Health impacts of a randomized biomass cookstove intervention in northern Ghana

Mona Abdo,Yolanda Hagar,Ernest Kanyomse,Rex Alirigia,Evan R Coffey,Katherine L Dickinson,David Diaz-Sanchez,Christine Wiedinmyer,Michael P Hannigan,Abraham Rexford Oduro,Ricardo Piedrahita,Daniel J Naumenko

doi:10.1186/s12889-021-12164-y

Abstract

BackgroundHousehold air pollution (HAP) from cooking with solid fuels has adverse health effects. REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) was a randomized cookstove intervention study that aimed to determine the effects of two types of “improved” biomass cookstoves on health using self-reported health symptoms and biomarkers of systemic inflammation from dried blood spots for female adult cooks and children, and anthropometric growth measures for children only.MethodsTwo hundred rural households were randomized into four different cookstove groups. Surveys and health measurements were conducted at four time points over a two-year period. Chi-square tests were conducted to determine differences in self-reported health outcomes. Linear mixed models were used to assess the effect of the stoves on inflammation biomarkers in adults and children, and to assess the z-score deviance for the anthropometric data for children.ResultsWe find some evidence that two biomarkers of oxidative stress and inflammation, serum amyloid A and C-reactive protein, decreased among adult primary cooks in the intervention groups relative to the control group. We do not find detectable impacts for any of the anthropometry variables or self-reported health.ConclusionsOverall, we conclude that the REACCTING intervention did not substantially improve the health outcomes examined here, likely due to continued use of traditional stoves, lack of evidence of particulate matter emissions reductions from “improved” stoves, and mixed results for HAP exposure reductions.Clinical trial registryClinicalTrials.gov (National Institutes of Health); Trial Registration Number: NCT04633135; Date of Registration: 11 November 2020 – Retrospectively registered.URL: https://clinicaltrials.gov/ct2/show/NCT04633135?term=NCT04633135&draw=2&rank=1

Highlights

Household air pollution (HAP) from cooking with solid fuels has adverse health effects
We examine indicators of the health impacts of the REACCTING (Research on Emissions, Air Quality, Climate, and Cooking Technologies in Northern Ghana) randomized cookstove intervention study [6]
We observed some reductions in personal exposure to particulate matter for all intervention groups, though results vary by pollutant; organic carbon exposure was reduced for all intervention groups, while elemental carbon was only reduced in groups receiving the Philips stove, relative to the control group [11]

Summary

Introduction

Household air pollution (HAP) from cooking with solid fuels has adverse health effects. We examine indicators of the health impacts of the REACCTING (Research on Emissions, Air Quality, Climate, and Cooking Technologies in Northern Ghana) randomized cookstove intervention study [6]. Given limited evidence on the effectiveness of these stoves for changing cooking behaviors and reducing HAP exposure in a field setting, the primary focus of the REACCTING study was on these intermediate impacts on the causal pathways towards health and environmental outcomes (see Fig. 1). We have reported effects of the intervention on cooking behavior [7, 8], stove emissions [9], fuel use [10], personal exposure [11, 12], and ambient air quality [11, 13]. We observed some reductions in personal exposure to particulate matter for all intervention groups, though results vary by pollutant; organic carbon exposure was reduced for all intervention groups, while elemental carbon was only reduced in groups receiving the Philips stove, relative to the control group [11]

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