Abstract
The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6–12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5–126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5–39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7–40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations.
Highlights
People living in poverty are unable to afford clean fuels and efficient cooking practices, and have the greatest exposure to household air pollution (HAP).[3,4]
Besides being linked to chronic obstructive pulmonary disease (COPD), exposure to HAP is associated with a wide range of other health-damaging outcomes.[1,6,7]
Mean PM2.5 exposures decreased in all countries as shown in Fig. 1: in Uganda to 95.1 μg/m3 (95%CI: 71.5–126.6), a total decrease of 31% (p = 0.073), in Vietnam to 31.1 μg/m3 (95%CI: 24.5–39.5), a total decrease of 32% (p = 0.048) and in Kyrgyzstan to 32.4 μg/m3 (95%CI: 25.7–40.8), a total decrease of 65% (p = 0.001)
Summary
Almost three billion people, mostly from low- and middle-income countries (LMICs), rely on open fires and burning of biomass fuels (wood, animal dung, crop residues, straw and charcoal) for cooking and heating.[1,2] Notably, people living in poverty are unable to afford clean fuels and efficient cooking practices, and have the greatest exposure to household air pollution (HAP).[3,4]Exposure to HAP for cooking and heating causes almost four million premature deaths each year, mostly in LMICs,[5,6,7] http://www.who.int/news-room/fact-sheets/detail/household-airpollution-and-health. Almost three billion people, mostly from low- and middle-income countries (LMICs), rely on open fires and burning of biomass fuels (wood, animal dung, crop residues, straw and charcoal) for cooking and heating.[1,2] Notably, people living in poverty are unable to afford clean fuels and efficient cooking practices, and have the greatest exposure to household air pollution (HAP).[3,4]. The drive behind these programmes was preventing deforestation and encouraging local economic development, rather than reducing health risks from HAP.[6,10] Some national programmes did make a transition to cleaner fuels including liquefied petroleum gas (LPG) as their socioeconomic circumstances improved.[11] Yet, the poorest people in rural areas still have limited opportunities to switch to clean fuels, and remain dependent on improved cookstoves and/or heaters as the sole technological option for reducing HAP exposure.[11,12]
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