Community effectiveness of stove and health education interventions for reducing exposureto indoor air pollution from solid fuels in four Chinese provinces

Abstract

Indoor air pollution (IAP) from biomass and coal is a leading cause of mortality anddisease burden in the developing world. There is limited evidence of the communityeffectiveness of interventions for reducing IAP exposure. We conducted a community-basedintervention study of stove and health education interventions in four low-income Chineseprovinces: Gansu, Guizhou, Inner Mongolia, and Shaanxi. Separate townships in onecounty in each province were assigned to stove plus behavioral interventions, behavioralinterventions alone, and control. Data on household fuel and stove use, and onconcentrations of respirable particles (RPM), carbon monoxide (CO), and sulfur dioxide(SO2),were collected in peak and late heating seasons before and after interventions. The effectivenessof interventions was evaluated using difference-in-difference analysis. Pollutant concentrationswere also measured in controlled tests, in which stoves were operated by expert users. Incontrolled tests, there was consistent and substantial reduction in concentrations of RPM(>88%) and CO(>66%); in the twocoal-using provinces, SO2 concentrations declined more in Shaanxi than in Guizhou. In community implementation,combined stove and behavioral interventions reduced the concentrations of pollutants inrooms where heating was the main purpose of stove use in the peak heating season, withsmaller, non-significant, reduction in late heating season. Gansu was the only provincewhere combined stove and behavioral interventions led to pollution reduction wherecooking was the primary purpose of stove use. Compared to the control group,no significant IAP reductions were seen in groups with health education alone.