Improving indoor air quality for poor families: a controlled experiment in Bangladesh

The impacts of cooking and indoor air quality assessment in the southwestern region of Bangladesh

The main objective of this study is to assess the impacts of cooking and indoor air quality (IAQ) in the southwestern region of Bangladesh. Here we report and compare the IAQ in considering a total of eight kitchens and living rooms of four selected households (HHs) in Jashore city and suburb area, the southwest district of Bangladesh. Air quality parameters, such as particulate matter (PM_2.5) and volatile organic compounds (VOC), were assessed continuously for 24 h. In addition, Carbon dioxide (CO₂) was evaluated in different phases during the study period. PM_2.5, VOC, and CO₂ levels were ranged from 18.52 to 207 μg/m³, 7.95-35.66 ppm, and 1061-2459 mg/m³, respectively, in the indoor cooking HHs. Conversely, while the average concentration was found between 20.63 and 23.72 μg/m³ PM_2.5, 11.18-12.36 ppm VOC, and 1097-1747 mg/m³ CO₂ in the outdoor cooking HHs. A significant increase in CO₂ due to kitchen activities (cooking, frying, boiling) was observed that ranged between 5 and 77% compared to the background level. The calculated range of toxicity potential (TP) values was between 0.8 and 8.3 for PM_2.5 in the HHs. In most of the observations, PM_2.5, VOC, and CO₂ exceed the standard values. The study reports that well ventilation systems and clean fuel use significantly reduce the indoor air contaminants level. Our study offers new insights about the IAQ of the southwest region of Bangladesh, particularly for suburbs and urban setups, and provides a background for further study, and decision-making. It will serve as a reference for the formulation and implementation of policies to improve air quality.

Household PM2.5 pollution in rural Chinese homes: Levels, dynamic characteristics and seasonal variations

Humans generally spend most of their time indoors, and fine particulate matter (PM_2.5) in indoor air can have seriously adverse effects on human health due to the long exposure time. This study conducted field measurements to explore seasonal variations of PM_2.5 concentrations in household air by revisiting the same rural homes in southern China and factors influencing indoor PM_2.5 concentrations were explored mainly by one-way ANOVA. The PM_2.5 concentrations of outdoor, kitchen and living room air were 38.9 ± 12.2, 47.1 ± 20.3 and 50.8 ± 24.1 μg/m³ in summer, respectively, which were 2.3 to 2.9 times lower than those in winter (p < 0.05). The lower indoor PM_2.5 pollution in summer was attributed to the transition to clean household energy and better ventilation. Fuel type can significantly affect PM_2.5 concentrations in the kitchen, with greater PM_2.5 pollution associated with wood combustion than electricity. Our study firstly found mosquito coil emission was an important contributor to PM_2.5 in the living room of rural households, which should be investigated further. Dynamic variations of PM_2.5 suggested that cooking, heating and mosquito coil emission can rapidly increase indoor PM_2.5 concentrations (up to one order of magnitude higher than baseline values), as well as the indoor/outdoor PM_2.5 ratios. This study had the first insight of seasonal differences of household PM_2.5 in the same rural homes using real-time monitors, confirming the different patterns and characteristics of household PM_2.5 pollution in different seasons.

Effect of a solar lighting intervention on fuel-based lighting use and exposure to household air pollution in rural Uganda: A randomized controlled trial

Solar lighting is an alternative to polluting kerosene and other fuel-based lighting devices relied upon by millions of families in resource-limited settings. Whether solar lighting provides sustained displacement of fuel-based lighting sources and reductions in personal exposure to fine particulate matter (PM₂ .₅ ) and black carbon (BC) has not been examined in randomized controlled trials. Eighty adult women living in rural Uganda who utilized fuel-based (candles and kerosene lamps) and/or clean (solar, grid, and battery-powered devices) lighting were randomized in a 1:1 ratio to receive a home solar lighting system at no cost to study participants (ClinicalTrials.gov NCT03351504). Among intervention group participants, kerosene lamps were completely displaced in 92% of households using them. The intervention led to an average exposure reduction of 36.1 μg/m³ (95% CI -70.3 to -2.0) in PM₂ .₅ and 10.8 μg/m³ (95% CI -17.6 to -4.1) in BC, corresponding to a reduction from baseline of 37% and 91%, respectively. Reductions were greatest among participants using kerosene lamps. Displacement of kerosene lamps and personal exposure reductions were sustained over 12 months of follow-up. Solar lighting presents an immediate opportunity for achieving sustained reductions in personal exposure to PM_2.5 and BC and should be considered in household air pollution intervention packages.

Air pollution dispersion from biomass stoves to neighboring homes in Mirpur, Dhaka, Bangladesh

BACKGROUND

Indoor air pollution, including fine particulate matter (PM2.5) and carbon monoxide (CO), is a major risk factor for pneumonia and other respiratory diseases. Biomass-burning cookstoves are major contributors to PM2.5 and CO concentrations. However, high concentrations of PM2.5 (> 1000 μg/m3) have been observed in homes in Dhaka, Bangladesh that do not burn biomass. We described dispersion of PM2.5 and CO from biomass burning into nearby homes in a low-income urban area of Dhaka, Bangladesh.

METHODS

We recruited 10 clusters of homes, each with one biomass-burning (index) home, and 3-4 neighboring homes that used cleaner fuels with no other major sources of PM2.5 or CO. We administered a questionnaire and recorded physical features of all homes. Over 24 h, we recorded PM2.5 and CO concentrations inside each home, near each stove, and outside one neighbor home per cluster. During 8 of these 24 h, we conducted observations for pollutant-generating activities such as cooking. For each monitor, we calculated geometric mean PM2.5 concentrations at 5-6 am (baseline), during biomass burning times, during non-cooking times, and over 24 h. We used linear regressions to describe associations between monitor location and PM2.5 and CO concentrations.

RESULTS

We recruited a total of 44 homes across the 10 clusters. Geometric mean PM2.5 and CO concentrations for all monitors were lowest at baseline and highest during biomass burning. During biomass burning, linear regression showed a decreasing trend of geometric mean PM2.5 and CO concentrations from the biomass stove (326.3 μg/m3, 12.3 ppm), to index home (322.7 μg/m3, 11.2 ppm), neighbor homes sharing a wall with the index home (278.4 μg/m3, 3.6 ppm), outdoors (154.2 μg/m3, 0.7 ppm), then neighbor homes that do not share a wall with the index home (83.1 μg/m3,0.2 ppm) (p = 0.03 for PM2.5, p = 0.006 for CO).

CONCLUSION

Biomass burning in one home can be a source of indoor air pollution for several homes. The impact of biomass burning on PM2.5 or CO is greatest in homes that share a wall with the biomass-burning home. Eliminating biomass burning in one home may improve air quality for several households in a community.

Characteristics and potential health risk of rural Tibetans' exposure to polycyclic aromatic hydrocarbons during summer period

Biomass fuels remain main energy sources in many remote rural regions, but potential health hazards from exposure to biomass combustion fumes have not been adequately assessed. Combustion of biomass fuels generates abundant polycyclic aromatic hydrocarbons (PAHs); hence residential exposure to PAHs can be used to evaluate the potential health risk to remote rural populations. The present study selected rural Tibetans to address the above-mentioned issue. Samples of indoor air and dust, human urine and local foods (Tsampa flour and buttered tea) were collected from five rural households in Langkazi County, an agricultural and pasturing region in Tibet of China in the summer season, which represented the best-case scenario as no heating was required. Residential exposure to PAHs by adults amounted to benzo[a]pyrene equivalent (BaP_eq) dosages of 110-760, 1.2-50 and 0.5-23 ng d^-1 for ingestion, inhalation and dermal contact, respectively. Daily intakes of naphthalene, fluorene, phenanthrene and pyrene estimated from urinary monohydroxy PAH metabolites and from diet and inhalation exposure to PAHs were comparable (3.9, 1.9, 12 and 3.3 μg d^-1 versus 9.5, 2.5, 5.1 and 1.1 μg d^-1), indicating the utility of external exposure in assessing daily intake of PAHs. The median incremental lifetime cancer risk was 32 × 10^-6 (95% confidence interval: 0.7-73 × 10^-6) for ingestion and 2.4 × 10^-6 (95% confidence interval: 0.02-12 × 10^-6) for inhalation and dermal contact combined, indicating moderate to slight potential cancer risk. Diet is the dominant source of health hazards for rural Tibetans, but cooking fumes also present a meaningful concern. The present study demonstrates that the pristine lifestyles of remote rural residents may be of global health concern, and merit further investigations.

Approximation of personal exposure to fine particulate matters (PM2.5) during cooking using solid biomass fuels in the kitchens of rural West Bengal, India

More than 85% of the rural Indian households use traditional solid biofuels (SBFs) for daily cooking. Burning of the easily available unprocessed solid fuels in inefficient earthen cooking stoves produce large quantities of particulate matters. Smaller particulates, especially with aerodynamic diameter of 2.5 μm or less (PM_2.5), largely generated during cooking, are considered to be health damaging in nature. In the present study, kitchen level exposure of women cooks to fine particulate matters during lunch preparation was assessed considering kitchen openness as surrogate to the ventilation condition. Two-way ANCOVA analysis considering meal quantity as a covariate revealed no significant interaction between the openness and the seasons explaining the variability of the personal exposure to the fine particulate matters in rural kitchen during cooking. Multiple linear regression analysis revealed the openness as the only significant predictor for personal exposure to the fine particulate matters. In the present study, the annual average fine particulate matter exposure concentration was found to be 974 μg m^-3.

Pilot Intervention Study of Household Ventilation and Fine Particulate Matter Concentrations in a Low-Income Urban Area, Dhaka, Bangladesh

Fine particulate matter (PM_2.5) is a risk factor for pneumonia; ventilation may be protective. We tested behavioral and structural ventilation interventions on indoor PM_2.5 in Dhaka, Bangladesh. We recruited 59 good ventilation (window or door in ≥ 3 walls) and 29 poor ventilation (no window, one door) homes. We monitored baseline indoor and outdoor PM_2.5 for 48 hours. We asked all participants to increase ventilation behavior, including opening windows and doors, and operating fans. Where permitted, we installed windows in nine poor ventilation homes, then repeated PM_2.5 monitoring. We estimated effects using linear mixed-effects models and conducted qualitative interviews regarding motivators and barriers to ventilation. Compared with poor ventilation homes, good ventilation homes were larger, their residents wealthier and less likely to use biomass fuel. In multivariable linear mixed-effects models, ventilation structures and opening a door or window were inversely associated with the number of hours PM_2.5 concentrations exceeded 100 and 250 μg/m³. Outdoor air pollution was positively associated with the number of hours PM_2.5 concentrations exceeded 100 and 250 μg/m³. Few homes accepted window installation, due to landlord refusal and fear of theft. Motivators for ventilation behavior included cooling of the home and sunlight; barriers included rain, outdoor odors or noise, theft risk, mosquito entry, and, for fan use, perceptions of wasting electricity or unavailability of electricity. We concluded that ventilation may reduce indoor PM_2.5 concentrations but, there are barriers to increasing ventilation and, in areas with high ambient PM_2.5 concentrations, indoor concentrations may remain above recommended levels.

Firewood, smoke and respiratory diseases in developing countries-The neglected role of outdoor cooking

Smoke from cooking in the kitchen is one of the world’s leading causes of premature child death, claiming the lives of 500,000 children under five annually. This study analyses the role of outdoor cooking and the prevalence of respiratory diseases among children under five years by means of probit regressions using information from 41 surveys conducted in 30 developing countries from Asia, Africa and Latin America. I find that outdoor cooking reduces respiratory diseases among young children aged 0-4 by around 9 percent, an effect that reaches 13 percent among children aged 0-1. The results suggest that simple behavioral interventions, such as promoting outdoor cooking, can have a substantial impact on health hazards.

A pilot study of traditional indoor biomass cooking and heating in rural Bhutan: gas and particle concentrations and emission rates

Although many studies have reported the health effects of biomass fuels in developing countries, relatively few have quantitatively characterized emissions from biomass stoves during cooking and heating. The aim of this pilot study was to characterize the emission characteristics of different biomass stoves in four rural houses in Bhutan during heating (metal chimney stove), rice cooking (traditional mud stove), fodder preparation (stone tripod stove), and liquor distillation (traditional mud stove). Three stage measurements (before, during, and after the activity had ceased) were conducted for PM_2.5 , particle number (PN), CO, and CO₂ . When stoves were operated, the pollutant concentrations were significantly elevated above background levels, by an average of 40 and 18 times for PM_2.5 and CO, respectively. Emission rates (mg/min) ranged from 1.07 × 10² (PM_2.5 ) and 3.50 × 10² (CO) for the stone tripod stove during fodder preparation to 6.20 × 10² (PM_2.5 ) and 2.22 × 10³ (CO) for the traditional mud stove during liquor distillation. Usable PN data were only available for one house, during heating using a metal chimney stove, which presented an emission rate of 3.24 × 10¹³ particles/min. Interventions to control household air pollution in Bhutan, in order to reduce the health risks associated with cooking and heating, are recommended.

Patterns of domestic exposure to carbon monoxide and particulate matter in households using biomass fuel in Janakpur, Nepal

Household Air Pollution (HAP) from biomass cooking fuels is a major cause of morbidity and mortality in low-income settings worldwide. In Nepal the use of open stoves with solid biomass fuels is the primary method of domestic cooking. To assess patterns of domestic air pollution we performed continuous measurement of carbon monoxide (CO) and particulate Matter (PM2.5) in 12 biomass fuel households in Janakpur, Nepal. We measured kitchen PM2.5 and CO concentrations at one-minute intervals for an approximately 48-h period using the TSI DustTrak II 8530/SidePak AM510 (TSI Inc, St. Paul MN, USA) or EL-USB-CO data logger (Lascar Electronics, Erie PA, USA) respectively. We also obtained information regarding fuel, stove and kitchen characteristics and cooking activity patterns. Household cooking was performed in two daily sessions (median total duration 4 h) with diurnal variability in pollutant concentrations reflecting morning and evening cooking sessions and peak concentrations associated with fire-lighting. We observed a strong linear relationship between PM2.5 measurements obtained by co-located photometric and gravimetric monitoring devices, providing local calibration factors of 4.9 (DustTrak) and 2.7 (SidePak). Overall 48-h average CO and PM2.5 concentrations were 5.4 (SD 4.3) ppm (12 households) and 417.6 (SD 686.4) μg/m3 (8 households), respectively, with higher average concentrations associated with cooking and heating activities. Overall average PM2.5 concentrations and peak 1-h CO concentrations exceeded WHO Indoor Air Quality Guidelines. Average hourly PM2.5 and CO concentrations were moderately correlated (r = 0.52), suggesting that CO has limited utility as a proxy measure for PM2.5 exposure assessment in this setting. Domestic indoor air quality levels associated with biomass fuel combustion in this region exceed WHO Indoor Air Quality standards and are in the hazardous range for human health.

Spatio-temporal measurement of indoor particulate matter concentrations using a wireless network of low-cost sensors in households using solid fuels

Many households use solid fuels for cooking and heating purposes. There is currently a knowledge gap in our understanding of the variations in indoor air quality throughout the household as most of the studies focus on the areas in the close proximity of the cookstove. A low-cost wireless particulate matter (PM) sensor network was developed and deployed in households in Raipur, India to establish the spatio-temporal variation of PM concentrations. The data from multiple sensors were acquired in real-time with a wireless system. Data collected from the sensors agreed well (R² =0.713) with the reference data collected from a commercially available instrument. Low spatial variability was observed within the kitchen due to its small size and poor ventilation - a common feature of most rural Indian kitchens. Due to insufficient ventilation from open doors and windows, high PM concentrations similar to those found in the kitchen were also found in the adjoining rooms. The same household showed significantly different post-extinguished cookstove PM concentration decay rates (0.26mg/m³-min and 0.87mg/m³-min) on different days, owing to varying natural air exchange rates (7.68m³/min and 37.40m³/min).

Household Air Pollution and Under-Five Mortality in Bangladesh (2004-2011)

Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among children under five years in Bangladesh. This study investigates the association between HAP from cooking fuel and under-five mortality using Bangladesh Demographic and Health Survey (BDHS) datasets over the period 2004–2011 (n = 18,308 children), and the extent to which this association differed by environmental and behavioral factors affecting level of exposure. The association between HAP and neonatal (age between 0–28 days), infant (age between 0 and 11 months) and under–five (age between 0 and 59 months) mortality was examined using multilevel logistic regression models. HAP was not strongly associated with overall neonatal (OR = 1.49, 95% CI = 1.01–2.22, p = 0.043), infant (OR = 1.27, 95% CI = 0.91–1.77, p = 0.157) or under-five mortality (OR = 1.14, 95% CI = 0.83–1.55, p = 0.422) in the context of overall decreasing trends in under-five mortality. The association was stronger for households with an indoor kitchen using polluting fuels, and in women who had never breastfed. Reductions in exposure to pollution from cooking fuel, given it is a ubiquitous and modifiable risk factor, can result in further declines in under-five mortality with household design and behavioural interventions.

Household-level risk factors for influenza among young children in Dhaka, Bangladesh: a case-control study

OBJECTIVES

To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh.

METHODS

We conducted a case-control study using existing active surveillance for respiratory illness. Cases were children aged 12-59 months with laboratory-confirmed influenza. Controls were children frequency-matched by age group with no respiratory illness in the prior 6 months. We interviewed caregivers and observed household handwashing behaviour. Soap consumption was estimated by summing weight differences of three bars of soap sequentially left in each household. We measured concentrations of airborne particulate matter <2.5 μg in diameter (PM2.5) in a subset of households. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS

We enrolled 145 cases and 341 controls between March 2009 and April 2010. Case and control household members were observed to wash hands with similar frequency during a 5-h period (mean, 0.64 events vs. 0.63, P = 0.87), and similar daily soap consumption per capita (mean 2.92 grams vs. 2.93, P = 0.92). Case households were more likely than controls to have crowded (≥4 persons) sleeping areas (aOR = 1.67, CI: 1.06-2.63) and cross-ventilated cooking spaces (aOR = 1.75, CI: 1.16-2.63). Case and control households had similar median 24-h geometric mean PM2.5 concentrations in the cooking (69.2 vs. 69.6 μg/m(3), P = 0.45) and sleeping (65.4 vs. 67.4 μg/m(3), P = 0.19) spaces.

CONCLUSIONS

Handwashing with soap was practiced infrequently and was not associated with paediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

Perception and Barriers to Indoor Air Quality and Perceived Impact on Respiratory Health: An Assessment in Rural Honduras

Objective. The aim of this study was to identify household-specific factors associated with respiratory symptoms and to study the perceived impact of indoor air pollution (IAP) as a health issue.Methods. An IRB-approved, voluntary, anonymous 23-item survey was conducted in Spanish at a medical outreach clinic in June 2012 and at the homes of survey respondentsN=79. Comparative analyses were performed to investigate relationships between specific house characteristics and respiratory complaints.Results. Seventy-nine surveys were completed. Respiratory symptoms were frequently reported by survey respondents: 42% stated that smoke in their household caused them to have watery eyes, 42% reported household members with coughs within the past two weeks, and 25% stated that there were currently household members experiencing difficulty in breathing. Stove location and kitchen roof construction material were significantly associated with frequency of respiratory symptoms. The vast majority used firewood as their major fuel type. Most respondents indicated that neither indoor air quality was a problem nor did it affect their daily life.Conclusions. Respiratory complaints are common in Yoro, Honduras. Stove location and kitchen roof construction material were significantly associated with frequency of respiratory symptoms; this may have implications for efforts to improve respiratory health in the region.

Chimney stoves modestly improved indoor air quality measurements compared with traditional open fire stoves: results from a small-scale intervention study in rural Peru

Nearly half of the world's population depends on biomass fuels to meet domestic energy needs, producing high levels of pollutants responsible for substantial morbidity and mortality. We compare carbon monoxide (CO) and particulate matter (PM2.5) exposures and kitchen concentrations in households with study-promoted intervention (OPTIMA-improved stoves and control stoves) in San Marcos Province, Cajamarca Region, Peru. We determined 48-h indoor air concentration levels of CO and PM2.5 in 93 kitchen environments and personal exposure, after OPTIMA-improved stoves had been installed for an average of 7 months. PM2.5 and CO measurements did not differ significantly between OPTIMA-improved stoves and control stoves. Although not statistically significant, a post hoc stratification of OPTIMA-improved stoves by level of performance revealed mean PM2.5 and CO levels of fully functional OPTIMA-improved stoves were 28% lower (n = 20, PM2.5, 136 μg/m(3) 95% CI 54-217) and 45% lower (n = 25, CO, 3.2 ppm, 95% CI 1.5-4.9) in the kitchen environment compared with the control stoves (n = 34, PM2.5, 189 μg/m(3), 95% CI 116-261; n = 44, CO, 5.8 ppm, 95% CI 3.3-8.2). Likewise, although not statistically significant, personal exposures for OPTIMA-improved stoves were 43% and 17% lower for PM2.5 (n = 23) and CO (n = 25), respectively. Stove maintenance and functionality level are factors worthy of consideration for future evaluations of stove interventions.

Association between proximity to a health center and early childhood mortality in Madagascar

Objective

To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance.

Methods

From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia.

Results

Compared with those who lived >1.5–3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0–10.0 km away from a health center were 1.36 (95% CI: 0.92–2.01) and 1.42 (95% CI: 1.06–1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status.

Conclusions

Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better infant health.

Indoor air pollution, cookstove quality, and housing characteristics in two Honduran communities

Elevated indoor air pollution exposures associated with the burning of biomass fuels in developing countries are well established. Improved cookstoves have the potential to substantially reduce these exposures. However, few studies have quantitatively evaluated exposure reductions associated with the introduction of improved stoves, likely due to the cost and time-intensive nature of such evaluations. Several studies have demonstrated the value of estimating indoor air pollution exposures by evaluating personal cooking practices and household parameters in addition to stove type. We assessed carbon monoxide (n=54) and fine particulate matter (PM(2.5)) (n=58) levels among non-smoking Honduran women cooking with traditional or improved wood-burning cookstoves in two communities, one semi-urban and one rural. Exposure concentrations were assessed via 8-h indoor monitoring, as well as 8-h personal PM(2.5) monitoring. Housing characteristics were determined to indicate ventilation that may affect carbon monoxide and PM(2.5). Stove quality was assessed using a four-level subjective scale representing the potential for indoor emissions, ranging from poorly functioning traditional stoves to well-functioning improved stoves. Univariately, the stove scale as compared to stove type (traditional versus improved) accounted for a higher percent of the variation in pollutant concentrations; for example, the stove scale predicted 79% of the variation and the stove type predicted 54% of the variation in indoor carbon monoxide concentrations. In multivariable models, the stove scale, age of the stove, and ventilation factors predicted more than 50% of the variation in personal and indoor PM(2.5) and 85% of the variation in indoor carbon monoxide. Results indicate that using type of stove alone as a proxy for exposure may lead to exposure misclassification and potentially biased exposure and health effects relationships. Utilizing stove quality and housing characteristics that influence ventilation may provide a viable alternative to the more time- and cost-intensive pollutant assessments for larger-scale studies. Designing kitchens with proper ventilation structures could lead to improved indoor environments, especially important in areas where biomass will continue to be the preferred and necessary cooking fuel for some time.