Air pollution and indoor settings

Indoor environments contribute significantly to total human exposure to air pollutants, as people spend most of their time indoors. Household air pollution (HAP) resulting from cooking with polluting ("dirty") fuels, which include coal, kerosene, and biomass (wood, charcoal, crop residues, and animal manure) is a global environmental health problem. Indoor pollutants are gases, particulates, toxins, and microorganisms among others, that can have an impact especially on the health of children and adults through a combination of different mechanisms on oxidative stress and gene activation, epigenetic, cellular, and immunological systems. Air pollution is a major risk factor and contributor to morbidity and mortality from major chronic diseases. Children are significantly affected by the impact of the environment due to biological immaturity, prenatal and postnatal lung development. Poor air quality has been related to an increased prevalence of clinical manifestations of allergic asthma and rhinitis. Health professionals should increase their role in managing the exposure of children and adults to air pollution with better methods of care, prevention, and collective action. Interventions to reduce household pollutants may promote health and can be achieved with education, community, and health professional involvement.

Prevalence and determinants of airflow limitation in urban and rural children exposed to cooking fuels in South-East Nigeria

Background Biofuels and other cooking fuels are used in households in low- and middle-income countries. Aim To investigate the impact of cooking fuels on lung function in children in urban and rural households in South-East Nigeria. Methods The multi-stage sampling method was used to enroll children exposed to cooking fuel in the communities. Lung function values FEV1, FVC and the FEV1/FVC ratio, were measured with ndd EasyOne^R spirometer. Airflow limitation was determined with FEV1/FVC Z-score values at -1.64 as the lower limit of normal (LLN5). The Global Lung Function Initiative 2012 software was used to calculate the lung function indices. Results The median age (range) of the 912 children enrolled was 10.6 years (6-18). Altogether, 468 (51.6%) children lived in rural areas. Seven hundred and thirty-seven (80.7%) were directly exposed to cooking fuels (418/737, 56.5% in rural areas). Wood and kerosene were the dominant fuels in rural and urban households. The respective mean Z-scores of the exposed children in rural and urban were zFEV1 -0.62, FVC -0.21, FEV1/FVC -0.83 and zFEV1 -0.57, zFVC -0.14, FEV1/FVC -0.75. Few (5.2%, 38/737) of the children had airflow limitation. Most of them (60.5%, 25/38) lived in the rural community; the lowest FEV1/FVC Z-scores were those of exposed to a combination of fuels. Conclusion Exposure to cooking fuels affects lung function in children with airway limitation in a small proportion, Control measures are advocated to reduce the morbidity related to cooking fuels exposure.

Study design of a cluster-randomized controlled trial to evaluate a large-scale distribution of cook stoves and water filters in Western Province, Rwanda

Background

In Rwanda, pneumonia and diarrhea are the first and second leading causes of death, respectively, among children under five. Household air pollution (HAP) resultant from cooking indoors with biomass fuels on traditional stoves is a significant risk factor for pneumonia, while consumption of contaminated drinking water is a primary cause of diarrheal disease. To date, there have been no large-scale effectiveness trials of programmatic efforts to provide either improved cookstoves or household water filters at scale in a low-income country. In this paper we describe the design of a cluster-randomized trial to evaluate the impact of a national-level program to distribute and promote the use of improved cookstoves and advanced water filters to the poorest quarter of households in Rwanda.

Methods/Design

We randomly allocated 72 sectors (administratively defined units) in Western Province to the intervention, with the remaining 24 sectors in the province serving as controls. In the intervention sectors, roughly 100,000 households received improved cookstoves and household water filters through a government-sponsored program targeting the poorest quarter of households nationally. The primary outcome measures are the incidence of acute respiratory infection (ARI) and diarrhea among children under five years of age. Over a one-year surveillance period, all cases of acute respiratory infection (ARI) and diarrhea identified by health workers in the study area will be extracted from records maintained at health facilities and by community health workers (CHW). In addition, we are conducting intensive, longitudinal data collection among a random sample of households in the study area for in-depth assessment of coverage, use, environmental exposures, and additional health measures.

Discussion

Although previous research has examined the impact of providing household water treatment and improved cookstoves on child health, there have been no studies of national-level programs to deliver these interventions at scale in a developing country. The results of this study, the first RCT of a large-scale programmatic cookstove or household water filter intervention, will inform global efforts to reduce childhood morbidity and mortality from diarrheal disease and pneumonia.

Trial registration

This trial is registered at Clinicaltrials.gov (NCT02239250).