM2.5 and CO following improved stove installation remained well above the World Health Organization indoor air standard of 25 µg/m3 or intermediate air quality guideline of 37.5 µg/m3. Trials that lower indoor air pollution further are needed.
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Affiliation(s)
- Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Laxman Shrestha
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Patrick Breysse
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott L Zeger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Naoko Kozuki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William Checkley
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven C LeClerq
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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55
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Williams KN, Thompson LM, Sakas Z, Hengstermann M, Quinn A, Díaz-Artiga A, Thangavel G, Puzzolo E, Rosa G, Balakrishnan K, Peel J, Checkley W, Clasen TF, Miranda JJ, Rosenthal JP, Harvey SA. Designing a comprehensive behaviour change intervention to promote and monitor exclusive use of liquefied petroleum gas stoves for the Household Air Pollution Intervention Network (HAPIN) trial. BMJ Open 2020; 10:e037761. [PMID: 32994243 PMCID: PMC7526279 DOI: 10.1136/bmjopen-2020-037761] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/02/2020] [Accepted: 07/30/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Increasing use of cleaner fuels, such as liquefied petroleum gas (LPG), and abandonment of solid fuels is key to reducing household air pollution and realising potential health improvements in low-income countries. However, achieving exclusive LPG use in households unaccustomed to this type of fuel, used in combination with a new stove technology, requires substantial behaviour change. We conducted theory-grounded formative research to identify contextual factors influencing cooking fuel choice to guide the development of behavioural strategies for the Household Air Pollution Intervention Network (HAPIN) trial. The HAPIN trial will assess the impact of exclusive LPG use on air pollution exposure and health of pregnant women, older adult women, and infants under 1 year of age in Guatemala, India, Peru, and Rwanda. METHODS Using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework and Behaviour Change Wheel (BCW) to guide formative research, we conducted in-depth interviews, focus group discussions, observations, key informant interviews and pilot studies to identify key influencers of cooking behaviours in the four countries. We used these findings to develop behavioural strategies likely to achieve exclusive LPG use in the HAPIN trial. RESULTS We identified nine potential influencers of exclusive LPG use, including perceived disadvantages of solid fuels, family preferences, cookware, traditional foods, non-food-related cooking, heating needs, LPG awareness, safety and cost and availability of fuel. Mapping formative findings onto the theoretical frameworks, behavioural strategies for achieving exclusive LPG use in each research site included free fuel deliveries, locally acceptable stoves and equipment, hands-on training and printed materials and videos emphasising relevant messages. In the HAPIN trial, we will monitor and reinforce exclusive LPG use through temperature data loggers, LPG fuel delivery tracking, in-home observations and behavioural reinforcement visits. CONCLUSION Our formative research and behavioural strategies can inform the development, implementation, monitoring and evaluation of theory-informed strategies to promote exclusive LPG use in future stove programmes and research studies. TRIAL REGISTRATION NUMBER NCT02944682, Pre-results.
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Affiliation(s)
- Kendra N Williams
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lisa M Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Zoe Sakas
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mayari Hengstermann
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ashlinn Quinn
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Anaité Díaz-Artiga
- Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Gurusamy Thangavel
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | - Elisa Puzzolo
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Ghislaine Rosa
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute for Higher Education and Research, Chennai, India
| | - Jennifer Peel
- Department of Environmental & Radiological Health Sciences, Colorado School of Public Health, Aurora, Colorado, USA
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Thomas F Clasen
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joshua P Rosenthal
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven A Harvey
- Department of International Health, Social and Behavioral Interventions, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Arku RE, Brauer M, Duong M, Wei L, Hu B, Ah Tse L, Mony PK, Lakshmi PVM, Pillai RK, Mohan V, Yeates K, Kruger L, Rangarajan S, Koon T, Yusuf S, Hystad P. Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study. ENVIRONMENTAL RESEARCH 2020; 188:109851. [PMID: 32798956 PMCID: PMC7748391 DOI: 10.1016/j.envres.2020.109851] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - MyLinh Duong
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Li Wei
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rajamohanan K Pillai
- School of Health Policy, Kerala University of Health Sciences, Trivandrum, India
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lanthe Kruger
- North-West University, Africa Unit for Transdisciplinary Health Research (AUTHeR), South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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Improving Child Survival in Sub-Saharan Africa: Key Environmental and Nutritional Interventions. Ann Glob Health 2020; 86:73. [PMID: 32704478 PMCID: PMC7350947 DOI: 10.5334/aogh.2908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Many countries in Sub-Saharan Africa (SSA), did not achieve the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015. A large proportion of under-five deaths in SSA and other developing regions have been attributed to undernutrition and poor household environmental conditions. Failure to address nutritional deficit and household environmental pollution in SSA will therefore likely result in many countries not meeting the Sustainable Development Goal (SDG) 3.2 target which aims to reduce under-five mortality to less than 25 deaths per 1000 livebirths by 2030. This paper pinpoints the nutritional and environmental threats to child health in SSA, and identify interventions that will work best to improve child survival in countries. It is important to broaden the spectrum of interventions for improving child survival beyond health systems strengthening to enable countries meet the SDG 3.2 target. The following interventions are thus proposed: strengthening child welfare clinics through digital technologies; investment in school feeding programmes; addressing household air pollution; and improving water, sanitation and hygiene (WASH) services in basic schools. There are certainly barriers to effective implementation of the proposed interventions in countries but are surmountable with strong political will and involvement of the private sector.
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Hussein H, Shamsipour M, Yunesian M, Hasanvand MS, Fotouhi A. Association of adverse birth outcomes with exposure to fuel type use: A prospective cohort study in the northern region of Ghana. Heliyon 2020; 6:e04169. [PMID: 32551393 PMCID: PMC7287244 DOI: 10.1016/j.heliyon.2020.e04169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/30/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022] Open
Abstract
We aimed to investigate the potential associations between exposure to fuel types for cooking and birth outcomes in Northern Region of Ghana. Third trimester pregnant women were recruited during antenatal visit to the hospital and followed-up till delivery. Three questionnaires were administered covering baseline information, exposure to fuel types, and birth outcomes. Adjusting for potential confounding factors, log binomial regression model was applied to investigate the association between low birth weights (LBW), preterm birth and perinatal deaths in mothers and fuel types. Of the 1626 participants recruited at baseline, about 1323 women in the delivery period completed the study. At delivery period, maternal mean (SD) age was 27.3 (5.2) years. Mothers who used charcoal and firewood for cooking had 1.47 times (95% CI 1.04–2.05) and 1.18 times (95% CI 0.83–1.69) increased in risk of preterm birth respectively after controlling for potential confounding variables. Although, non-significant, mothers who used charcoal had 1.34 times (95% CI 0.45–3.97) increased risk in LBW, while those who used firewood had 1.23 times (95% CI 0.41–3.71) risk in LBW. Similarly, babies of mothers who used charcoal and those who used firewood respectively had 1.72 times (95% CI 0.52–5.65) and 1.70 times (95% CI 0.49–5.92) risk in small for gestational age after controlling for maternal BMI at first visit and anemia. Lastly, mothers who used charcoal and those who used firewood respectively had 1.87 times (95% CI 0.29–11.64) and 2.02 times (95% CI 0.31–13.04) increased risk in perinatal mortality after controlling for potential confounding variables. We observed a significant association between charcoal and preterm birth. Also, we observed a non-significant association between charcoal and firewood users and LBW, SGA and perinatal mortality respectively, compared to those using gas or electricity. This suggests cooking with charcoal and firewood could have health consequences on the outcome of pregnancy.
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Affiliation(s)
- Hawawu Hussein
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,African Union Scientific Technical and Research Commission, Abuja, Nigeria.,Tamale Teaching Hospital, Research Department, Tamale, Ghana
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.,Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hasanvand
- Centre for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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59
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Burrowes VJ, Piedrahita R, Pillarisetti A, Underhill LJ, Fandiño‐Del‐Rio M, Johnson M, Kephart JL, Hartinger SM, Steenland K, Naeher L, Kearns K, Peel JL, Clark ML, Checkley W. Comparison of next-generation portable pollution monitors to measure exposure to PM 2.5 from household air pollution in Puno, Peru. INDOOR AIR 2020; 30:445-458. [PMID: 31885107 PMCID: PMC7217081 DOI: 10.1111/ina.12638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 05/05/2023]
Abstract
Assessment of personal exposure to PM2.5 is critical for understanding intervention effectiveness and exposure-response relationships in household air pollution studies. In this pilot study, we compared PM2.5 concentrations obtained from two next-generation personal exposure monitors (the Enhanced Children MicroPEM or ECM; and the Ultrasonic Personal Air Sampler or UPAS) to those obtained with a traditional Triplex Cyclone and SKC Air Pump (a gravimetric cyclone/pump sampler). We co-located cyclone/pumps with an ECM and UPAS to obtain 24-hour kitchen concentrations and personal exposure measurements. We measured Spearmen correlations and evaluated agreement using the Bland-Altman method. We obtained 215 filters from 72 ECM and 71 UPAS co-locations. Overall, the ECM and the UPAS had similar correlation (ECM ρ = 0.91 vs UPAS ρ = 0.88) and agreement (ECM mean difference of 121.7 µg/m3 vs UPAS mean difference of 93.9 µg/m3 ) with overlapping confidence intervals when compared against the cyclone/pump. When adjusted for the limit of detection, agreement between the devices and the cyclone/pump was also similar for all samples (ECM mean difference of 68.8 µg/m3 vs UPAS mean difference of 65.4 µg/m3 ) and personal exposure samples (ECM mean difference of -3.8 µg/m3 vs UPAS mean difference of -12.9 µg/m3 ). Both the ECM and UPAS produced comparable measurements when compared against a cyclone/pump setup.
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Affiliation(s)
- Vanessa J. Burrowes
- Division of Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreMDUSA
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
- Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Ajay Pillarisetti
- Environmental Health SciencesUniversity of California BerkeleyBerkeleyCAUSA
- Department of Environmental HealthEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Lindsay J. Underhill
- Division of Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreMDUSA
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Magdalena Fandiño‐Del‐Rio
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | | | - Josiah L. Kephart
- Division of Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreMDUSA
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
- Department of Environmental Health and EngineeringJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Stella M. Hartinger
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
- Facultad de Salud Pública y AdministraciónUniversidad Peruana Cayetano HerediaLimaPeru
- Swiss Tropical and Public Health InstituteBaselSwitzerland
| | - Kyle Steenland
- Department of Environmental HealthEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Luke Naeher
- Department of Environmental Health SciencesUniversity of Georgia College of Public HealthAthensGAUSA
| | - Katie Kearns
- Department of Environmental Health SciencesUniversity of Georgia College of Public HealthAthensGAUSA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health SciencesColorado State UniversityCOUSA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health SciencesColorado State UniversityCOUSA
| | - William Checkley
- Division of Pulmonary and Critical CareJohns Hopkins University School of MedicineBaltimoreMDUSA
- Center for Global Non‐Communicable Disease Research and TrainingSchool of MedicineJohns Hopkins UniversityBaltimoreMDUSA
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60
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James BS, Shetty RS, Kamath A, Shetty A. Household cooking fuel use and its health effects among rural women in southern India-A cross-sectional study. PLoS One 2020; 15:e0231757. [PMID: 32339177 PMCID: PMC7185712 DOI: 10.1371/journal.pone.0231757] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 04/01/2020] [Indexed: 11/18/2022] Open
Abstract
The use of biomass fuel is associated with the deterioration of human health and women are more likely to develop health conditions due to their exposure to indoor air pollution during cooking. This study was conducted to assess the pattern of fuel used for cooking in households as well as to determine the association between the types of fuel used with respect to socio-demographic characteristics and health status of women. A community based cross-sectional survey was conducted between August 2016 and September 2018 in four rural areas and one semi-urban area of Udupi district, Karnataka, India. The study comprised 587 families including 632 women. A pre-tested semi-structured questionnaire was used to collect data on the type of fuel as well as self-reported health conditions. Overall, 72.5% of the families used biomass, where 67.2% families were currently using both biomass and liquefied petroleum gas while only biomass was used in 5.3% of the families for cooking. Among women, being ever exposed to biomass fuel was significantly associated with their age, literacy level, occupation and socio-economic status (p < 0.001). Those who were exposed to biomass fuel showed a significant association with self-reported ophthalmic (AOR = 3.85; 95% CI: 1.79–8.29), respiratory (OR = 5.04; 95% CI: 2.52–10.07), cardiovascular (OR = 6.07; 95% CI: 1.88–19.67), dermatological symptoms /conditions (AOR = 3.67; 95% CI: 1.07–12.55) and history of adverse obstetric outcomes (AOR = 2.45; 95% CI: 1.08–5.57). A positive trend was observed between cumulative exposure to biomass in hour-years and various self-reported health symptoms/conditions (p < 0.001). It was observed that more than two-thirds of women using biomass fuel for cooking were positively associated with self-reported health symptoms. Further longitudinal studies are essential to determine the level of harmful air pollutants in household environment and its association with various health conditions among women in this region.
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Affiliation(s)
| | - Ranjitha S. Shetty
- Department of Community Medicine, Manipal Academy of Higher Education, Kasturba Medical College Manipal, Manipal, Karnataka, India
- * E-mail:
| | - Asha Kamath
- Department of Data Science, Manipal Academy of Higher Education, Prasanna School of Public Health, Manipal, Karnataka, India
| | - Avinash Shetty
- Department of Community Medicine, Manipal Academy of Higher Education, Kasturba Medical College Manipal, Manipal, Karnataka, India
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Clasen T, Checkley W, Peel JL, Balakrishnan K, McCracken JP, Rosa G, Thompson LM, Barr DB, Clark ML, Johnson MA, Waller LA, Jaacks LM, Steenland K, Miranda JJ, Chang HH, Kim DY, McCollum ED, Davila-Roman VG, Papageorghiou A, Rosenthal JP. Design and Rationale of the HAPIN Study: A Multicountry Randomized Controlled Trial to Assess the Effect of Liquefied Petroleum Gas Stove and Continuous Fuel Distribution. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:47008. [PMID: 32347766 PMCID: PMC7228119 DOI: 10.1289/ehp6407] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Globally, nearly 3 billion people rely on solid fuels for cooking and heating, the vast majority residing in low- and middle-income countries (LMICs). The resulting household air pollution (HAP) is a leading environmental risk factor, accounting for an estimated 1.6 million premature deaths annually. Previous interventions of cleaner stoves have often failed to reduce exposure to levels that produce meaningful health improvements. There have been no multicountry field trials with liquefied petroleum gas (LPG) stoves, likely the cleanest scalable intervention. OBJECTIVE This paper describes the design and methods of an ongoing randomized controlled trial (RCT) of LPG stove and fuel distribution in 3,200 households in 4 LMICs (India, Guatemala, Peru, and Rwanda). METHODS We are enrolling 800 pregnant women at each of the 4 international research centers from households using biomass fuels. We are randomly assigning households to receive LPG stoves, an 18-month supply of free LPG, and behavioral reinforcements to the control arm. The mother is being followed along with her child until the child is 1 year old. Older adult women (40 to < 80 years of age) living in the same households are also enrolled and followed during the same period. Primary health outcomes are low birth weight, severe pneumonia incidence, stunting in the child, and high blood pressure (BP) in the older adult woman. Secondary health outcomes are also being assessed. We are assessing stove and fuel use, conducting repeated personal and kitchen exposure assessments of fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ), carbon monoxide (CO), and black carbon (BC), and collecting dried blood spots (DBS) and urinary samples for biomarker analysis. Enrollment and data collection began in May 2018 and will continue through August 2021. The trial is registered with ClinicalTrials.gov (NCT02944682). CONCLUSIONS This study will provide evidence to inform national and global policies on scaling up LPG stove use among vulnerable populations. https://doi.org/10.1289/EHP6407.
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Affiliation(s)
- Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L. Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, Tamil Nadu, India
| | - John P. McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Ghislaine Rosa
- Department of Disease Control, Faculty of Infections and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisa M. Thompson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Dana Boyd Barr
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Maggie L. Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | | | - Lance A. Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lindsay M. Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kyle Steenland
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Howard H. Chang
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dong-Yun Kim
- Office of Biostatistics Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Eric D. McCollum
- Eudowood Division of Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Victor G. Davila-Roman
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aris Papageorghiou
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
| | - Joshua P. Rosenthal
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - HAPIN Investigators
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
- Department of Environmental Health Engineering, ICMR Center for Advanced Research on Air Quality, Climate and Health, Sri Ramachandra Institute for Higher Education and Research (Deemed University), Chennai, Tamil Nadu, India
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Department of Disease Control, Faculty of Infections and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Berkeley Air Monitoring Group, Berkeley, California, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Office of Biostatistics Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Eudowood Division of Respiratory Sciences, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri, USA
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
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Lee AG, Kaali S, Quinn A, Delimini R, Burkart K, Opoku-Mensah J, Wylie BJ, Yawson AK, Kinney PL, Ae-Ngibise KA, Chillrud S, Jack D, Asante KP. Prenatal Household Air Pollution Is Associated with Impaired Infant Lung Function with Sex-Specific Effects. Evidence from GRAPHS, a Cluster Randomized Cookstove Intervention Trial. Am J Respir Crit Care Med 2020; 199:738-746. [PMID: 30256656 DOI: 10.1164/rccm.201804-0694oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Approximately 2.8 billion people are exposed daily to household air pollution from polluting cookstoves. The effects of prenatal household air pollution on lung development are unknown. OBJECTIVES To prospectively examine associations between prenatal household air pollution and infant lung function and pneumonia in rural Ghana. METHODS Prenatal household air pollution exposure was indexed by serial maternal carbon monoxide personal exposure measurements. Using linear regression, we examined associations between average prenatal carbon monoxide and infant lung function at age 30 days, first in the entire cohort (n = 384) and then stratified by sex. Quasi-Poisson generalized additive models explored associations between infant lung function and pneumonia. MEASUREMENTS AND MAIN RESULTS Multivariable linear regression models showed that average prenatal carbon monoxide exposure was associated with reduced time to peak tidal expiratory flow to expiratory time (β = -0.004; P = 0.01), increased respiratory rate (β = 0.28; P = 0.01), and increased minute ventilation (β = 7.21; P = 0.05), considered separately, per 1 ppm increase in average prenatal carbon monoxide. Sex-stratified analyses suggested that girls were particularly vulnerable (time to peak tidal expiratory flow to expiratory time: β = -0.003, P = 0.05; respiratory rate: β = 0.36, P = 0.01; minute ventilation: β = 11.25, P = 0.01; passive respiratory compliance normalized for body weight: β = 0.005, P = 0.01). Increased respiratory rate at age 30 days was associated with increased risk for physician-assessed pneumonia (relative risk, 1.02; 95% confidence interval, 1.00-1.04) and severe pneumonia (relative risk, 1.04; 95% confidence interval, 1.00-1.08) in the first year of life. CONCLUSIONS Increased prenatal household air pollution exposure is associated with impaired infant lung function. Altered infant lung function may increase risk for pneumonia in the first year of life. These findings have implications for future respiratory health. Clinical trial registered with www.clinicaltrials.gov (NCT 01335490).
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Affiliation(s)
- Alison G Lee
- 1 Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Seyram Kaali
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Ashlinn Quinn
- 3 Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Rupert Delimini
- 4 Department of Biomedical Sciences, University of Health and Allied Services, Volta Region, Ghana
| | - Katrin Burkart
- 5 Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Jones Opoku-Mensah
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Blair J Wylie
- 6 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massacusetts
| | - Abena Konadu Yawson
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Patrick L Kinney
- 7 Department of Health, Boston University School of Public Health, Boston, Massachusetts; and
| | - Kenneth A Ae-Ngibise
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
| | - Steven Chillrud
- 8 Lamont-Doherty Earth Observatory at Columbia University, Palisades, New York
| | - Darby Jack
- 5 Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Kwaku Poku Asante
- 2 Kintampo Health Research Centre, Ghana Health Service, Brong Ahafo Region, Kintampo, Ghana
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63
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Gould CF, Urpelainen J. The Gendered Nature of Liquefied Petroleum Gas Stove Adoption and Use in Rural India. THE JOURNAL OF DEVELOPMENT STUDIES 2019; 56:1309-1329. [PMID: 32508360 PMCID: PMC7274193 DOI: 10.1080/00220388.2019.1657571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 08/12/2019] [Indexed: 05/04/2023]
Abstract
Clean cooking fuels promise substantial health benefits for rural households, but almost three billion people continue to rely on traditional biomass for their cooking needs. We explore the role of gender in the adoption of LPG, a clean cooking fuel, in rural India. Given that women are responsible for most households' cooking needs, we propose that gender inequality is an obstacle to LPG adoption because men may fail to appreciate the full benefits of clean cooking fuels. Using data for 8,563 households from the ACCESS survey, we demonstrate that households where women participant in decison-making are more likely to adopt LPG for cooking than households in which a man is the sole decision-maker. We extend our analytic framework to evaluate the relationship between household characteristics and LPG and firewood use. Access and cylinder costs were both negatively associated with LPG use and while LPG adoption reduced firewood use, fuel stacking remains the norm in study households. This study has implications for future policy designs to increase LPG adoption and use to obtain the multiple benefits of cleaner cooking.
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Affiliation(s)
- Carlos F Gould
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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64
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Pillarisetti A, Ghorpade M, Madhav S, Dhongade A, Roy S, Balakrishnan K, Sankar S, Patil R, Levine DI, Juvekar S, Smith KR. Promoting LPG usage during pregnancy: A pilot study in rural Maharashtra, India. ENVIRONMENT INTERNATIONAL 2019; 127:540-549. [PMID: 30981912 PMCID: PMC7213905 DOI: 10.1016/j.envint.2019.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 05/05/2023]
Abstract
Household air pollution from the combustion of biomass and coal is estimated to cause approximately 780,000 premature deaths a year in India. The government has responded by promoting uptake of liquefied petroleum gas (LPG) by tens of millions of poor rural families. Many poor households with new LPG stoves, however, continue to partially use traditional smoky chulhas. Our primary objective was to evaluate three strategies to transition pregnant women in rural Maharashtra to exclusive use of LPG for cooking. We also measured reductions in kitchen concentrations of PM2.5 before and after our interventions. Our core intervention was a free stove, 2 free LPG cylinders (one on loan until delivery), and repeated health messaging. We measured stove usage of both the traditional and intervention stoves until delivery. In households that received the core intervention, an average of 66% days had no indoor cooking on a chulha. In an adjacent area, we evaluated a conditional cash transfer (CCT) based on usage of LPG in addition to the core intervention. Results were less successful, due to challenges implementing the CCT. Pregnant women in a third nearby area received the core intervention plus a maximum of one 14.2 kg cylinder per month of free fuel. In their homes, 90% of days had no indoor cooking on a chulha. On average, exclusive LPG use decreased kitchen concentrations of PM2.5 by approximately 85% (from 520 to 72 μg/m3). 85% of participating households agreed to pay the deposit on the 2nd cylinder. This high purchase rate suggests they valued how the second cylinder permitted continuous LPG supply. A program to increase access to second cylinders may, thus, be a straightforward way to encourage use of clean fuels in rural areas.
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Affiliation(s)
- Ajay Pillarisetti
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, United States.
| | - Makarand Ghorpade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sathish Madhav
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Arun Dhongade
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Sudipto Roy
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kalpana Balakrishnan
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sambandam Sankar
- Department of Environmental Health Engineering, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Rutuja Patil
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - David I Levine
- Haas School of Business, University of California, Berkeley, CA 94720, United States
| | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
| | - Kirk R Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720, United States; Collaborative Clean Air Policy Centre, New Delhi, India
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65
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Arinola GO, Dutta A, Oluwole O, Olopade CO. Household Air Pollution, Levels of Micronutrients and Heavy Metals in Cord and Maternal Blood, and Pregnancy Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122891. [PMID: 30562990 PMCID: PMC6313792 DOI: 10.3390/ijerph15122891] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/02/2022]
Abstract
Cooking with kerosene emits toxic pollutants that may impact pregnancy outcomes. Sixty-eight women in their first trimester of pregnancy, kerosene users (n = 42) and liquefied natural gas (LNG) users (n = 26), were followed until birth. Maternal and cord blood were collected immediately after birth. Levels of micronutrients and heavy metals were quantified. Pregnancy outcomes (gestation age (GA), birth weight (BW), and chest and head circumference) were also measured. Mean (± standard deviation (SD)) age of mothers in kerosene and LNG groups were similar (p = 0.734). Mean (±SD) BW of newborns of LNG users was significantly higher compared to newborns of kerosene users (3.43 ± 0.32 vs. 3.02 ± 0.43, p < 0.001). Mean GA (in weeks) was similar between the two groups (p = 0.532). Women in the kerosene group had significantly higher cord blood levels of zinc, lead, mercury, iodine and vitamin B6 and lower levels of folic acid compared to LNG users (p < 0.05). Newborns of kerosene users had reduced levels of zinc, lead, mercury, iodine, vitamins B6 and B12, folic acid, and homocysteine compared with LNG users (p < 0.05). Also, cooking with kerosene was significantly associated with reduced birth weight after adjusting for potential confounders (β ± standard error (SE) = −0.326 ± 0.155; p = 0.040). Smoke from kerosene stove was associated with reduced birth weight and micronutrients imbalance in mothers and newborns.
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Affiliation(s)
| | - Anindita Dutta
- Department of Medicine and Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021 Chicago, IL 60637, USA.
| | - Oluwafemi Oluwole
- Department of Pediatrics and the Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada.
| | - Christopher O Olopade
- Department of Medicine and Center for Global Health, University of Chicago, 5841 S. Maryland Avenue, MC 2021 Chicago, IL 60637, USA.
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Shupler M, Godwin W, Frostad J, Gustafson P, Arku RE, Brauer M. Global estimation of exposure to fine particulate matter (PM 2.5) from household air pollution. ENVIRONMENT INTERNATIONAL 2018; 120:354-363. [PMID: 30119008 DOI: 10.1016/j.envint.2018.08.026] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 05/22/2023]
Abstract
BACKGROUND Exposure to household air pollution (HAP) from cooking with dirty fuels is a leading health risk factor within Asia, Africa and Central/South America. The concentration of particulate matter of diameter ≤ 2.5 μm (PM2.5) is an important metric to evaluate HAP risk, however epidemiological studies have demonstrated significant variation in HAP-PM2.5 concentrations at household, community and country levels. To quantify the global risk due to HAP exposure, novel estimation methods are needed, as financial and resource constraints render it difficult to monitor exposures in all relevant areas. METHODS A Bayesian, hierarchical HAP-PM2.5 global exposure model was developed using kitchen and female HAP-PM2.5 exposure data available in peer-reviewed studies from an updated World Health Organization Global HAP database. Cooking environment characteristics were selected using leave-one-out cross validation to predict quantitative HAP-PM2.5 measurements from 44 studies. Twenty-four hour HAP-PM2.5 kitchen concentrations and male, female and child exposures were estimated for 106 countries in Asia, Africa and Latin America. RESULTS A model incorporating fuel/stove type (traditional wood, improved biomass, coal, dung and gas/electric), urban/rural location, wet/dry season and socio-demographic index resulted in a Bayesian R2 of 0.57. Relative to rural kitchens using gas or electricity, the mean global 24-hour HAP-PM2.5 concentrations were 290 μg/m3 higher (range of regional averages: 110, 880) for traditional stoves, 150 μg/m3 higher (range of regional averages: 50, 290) for improved biomass stoves, 850 μg/m3 higher (range of regional averages: 310, 2600) for animal dung stoves, and 220 μg/m3 higher (range of regional averages: 80, 650) for coal stoves. The modeled global average female/kitchen exposure ratio was 0.40. Average modeled female exposures from cooking with traditional wood stoves were 160 μg/m3 in rural households and 170 μg/m3 in urban households. Average male and child rural area exposures from traditional wood stoves were 120 μg/m3 and 140 μg/m3, respectively; average urban area exposures were identical to average rural exposures among both sub-groups. CONCLUSIONS A Bayesian modeling approach was used to generate unique HAP-PM2.5 kitchen concentrations and personal exposure estimates for all countries, including those with little to no available quantitative HAP-PM2.5 exposure data. The global exposure model incorporating type of fuel-stove combinations can add specificity and reduce exposure misclassification to enable an improved global HAP risk assessment.
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Affiliation(s)
- Matthew Shupler
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
| | - William Godwin
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
| | - Joseph Frostad
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raphael E Arku
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Michael Brauer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, United States of America
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67
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Amegah AK. Proliferation of low-cost sensors. What prospects for air pollution epidemiologic research in Sub-Saharan Africa? ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 241:1132-1137. [PMID: 30029322 DOI: 10.1016/j.envpol.2018.06.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 05/22/2023]
Abstract
Addressing the worsening urban air quality situation in Sub-Saharan Africa (SSA) is proving increasingly difficult owing to paucity of data on air pollution levels and also, lack of local evidence on the magnitude of the associated health effects. There is therefore the urgent need to expand air quality monitoring (AQM) networks in SSA to enable the conduct of high quality epidemiologic studies to help inform policies aimed at addressing air pollution and the associated health effects. In this commentary, I explore the prospects that the proliferation of low-cost sensors in recent times holds for air pollution epidemiologic research in SSA. This commentary is timely because most SSA governments do not see investments in air pollution control that requires assembling a network of sophisticated and prohibitively expensive instrumentation for AQM as necessary for improving and protecting public health. I conclude that, in a region that is bereft of air pollution data, the growing influx of low-cost sensors represents an excellent opportunity for bridging the data gap to inform air pollution control policies and regulations for public health protection. However, it is essential that only the most promising sensor technologies that performs creditably well in the harsh environmental conditions of the region are promoted.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.
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68
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Ozier A, Charron D, Chung S, Sarma V, Dutta A, Jagoe K, Obueh J, Stokes H, Munangagwa CL, Johnson M, Olopade CO. Building a consumer market for ethanol-methanol cooking fuel in Lagos, Nigeria. ENERGY FOR SUSTAINABLE DEVELOPMENT : THE JOURNAL OF THE INTERNATIONAL ENERGY INITIATIVE 2018; 46:65-70. [PMID: 30906132 PMCID: PMC6430031 DOI: 10.1016/j.esd.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A recently completed randomized controlled study in Nigeria that transitioned pregnant women from traditional fuels to ethanol in their cook stoves demonstrated improved pregnancy outcomes in mothers and children. We subsequently conducted a pilot study of 30 households in Lagos, Nigeria, to determine the acceptability of blended ethanol/methanol as cooking fuel and willingness to pay for the Clean Cook stove. A third of the pilot participants expressed a willingness to purchase the stove for the minimum price of 42 USD or more. Fuel sales data suggest sustained, but non-exclusive, use of the CleanCook stove. These results will influence the final design and implementation of a planned 2500 stove commercial pilot that is scheduled to start in Nigeria in August 2018.
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69
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Snider G, Carter E, Clark S, Tseng JTW, Yang X, Ezzati M, Schauer JJ, Wiedinmyer C, Baumgartner J. Impacts of stove use patterns and outdoor air quality on household air pollution and cardiovascular mortality in southwestern China. ENVIRONMENT INTERNATIONAL 2018; 117:116-124. [PMID: 29734062 PMCID: PMC7615186 DOI: 10.1016/j.envint.2018.04.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/28/2018] [Accepted: 04/27/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Decades of intervention programs that replaced traditional biomass stoves with cleaner-burning technologies have failed to meet the World Health Organization (WHO) interim indoor air quality target of 35-μg m-3 for PM2.5. Many attribute these results to continued use of biomass stoves and poor outdoor air quality, though the relative impacts of these factors have not been empirically quantified. METHODS We measured 496 days of real-time stove use concurrently with outdoor and indoor air pollution (PM2.5) in 150 rural households in Sichuan, China. The impacts of stove use patterns and outdoor air quality on indoor PM2.5 were quantified. We also estimated the potential avoided cardiovascular mortality in southwestern China associated with transition from traditional to clean fuel stoves using established exposure-response relationships. RESULTS Mean daily indoor PM2.5 was highest in homes using both wood and clean fuel stoves (122 μg m-3), followed by exclusive use of wood stoves (106 μg m-3) and clean fuel stoves (semi-gasifiers: 65 μg m-3; gas or electric: 55 μg m-3). Wood stoves emitted proportionally higher indoor PM2.5 during ignition, and longer stove use was not associated with higher indoor PM2.5. Only 24% of days with exclusive use of clean fuel stoves met the WHO indoor air quality target, though this fraction rose to 73% after subtracting the outdoor PM2.5 contribution. Reduced PM2.5 exposure through exclusive use of gas or electric stoves was estimated to prevent 48,000 yearly premature deaths in southwestern China, with greater reductions if local outdoor PM2.5 is also reduced. CONCLUSIONS Clean stove and fuel interventions are not likely to reduce indoor PM2.5 to the WHO target unless their use is exclusive and outdoor air pollution is sufficiently low, but may still offer some cardiovascular benefits.
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Affiliation(s)
- Graydon Snider
- Institute for Health and Social Policy, McGill University, Montréal, QC, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
| | - Ellison Carter
- Civil and Environmental Engineering, Colorado State University, Fort Collins, CO, USA
| | - Sierra Clark
- Institute for Health and Social Policy, McGill University, Montréal, QC, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
| | - Joy Tzu Wei Tseng
- Institute for Health and Social Policy, McGill University, Montréal, QC, Canada
| | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, China
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - James J Schauer
- Environmental Chemistry and Technology Program, University of Wisconsin, Madison, WI, USA; Wisconsin State Laboratory of Hygiene, University of Wisconsin, Madison, WI, USA
| | | | - Jill Baumgartner
- Institute for Health and Social Policy, McGill University, Montréal, QC, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada; Institute on the Environment, University of Minnesota, St. Paul, MN, USA.
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