Reduce Household Air Pollution Research Articles

The effect of a cluster-randomized cookstove intervention to reduce household air pollution exposures on child growth trajectories through age one year

The effect of a cluster-randomized cookstove intervention to reduce household air pollution exposures on child growth trajectories through age one year

Effects and acceptability of implementing improved cookstoves and heaters to reduce household air pollution: a FRESH AIR study

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.

Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study

Introduction. Switching from polluting (e.g. wood, crop waste, coal) to clean (e.g. gas, electricity) cooking fuels can reduce household air pollution exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. Methods. We examined longitudinal survey data from 24 172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology study. We assessed household-level primary cooking fuel switching during a median of 10 years of follow up (∼2005–2015). We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. Results. One-half of study households (12 369) reported changing their primary cooking fuels between baseline and follow up surveys. Of these, 61% (7582) switched from polluting (wood, dung, agricultural waste, charcoal, coal, kerosene) to clean (gas, electricity) fuels, 26% (3109) switched between different polluting fuels, 10% (1164) switched from clean to polluting fuels and 3% (522) switched between different clean fuels. Among the 17 830 households using polluting cooking fuels at baseline, household-level factors (e.g. larger household size, higher wealth, higher education level) were most strongly associated with switching from polluting to clean fuels in India; in all other countries, community-level factors (e.g. larger population density in 2010, larger increase in population density between 2005 and 2015) were the strongest predictors of polluting-to-clean fuel switching. Conclusions. The importance of community and sub-national factors relative to household characteristics in determining polluting-to-clean fuel switching varied dramatically across the nine countries examined. This highlights the potential importance of national and other contextual factors in shaping large-scale clean cooking transitions among rural communities in low- and middle-income countries.

Indian annual ambient air quality standard is achievable by completely mitigating emissions from household sources

Exposures to ambient and household fine-particulate matter (PM2.5) together are among the largest single causes of premature mortality in India according to the Global Burden of Disease Studies (GBD). Several recent investigations have estimated that household emissions are the largest contributor to ambient PM2.5 exposure in the country. Using satellite-derived district-level PM2.5 exposure and an Eulerian photochemical dispersion model CAMx (Comprehensive Air Quality Model with Extensions), we estimate the benefit in terms of population exposure of mitigating household sources--biomass for cooking, space- and water-heating, and kerosene for lighting. Complete mitigation of emissions from only these household sources would reduce India-wide, population-weighted average annual ambient PM2.5 exposure by 17.5, 11.9, and 1.3%, respectively. Using GBD methods, this translates into reductions in Indian premature mortality of 6.6, 5.5, and 0.6%. If PM2.5 emissions from all household sources are completely mitigated, 103 (of 597) additional districts (187 million people) would meet the Indian annual air-quality standard (40 μg m-3) compared with baseline (2015) when 246 districts (398 million people) met the standard. At 38 μg m-3, after complete mitigation of household sources, compared with 55.1 μg m-3 at baseline, the mean annual national population-based concentration would meet the standard, although highly polluted areas, such as Delhi, would remain out of attainment. Our results support expansion of programs designed to promote clean household fuels and rural electrification to achieve improved air quality at regional scales, which also has substantial additional health benefits from directly reducing household air pollution exposures.

Household air pollution in Nairobi's slums: A long-term policy evaluation using participatory system dynamics

58% of Nairobi's population live in informal settlements in extremely poor conditions. Household air pollution is one of the leading causes of premature death and disease in these settlements. Regulatory frameworks and government budgets for household air pollution do not exist and humanitarian organisations remain largely inattentive and inactive on this issue. The purpose of this paper is to evaluate the effectiveness of potential indoor-air related policies, as identified together with various stakeholders, in lowering household air pollution in Nairobi's slums. Applying a novel approach in this context, we used participatory system dynamics within a series of stakeholder workshops in Nairobi, to map and model the complex dynamics surrounding household air pollution and draw up possible policy options. Workshop participants included community members, local and national policy-makers, representatives from parastatals, NGOs and academics. Simulation modelling demonstrates that under business-as-usual, the current trend of slowly improving indoor air quality will soon come to a halt. If we aim to continue to substantially reduce household PM2.5 levels, a drastic acceleration in the uptake of clean stoves is needed. We identified the potentially high impact of redirecting investment towards household air quality monitoring and health impact assessment studies, therefore raising the public's and the government's awareness and concern about this issue and its health consequences. Such investments, due to their self-reinforcing nature, can entail high returns on investment, but are likely to give ‘worse-before-better’ results due to the time lags involved. We also discuss the usefulness of the participatory process within similar multi-stakeholder contexts. With important implications for such settings this work advances our understanding of the efficacy of high-level policy options for reducing household air pollution. It makes a case for the usefulness of participatory system dynamics for such complex, multi-stakeholder, environmental issues.

Emission of black carbon from rural households kitchens and assessment of lifetime excess cancer risk in villages of North India

The use of biomass solid fuels (BSFs) for cooking, contribute significantly to the household air pollution (HAP) in developing countries. Emissions resulting from a variety of BSFs (cow dung cakes, wood, and agriculture residues) contain a significant amount of air pollutants, which are now recognized for their role in climatic change and adverse human health impacts. In the current study, daily variations in black carbon (BC) or Short-Lived Climate Forcer concentrations were studied from rural household kitchens using portable aethalometer. The hourly average concentration of BC ranges from 5.4 μg·m−3 to 34.9 μg·m−3 for various types of household kitchens. The peak levels of BC were found to be significantly higher, when compared to World Health Organization PM2.5 limits for ambient air and hence pose a threat to the health of the vulnerable population, i.e., women, children, older adults and those who have health problems. The study also highlights the variation of BC concentration in different kitchen type. The average BC concentration in indoor, outdoor and semi-open kitchen was observed to be 14.54, 14.28 and 24.69 μg·m−3, respectively. The excess lifetime carcinogenic risk for cooking 4 h/day in these kitchens in the North Indian villages was estimated to be 1.25 × 10−7, 1.22 × 10−7, and 2.12 × 10−7 respectively. Age-specific excess cancer deaths due to BC exposure were measured highest in children below four years of age in Chandigarh, India. Hence, there is a need to shift the BSF users to clean fuel alternatives to reduce the exposure to HAP. This can be achieved by generating local/regional evidences of BSFs associated health risks to support policy interventions. Further, more research is required to improve the air quality in indoor micro-environments and specifically in kitchens. NoveltyThe first study reporting the near real-time measurements of BC from different types of rural households kitchens of north India. Diurnal pattern of BC concentration was also studied including the effect of chimney, ventilation and kitchen size on observed BC concentration. This study also estimates lifetime excess cancer risk due to BC exposure in rural households in India. The recent ‘Global Burden of Disease’ report identifies household air pollutants as a major cause of disease and disability in Asia. The study will help to plan suitable policies and intervention to reduce household air pollution in the region.

Introduction: Implementation Science to Reduce Household Air Pollution (HAP) Exposures in Low and Middle-Income Countries (LMICs)

HAP exposures are responsible for a major proportion of the total disease burden in LMICs. To address this, the NIH led Clean Cooking Implementation Science Network (ISN) is developing methods to elucidate technologies, conditions, and implementation strategies that can result in the largest reductions in HAP exposures. The challenge is to accelerate widespread, sustained and nearly exclusive adoption of clean cooking to promote public health. In this symposium we present a brief introduction to the network and its approach, followed by study results from interventional and natural experiments in India and Sub-Saharan Africa. For example, India has recently launched an enormous effort to provide access to clean cooking fuels such as Liquified Petroleum Gas (LPG) to nearly 50 million homes by 2019, but challenges of sustaining LPG use remain to be overcome. Implementation science has evolved precisely to meet this kind of complex, multidimensional problem. Finance, access to services, ambient air quality, climate, home construction, community structure, cultural traditions and gender are among the complex variables addressed in the network’s research. The ISN projects presented here use a diversity of methods – including social network analysis, microfinance experimentation, novel survey methodologies and sensor-based monitoring of stove-use and resulting exposure levels – to understand the potential drivers of decision making in rural and peri-urban, low income settings. In this brief introduction to the research we provide background on the scope of the problem and an outline of the approaches we are taking to employ research that will accelerate the transition to clean cooking fuels around the world.

Effectiveness of Liquefied Petroleum Gas Stove Ownership for Reducing Household Air Pollution Exposure during Pregnancy in Guatemala

Background: Household air pollution from solid fuel use has been associated with adverse birth outcomes. Efforts to reduce exposure focused on chimney stoves have had limited success, and switching...

Understanding Household, Network, and Organizational Drivers of Adoption, Sustained Use, and Maintenance of Clean Cooking Fuels in Rural India

To reduce household air pollution (HAP) the emphasis is now on transitioning households and communities to cleaner Liquefied Petroleum Gas (LPG) based cooking systems. The objective of our case-con...

The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old.

Household air pollution is estimated to cause half a million deaths from pneumonia in children worldwide. The Cooking and Pneumonia Study (CAPS) was conducted to determine whether the use of cleaner-burning biomass-fueled cookstoves would reduce household air pollution and thereby the incidence of pneumonia in young children in rural Malawi. Here we report a cross-sectional assessment of carbon monoxide (CO) exposure and carboxyhemoglobin (COHgB) levels at recruitment to CAPS. Mean (SD; range) 48-h CO exposure of 1928 participating children was 0.90 (2.3; 0–49) ppm and mean (SD; range) COHgB level was 5.8% (3.3; 0–20.3). Higher mean CO and COHgB levels were associated with location (Chikhwawa versus Chilumba) (OR 3.55 (1.73–7.26)); (OR 2.77 (1.08–7.08)). Correlation between mean CO and COHgB was poor (Spearman’s ρ = 0.09, p < 0.001). The finding of high COHgB levels in young children in rural Malawi that are at levels at which adverse neurodevelopmental and cognitive effects occur is of concern. Effective approaches for reducing exposure to CO and other constituents of air pollution in rural sub-Saharan African settings are urgently needed.

Urban systems complexity in sustainability and health: an interdisciplinary modelling study

BackgroundImproving urban health and sustainability raises complex questions that are best addressed through interdisciplinary and even transdisciplinary approaches, in which scientific research and analysis and stakeholder engagement have important roles. In this study we report pilot work in Nairobi (Kenya) and London (UK) that uses innovative methods to integrate qualitative and quantitative modelling to provide evidence to support policy development for health and sustainability in these cities. MethodsWe used two primary modelling methods, system dynamics and microsimulation, and sought to understand the value of these tools in combination to support policy decisions. System dynamics was used to establish an aggregated and non-linear causal map of the interconnections between diverse variables, and thus to gain insight into the policies and specific processes that need to be examined in further depth. System dynamics was a key tool for city-level stakeholder engagement. In part informed by the outcome of the system dynamics process, microsimulation was then used to quantify local effects on health of selected policy options. The results were mapped using geographic information systems methods. FindingsThe combination of system dynamics and microsimulation models provided a framework that enhanced collective knowledge about the interrelationships of policy decisions, funding, public awareness, and environmental and health effects. Our initial participatory system dynamics work on air pollution in Nairobi found that a combination of policies that focus on households and outdoor air could reduce household air pollution by about 50%, leaving it still above WHO-recommended levels. Yet, the investments in monitoring and health impact assessment have the potential to trigger reinforcing mechanisms that create synergies among existing policies and increase the return on investment. Preliminary 106-year microsimulation runs of the effects of PM2·5 in London revealed that anthropogenic emissions are associated with about 2300 incident cases of ischaemic heart disease annually. The two methods appeared to have valuable complementarity in their focus on aggregated dynamics at the policy level versus local policy effects. InterpretationThe use of system dynamics can produce a quantitative model of the policy implementation process, including the organisational barriers and opportunities for change. This can be extended to include aggregate outputs from other models to quantify a more holistic and high-level quantitative model of the dynamics of selected policy questions. Together, these methods can estimate regional environmental and local health effects of selected policies, but also inform about overcoming the barriers to these policies. FundingThe Housing in Nairobi's Informal Settlements—A Complex Urban System project funded by the Engineering and Physical Sciences Research Council, and the Complex Urban Systems for Sustainability and Health project funded by the Wellcome Trust.

Dynamics of sustained use and abandonment of clean cooking systems: lessons from rural India

Clean cooking technologies—ranging from efficient cookstoves to clean fuels—are widely deployed to reduce household air pollution and alleviate adverse health and climate consequences. Although much progress has been made on the technical aspects, sustained and proper use of clean cooking technologies by populations with the most need has been problematic. Only by understanding how clean cooking as an intervention is embedded within complex community processes can we ensure its sustained implementation. Using a community-based system dynamics approach, we engaged two rural communities in co-creating a dynamic model to explain the processes influencing the uptake and transition to sustained use of biogas (an anaerobic methane digester), a clean fuel and cooking technology. The two communities provided contrasting cases: one abandoned biogas while the other continues to use it. We present a system dynamics simulation model, associated analyses, and experiments to understand what factors drive transition and sustained use. A central insight of the model is community processes influencing the capacity to solve technical issues. Model analysis shows that families begin to abandon the technology when it takes longer to solve problems. The momentum in the community then shifts from a determination to address issues with the cooking technology toward caution in further adhering to it. We also conducted experiments using the simulation model to understand the impact of interventions aimed at renewing the use of biogas. A combination of theoretical interventions, including repair of non-functioning biogas units and provision of embedded technical support in communities, resulted in a scenario where the community can continue using the technology even after support is retracted. Our study also demonstrates the utility of a systems approach for engaging local stakeholders in delineating complex community processes to derive significant insights into the dynamic feedback mechanisms involved in the sustained use of biogas by the poor.

Reducing Household Air Pollution and Improving Health in Nairobi’s Informal Settlements: A Participatory System Dynamics Approach

Background/Aim: Rapid growth and unequal development has resulted in more than 60% of Nairobi’s population living in informal settlements. Household air pollution (HAP), primarily fine particulate matter (PM2.5), is a major contributor to the large environmental burdens of disease and mortality in these areas, but actions to reduce HAP exposure have so far had limited success. This pilot study is attempting to understand the problem as a complex, interconnected system and to assess the potential implications of different policy options. Methods: We used a participatory system dynamics approach to map the drivers and effects of HAP pollution in Nairobi’s informal settlements. The model was developed through a series of workshops with stakeholders (including community members, policymakers, NGOs, and academics), refined and calibrated to the Korogocho area of the city using available data, including recent trends in key variables. Expected impacts of changes in PM2.5 exposure on life expectancy were estimated within the model using life tables. Results: The system dynamics process identified key drivers of HAP exposure, such as outdoor air pollution levels, household ventilation and the proportion of households using clean stoves/lighting. Subsequent modelling revealed how these drivers interact and form important feedback loops in the system. Analysis of policy options suggests that combinations of policies may be more effective than single policies for reducing HAP exposure and improving health. In particular, the model highlighted the importance of awareness raising and investment in monitoring and health impact assessment, which can trigger reinforcing mechanisms to create synergies among policies. Conclusions: Despite limitations of the available data in this setting, the pilot study demonstrates the value that participatory system dynamics brings to understanding complex urban systems. It also indicates the importance of developing evidence-based health policy.

Attributable risk and potential impact of interventions to reduce household air pollution associated with under-five mortality in South Asia

BackgroundSolid fuel use is the major source of household air pollution (HAP) and accounts for a substantial burden of morbidity and mortality in low and middle income countries. To evaluate and compare childhood mortality attributable to HAP in four South Asian countries.MethodsA series of Demographic and Health Survey (DHS) datasets for Bangladesh, India, Nepal and Pakistan were used for analysis. Estimates of relative risk and exposure prevalence relating to use of cooking fuel and under-five mortality were used to calculate population attributable fractions (PAFs) for each country. Potential impact fractions (PIFs) were also calculated assessing theoretical scenarios based on published interventions aiming to reduce exposure prevalence.ResultsThere are an increased risk of under-five mortality in those exposed to cooking fuel compared to those not exposed in the four South Asian countries (OR = 1.30, 95% CI = 1.07–1.57, P = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1–81.5%) of the 13,290 estimated cases of under-five mortality was attributable to HAP. Joint PIF estimates (assuming achievable reductions in HAP reported in intervention studies conducted in South Asia) indicates 47% of neonatal and 43% of under-five mortality cases associated with HAP could be avoidable in the four South Asian countries studied.ConclusionsElimination of exposure to use of cooking fuel in the household targeting valuable intervention strategies (such as cooking in separate kitchen, improved cook stoves) could reduce substantially under-five mortality in South Asian countries.

Effects of a liquefied petroleum gas stove intervention on pollutant exposure and adult cardiopulmonary outcomes (CHAP): study protocol for a randomized controlled trial

BackgroundBiomass fuel smoke is a leading risk factor for the burden of disease worldwide. International campaigns are promoting the widespread adoption of liquefied petroleum gas (LPG) in resource-limited settings. However, it is unclear if the introduction and use of LPG stoves, in settings where biomass fuels are used daily, reduces pollution concentration exposure, improves health outcomes, or how cultural and social barriers influence the exclusive adoption of LPG stoves.MethodsWe will conduct a randomized controlled, field intervention trial of LPG stoves and fuel distribution in rural Puno, Peru, in which we will enroll 180 female participants aged 25–64 years and follow them for 2 years. After enrollment, we will collect information on sociodemographic characteristics, household characteristics, and cooking practices. During the first year of the study, LPG stoves and fuel tanks will be delivered to the homes of 90 intervention participants. During the second year, participants in the intervention arm will keep their LPG stoves, but the gas supply will stop. Control participants will receive LPG stoves and vouchers to obtain free fuel from distributors at the beginning of the second year, but gas will not be delivered. Starting at baseline, we will collect longitudinal measurements of respiratory symptoms, pulmonary function, blood pressure, endothelial function, carotid artery intima-media thickness, 24-h dietary recalls, exhaled carbon monoxide, quality-of-life indicators, and stove-use behaviors. Environmental exposure assessments will occur six times over the 2-year follow-up period, consisting of 48-h personal exposure and kitchen concentration measurements of fine particulate matter and carbon monoxide, and 48-h kitchen concentrations of nitrogen dioxide for a subset of 100 participants.DiscussionFindings from this study will allow us to better understand behavioral patterns, environmental exposures, and cardiovascular and pulmonary outcomes resulting from the adoption of LPG stoves. If this trial indicates that LPG stoves are a feasible and effective way to reduce household air pollution and improve health, it will provide important information to support widespread adoption of LPG fuel as a strategy to reduce the global burden of disease.Trial registrationClinicalTrials.gov, ID: NCT02994680, Cardiopulmonary Outcomes and Household Air Pollution (CHAP) Trial. Registered on 28 November 2016.

Fuelling the transition: Cost effective pathways for reducing household air pollution and resultant disease burden in India

Fuelling the transition: Cost effective pathways for reducing household air pollution and resultant disease burden in India

Fuel efficiency and air pollutant concentrations of wood-burning improved cookstoves in Malawi: Implications for scaling-up cookstove programs

Developing countries are grappling with how to reduce household air pollution (HAP) from cooking with solid fuels and the traditional three stone fire (TSF). Laboratory studies have shown that improved cookstoves may offer reductions in fuel use, emissions of carbon monoxide (CO) and fine particulate matter (PM2.5), yet there is limited evidence from “real-world” settings showing how improved stoves perform compared to the traditional TSF. Our study takes place in a semi-controlled setting in Malawi and was designed to quantify fuel efficiency improvements and air pollutant concentration reductions capabilities of two improved cookstoves. We perform a Water Boiling Test to compare the TSF with the locally produced clay stove known as the Chitetezo Mbaula (CM) and the Philips gasifying stove. We find that the CM uses 53% of the fuel used by the traditional TSF, and produces 59% of CO, and 50% of PM2.5 of the TSF. The Philips stove uses 31% of the fuel, and produces 38% of CO, and 22% of PM2.5 of the TSF. We consider the potential for the wide-scale adoption of these technologies given their relative costs and conclude that lower-cost, intermediate quality cookstoves are an important and realistic first step toward reducing HAP.

Characterizing Particulate Matter Exfiltration Estimates for Alternative Cookstoves in a Village-Like Household in Rural Nepal.

Alternative stoves are an intervention option to reduce household air pollution. The amount of air pollution exiting homes when alternative stoves are utilized is not known. In this paper, particulate matter exfiltration estimates are presented for four types of alternative stoves within a village-like home, which was built to reflect the use of local materials and common size, in rural Nepal. Four alternative stoves with chimneys were examined, which included an alternative mud brick stove, original Envirofit G3355 model, manufacture altered Envirofit G3355, and locally altered Envirofit G3355. Multiple linear regression was utilized to determine estimates of PM2.5 exfiltration. Overall exfiltration fraction average (converted to a percent) for the four stoves were: alternative mud brick stove with chimney 56%, original Envirofit G3355 model with chimney 87%, manufacture altered Envirofit G3355 model with chimney 69%, and locally altered Envirofit G3355 model with chimney 69%. Alternative cookstoves resulted in higher overall average exfiltration due to direct and indirect ventilation relative to traditional, mud-based stoves. This contrast emphasizes the need for an improved understanding of the climate and health implications that are believed to come from implementing alternative stoves on a large scale and the resultant shift of exposure burden from indoors to outdoors.

Clean Fuels to Reduce Household Air Pollution and Improve Health. Still Hoping to Answer Why and How.

Clean Fuels to Reduce Household Air Pollution and Improve Health. Still Hoping to Answer Why and How.

Evaluation of short-term health effects among rural women and reduction in household air pollution due to improved cooking stoves: quasi experimental study

An improved efficient stove is the mainstay intervention to reduce household air pollution (HAP) associated with biomass fuel use. It potentially addresses the adverse health outcomes by reducing smoke exposure, fuel consumption, and cooking time. This study evaluated two stove intervention programs and compared them for health effects (respiratory and eye symptoms, lung function, blood pressure and burns) among women who were the main cook of the household. A total of 83 and 134 improved and 209 and 179 traditional stoves in Sindh and Punjab provinces of Pakistan, respectively, were evaluated after 3 months of installation, during June to September, 2014. Twenty-four-hour particulate matter (<2.5 μm) (PM2.5) and carbon monoxide (CO) levels were measured in the kitchens in a subsample (n = 40). Multivariate logistic regression and general linear model were used to determine the health impact of improved stoves among women. PM2.5 and CO levels were significantly less in improved stove kitchens. Among women in Sindh program, significantly less cough (aRR 0.27, CI 0.20, 0.38), phlegm (aRR 0.27, CI 0.18, 0.40), shortness of breath (aRR 0.16, CI 0.11, 0.22), chest tightness (aRR 0.23, CI 0.17, 0.31), attack of asthma (aRR 0.33, CI 0.22, 0.49) (p < 0.001), sandy eyes (aRR 0.63, CI 0.47, 0.97), and itching in eyes (aRR 0.62, CI 0.41, 0.95 (p < 0.050) were present. While in Punjab program, risk reduction for phlegm (aRR 0.60, CI 0.45, 0.81) and protection from burns (aRR 0.56, CI 0.34, 0.91) were observed among women. Mean peak expiratory flow was higher among women using improved stoves in Sindh program (31.58, CI 17.90, 45.25 L/min) only. Overall, the positive health impact was greater among those women using closed kitchens. Interventions with improved stoves can have favorable health impact among women. However, variations in health gains were noted among the two programs, as well as greater impact among women using closed kitchen.