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Demelash Enyew H, Hailu AB, Mereta ST. The effect of chimney fitted improved stove on kitchen fine particulate matter (PM2.5) concentrations in rural Ethiopia: Evidence from a randomized controlled trial. ENVIRONMENTAL RESEARCH 2024; 250:118488. [PMID: 38387494 DOI: 10.1016/j.envres.2024.118488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Millions of Ethiopian people cook with biomass fuels using traditional stoves, releasing harmful pollutants and contributing to a significant public health crisis. Improved stoves offer a potential escape route, but their effectiveness needs close scrutiny. This study delves into the impact of chimney-fitted stoves on kitchen PM2.5 concentrations in rural Ethiopian households. METHOD We conducted a randomized controlled trial with 86 households equally divided (1:1 ratio) between intervention and control groups. The 24-h average kitchen PM2.5 concentrations was measured using Particle and Temperature Sensor (PATS+) at baseline and after intervention. All relevant sociodemographic and cooking related characteristics were collected at baseline and dynamic characteristics were updated during air monitoring visits. Three distinct statistical models, including independent sample t-tests, paired sample t-tests and one-way analysis of variance were used to analyze the data using Statistical Package for the Social Sciences (SPSS) software for Windows (v 24.0). RESULT At baseline, the average 24-h kitchen PM2.5 concentrations were 482 μg/m3 (95% CI: 408, 557) for the control and 405 μg/m3 (95% CI: 318, 492) for the intervention groups. Despite remaining elevated at 449 μg/m3 (95% CI: 401, 496) in the control group, PM2.5 concentrations reduced to 104 μg/m3 (95% CI: 90,118) in the intervention group, indicating a statistically significant difference (t = 6.97, p < 0.001). All three statistical analyses delivered remarkably consistent results, estimating a PM2.5 reductions of 74% with the before-and-after approach, 76% when comparing groups, and 74% for difference in difference analysis. Beyond the overall reduction, homes with primary school completed women, larger kitchens, smaller family size, and those specifically baking Injera (the traditional energy-intensive staple food), witnessed even greater drops in PM2.5 levels. CONCLUSION Pregnant women in our study encountered dangerously high PM2.5 exposures in their kitchens. While the intervention achieved a significant PM2.5 reductions, unfortunately remained above the WHO's safe limit, highlighting the need for further interventions.
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Affiliation(s)
- Habtamu Demelash Enyew
- Debre Tabor University, College of Health Sciences, Department of Public Health, Ethiopia.
| | - Abebe Beyene Hailu
- Jimma University, Institution of Health, Department of Environmental Health Science and Technology, Ethiopia
| | - Seid Tiku Mereta
- Jimma University, Institution of Health, Department of Environmental Health Science and Technology, Ethiopia
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Enyew HD, Hailu AB, Mereta ST. Kitchen fine particulate matter (PM 2.5) concentrations from biomass fuel use in rural households of Northwest Ethiopia. Front Public Health 2023; 11:1241977. [PMID: 37915824 PMCID: PMC10616595 DOI: 10.3389/fpubh.2023.1241977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023] Open
Abstract
Background Combustion of solid biomass fuels using traditional stoves which is the daily routine for 3 billion people emits various air pollutants including fine particulate matter which is one of the widely recognized risk factors for various cardiorespiratory and other health problems. But, there is only limited evidences of kitchen PM2.5 concentrations in rural Ethiopia. Objective This study is aimed to estimate the 24-h average kitchen area concentrations of PM2.5 and to identify associated factors in rural households of northwest Ethiopia. Method The average kitchen area PM2.5 concentrations were measured using a low-cost light-scattering Particle and Temperature Sensor Plus (PATS+) for a 24-h sampling period. Data from the PATS+ was downloaded in electronic form for further analysis. Other characteristics were collected using face-to-face interviews. Independent sample t-test and one-way analysis of variance were used to test differences in PM2.5 concentrations between and among various characteristics, respectively. Result Mixed fuels were the most common cooking biomass fuel. The 24-h average kitchen PM2.5 concentrations was estimated to be 405 μg/m3, ranging from 52 to 965 μg/m3. The average concentrations were 639 vs. 336 μg/m3 (p < 0.001) in the thatched and corrugated iron sheet roof kitchens, respectively. The average concentration was also higher among mixed fuel users at 493 vs. 347 μg/m3 (p = 0.042) compared with firewood users and 493 vs. 233 μg/m3 (p = 0.007) as compared with crop residue fuel users. Statistically significant differences were also observed across starter fuel types 613 vs. 343 μg/m3 (p = 0.016) for kerosene vs. dried leaves and Injera baking events 523 vs. 343 μg/m3 (p < 0.001) for baked vs. not baked events. Conclusion The average kitchen PM2.5 concentrations in the study area exceeded the world health organization indoor air quality guideline value of 15 μg/m3 which can put pregnant women at greater risk and contribute to poor pregnancy outcomes. Thatched roof kitchen, mixed cooking fuel, kerosene fire starter, and Injera baking events were positively associated with high-level average kitchen PM2.5. concentration. Simple cost-effective interventions like the use of chimney-fitted improved stoves and sensitizing women about factors that aggravate kitchen PM2.5 concentrations could reduce kitchen PM 2.5 levels in the future.
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Affiliation(s)
- Habtamu Demelash Enyew
- Department of Public Health, College of Health Sciences, Debre Tabor University, Gondar, Ethiopia
| | - Abebe Beyene Hailu
- Department of Environmental Health Science and Technology, Institution of Health, Jimma University, Jimma, Ethiopia
| | - Seid Tiku Mereta
- Department of Environmental Health Science and Technology, Institution of Health, Jimma University, Jimma, Ethiopia
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Shine S, Tamirie M, Kumie A, Addissie A, Athlin S, Mekonnen H, Girma E, Molla M, Kaba M. Pregnant women's perception on the health effects of household air pollution in Rural Butajira, Ethiopia: a phenomenological qualitative study. BMC Public Health 2023; 23:1636. [PMID: 37626318 PMCID: PMC10463278 DOI: 10.1186/s12889-023-16578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 08/22/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Household air pollution is the major public health problem in developing countries. Pregnant women spent the majority of their time at home and are the most affected population by household air pollution. Exploring the perception of pregnant women on adverse health effects is important to enhance the mitigation strategies. Therefore, this study aim to explore the pregnant women's perceptions about health effects of household air pollution in rural Butajira, Ethiopia. METHODS A phenomenological qualitative study design was conducted among 15 selected pregnant women. All interviews were carried out at the participants´ house and audio-recorded while housing and cooking conditions were observed and appropriate notes were taken for each. The collected data were transcribed verbatim and translated into the English language. Then, the data were imported into Open code software to manage the overall data coding processes and analyzed thematically. RESULTS Study participants perceived that respiratory problems such as coughing, sneezing and asthma and eye problem were the major health problem caused by household air pollution among pregnant women. Study participants also mentioned asphyxiated, abortion, reduces weight, and hydrocephalus was caused by household air pollution on the foetus. Study participants perceived that financial inability, spouse negligence, autonomy and knowledge level of the women were the barriers to tackling household air pollution. Study participant also suggested that opening the door and window; using improved cookstove and reduce workload were the perceived solution for household air pollution. CONCLUSIONS This study explores pregnant women's perceptions on health effects of household air pollution. The finding of this study was important to deliver suitable intervention strategies to mitigate household air pollution. Therefore, educating the women on way of mitigating household air pollution, improving existing structure of the house and minimize the time to stay in the kitchen is important to mitigate household air pollution exposure.
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Affiliation(s)
- Sisay Shine
- Department of Public Health, School of Public Health, Debre Berhan University, P.O.Box 445, Debre Berhan, Ethiopia.
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, P.O. Box 9086, Ethiopia.
| | - Mulugeta Tamirie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, P.O. Box 9086, Ethiopia
| | - Abera Kumie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, P.O. Box 9086, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, P.O. Box 9086, Ethiopia
| | - Simon Athlin
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Hussen Mekonnen
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, P.O. Box 9086, Ethiopia
| | - Eshetu Girma
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, P.O. Box 9086, Ethiopia
| | - Mitike Molla
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, P.O. Box 9086, Ethiopia
| | - Mirgissa Kaba
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, P.O. Box 9086, Ethiopia
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Hansson A, Rankin G, Uski O, Friberg M, Pourazar J, Lindgren R, García-López N, Boman C, Sandström T, Behndig A, Muala A. Reduced bronchoalveolar macrophage phagocytosis and cytotoxic effects after controlled short-term exposure to wood smoke in healthy humans. Part Fibre Toxicol 2023; 20:30. [PMID: 37517998 PMCID: PMC10388518 DOI: 10.1186/s12989-023-00541-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Exposure to wood smoke has been shown to contribute to adverse respiratory health effects including airway infections, but the underlying mechanisms are unclear. A preceding study failed to confirm any acute inflammation or cell influx in bronchial wash (BW) or bronchoalveolar lavage (BAL) 24 h after wood smoke exposure but showed unexpected reductions in leukocyte numbers. The present study was performed to investigate responses at an earlier phase, regarding potential development of acute inflammation, as well as indications of cytotoxicity. METHODS In a double-blind, randomised crossover study, 14 healthy participants were exposed for 2 h to filtered air and diluted wood smoke from incomplete wood log combustion in a common wood stove with a mean particulate matter concentration of 409 µg/m3. Bronchoscopy with BW and BAL was performed 6 h after exposure. Differential cell counts, assessment of DNA-damage and ex vivo analysis of phagocytic function of phagocytosing BAL cells were performed. Wood smoke particles were also collected for in vitro toxicological analyses using bronchial epithelial cells (BEAS-2B) and alveolar type II-like cells (A549). RESULTS Exposure to wood smoke increased BAL lactate dehydrogenase (LDH) (p = 0.04) and reduced the ex vivo alveolar macrophage phagocytic capacity (p = 0.03) and viability (p = 0.02) vs. filtered air. BAL eosinophil numbers were increased after wood smoke (p = 0.02), while other cell types were unaffected in BW and BAL. In vitro exposure to wood smoke particles confirmed increased DNA-damage, decreased metabolic activity and cell cycle disturbances. CONCLUSIONS Exposure to wood smoke from incomplete combustion did not induce any acute airway inflammatory cell influx at 6 h, apart from eosinophils. However, there were indications of a cytotoxic reaction with increased LDH, reduced cell viability and impaired alveolar macrophage phagocytic capacity. These findings are in accordance with earlier bronchoscopy findings at 24 h and may provide evidence for the increased susceptibility to infections by biomass smoke exposure, reported in population-based studies.
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Affiliation(s)
- Alva Hansson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Gregory Rankin
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Oskari Uski
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Maria Friberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jamshid Pourazar
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Robert Lindgren
- Thermochemical Energy Conversion Laboratory, Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Natxo García-López
- Thermochemical Energy Conversion Laboratory, Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Christoffer Boman
- Thermochemical Energy Conversion Laboratory, Department of Applied Physics and Electronics, Umeå University, Umeå, Sweden
| | - Thomas Sandström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Annelie Behndig
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ala Muala
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Qin L, Zhai M, Cheng H. Indoor air pollution from the household combustion of coal: Tempo-spatial distribution of gaseous pollutants and semi-quantification of source contribution. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 882:163502. [PMID: 37075989 DOI: 10.1016/j.scitotenv.2023.163502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
Coal is a widely used solid fuel for cooking and heating activities in rural households, whose incomplete combustion in inefficient household stoves releases a range of gaseous pollutants. To evaluate the impact of coal combustion on indoor air quality, this study comprehensively investigated the indoor air pollution of typical gaseous pollutants, including formaldehyde (HCHO), carbon dioxide (CO2), carbon monoxide (CO), total volatile organic compounds (TVOC), and methane (CH4), during coal combustion process in rural households using online monitoring with high tempo-spatial resolution. The indoor concentrations of gaseous pollutants were considerably elevated during the coal combustion period, with the indoor concentrations being significantly higher than those in courtyard air. The levels of several gaseous pollutants (CO2, CO, TVOC, and CH4) in indoor air were much higher during the flaming phase than the de-volatilization and smoldering phases, while HCHO peaked in the de-volatilization phase. The gaseous pollutant concentrations mostly decreased from the room ceiling to the ground level, while their horizontal distribution was relatively uniform within the room. It was estimated that coal combustion accounted for about 71 %, 92 %, 63 %, 59 %, and 21 % of total exposure to indoor CO2, CO, TVOC, CH4, and HCHO, respectively. Improved stove combined with clean fuel could effectively lower the concentrations of CO2, CO, TVOC, and CH4 in indoor air and reduce the contributions of coal combustion to these gaseous pollutants by about 21-68 %. These findings help better understand the indoor air pollution resulting from residential coal combustion and could guide the development of intervention programs to improve indoor air quality in rural households of northern China.
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Affiliation(s)
- Lifan Qin
- MOE Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Mengkun Zhai
- MOE Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China
| | - Hefa Cheng
- MOE Laboratory for Earth Surface Processes, College of Urban and Environmental Sciences, Peking University, Beijing 100871, China.
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Asefa EM, Mergia MT. Human exposure to indoor air pollution in Ethiopian households. Heliyon 2022; 8:e11528. [DOI: 10.1016/j.heliyon.2022.e11528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/24/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
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Eriksson A, Abera A, Malmqvist E, Isaxon C. Characterization of fine particulate matter from indoor cooking with solid biomass fuels. INDOOR AIR 2022; 32:e13143. [PMID: 36437670 PMCID: PMC9828024 DOI: 10.1111/ina.13143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 05/06/2023]
Abstract
Household burning of solid biomass fuels emits pollution particles that are a huge health risk factor, especially in low-income countries (LICs) such as those in Sub-Saharan Africa. In epidemiological studies, indoor exposure is often more challenging to assess than outdoor exposure. Laboratory studies of solid biomass fuels, performed under real-life conditions, are an important path toward improved exposure assessments. Using on- and offline measurement techniques, particulate matter (PM) from the most commonly used solid biomass fuels (charcoal, wood, dung, and crops residue) was characterized in laboratory settings using a way of burning the fuels and an air exchange rate that is representative of real-world settings in low-income countries. All the fuels generated emissions that resulted in concentrations which by far exceed both the annual and the 24-hour-average WHO guidelines for healthy air. Fuels with lower energy density, such as dung, emitted orders of magnitude more than, for example, charcoal. The vast majority of the emitted particles were smaller than 300 nm, indicating high deposition in the alveoli tract. The chemical composition of the indoor pollution changes over time, with organic particle emissions often peaking early in the stove operation. The chemical composition of the emitted PM is different for different biomass fuels, which is important to consider both in toxicological studies and in source apportionment efforts. For example, dung and wood yield higher organic aerosol emissions, and for dung, nitrogen content in the organic PM fraction is higher than for the other fuels. We show that aerosol mass spectrometry can be used to differentiate stove-related emissions from fuel, accelerant, and incense. We argue that further emission studies, targeting, for example, vehicles relevant for LICs and trash burning, coupled with field observations of chemical composition, would advance our understanding of air pollution in LIC. We believe this to be a necessary step for improved air quality policy.
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Affiliation(s)
- Axel Eriksson
- Division of Ergonomics and Aerosol TechnologyLund UniversityLundSweden
| | - Asmamaw Abera
- Ethiopia Institute of Water ResourcesAddis Ababa UniversityAddis AbabaEthiopia
| | - Ebba Malmqvist
- Division of Occupational and Environmental MedicineLund UniversityLundSweden
| | - Christina Isaxon
- Division of Ergonomics and Aerosol TechnologyLund UniversityLundSweden
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Flanagan E, Oudin A, Walles J, Abera A, Mattisson K, Isaxon C, Malmqvist E. Ambient and indoor air pollution exposure and adverse birth outcomes in Adama, Ethiopia. ENVIRONMENT INTERNATIONAL 2022; 164:107251. [PMID: 35533531 DOI: 10.1016/j.envint.2022.107251] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 06/14/2023]
Abstract
Air pollution poses a threat to human health, with pregnant women and their developing fetuses being particularly vulnerable. A high dual burden of ambient and indoor air pollution exposure has been identified in Ethiopia, but studies investigating their effects on adverse birth outcomes are currently lacking. This study explores the association between ambient air pollution (NOX and NO2) and indoor air pollution (cooking fuel type) and fetal and neonatal death in Adama, Ethiopia. A prospective cohort of mothers and their babies was used, into which pregnant women were recruited at their first antenatal visit (n = 2085) from November 2015 to February 2018. Previously developed land-use regression models were utilized to assess ambient concentrations of NOX and NO2 at the residential address, whereas data on cooking fuel type was derived from questionnaires. Birth outcome data was obtained from self-reported questionnaire responses during the participant's postnatal visit or by phone if an in-person meeting was not possible. Binary logistic regression was employed to assess associations within the final study population (n = 1616) using both univariate and multivariate models; the latter of which adjusted for age, education, parity, and HIV status. Odds ratios (OR) and their corresponding 95% confidence intervals (CI) were reported. Within the cohort, 69 instances of fetal death (n = 16 miscarriages; n = 53 stillbirths) and 16 cases of neonatal death were identified. The findings suggest a tendency towards an association between ambient NOX and NO2 exposure during pregnancy and an increased risk of fetal death overall as well as stillbirth, specifically. However, statistical significance was not observed. Results for indoor air pollution and neonatal death were inconclusive. As limited evidence on the effects of exposure to ambient air pollution on adverse birth outcomes exists in Sub-Saharan Africa and Ethiopia, additional studies with larger study populations should be conducted.
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Affiliation(s)
- Erin Flanagan
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Anna Oudin
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - John Walles
- Clinical Infection Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Asmamaw Abera
- Ethiopia Institute of Water Resources, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kristoffer Mattisson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christina Isaxon
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Faculty of Engineering, LTH, Lund University, Lund, Sweden
| | - Ebba Malmqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Faculty of Medicine, Lund University, Lund, Sweden
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