Household air pollution and the sustainable development goals

The effect of chimney fitted improved stove on kitchen fine particulate matter (PM2.5) concentrations in rural Ethiopia: Evidence from a randomized controlled trial

BACKGROUND

Millions of Ethiopian people cook with biomass fuels using traditional stoves, releasing harmful pollutants and contributing to a significant public health crisis. Improved stoves offer a potential escape route, but their effectiveness needs close scrutiny. This study delves into the impact of chimney-fitted stoves on kitchen PM2.5 concentrations in rural Ethiopian households.

METHOD

We conducted a randomized controlled trial with 86 households equally divided (1:1 ratio) between intervention and control groups. The 24-h average kitchen PM2.5 concentrations was measured using Particle and Temperature Sensor (PATS+) at baseline and after intervention. All relevant sociodemographic and cooking related characteristics were collected at baseline and dynamic characteristics were updated during air monitoring visits. Three distinct statistical models, including independent sample t-tests, paired sample t-tests and one-way analysis of variance were used to analyze the data using Statistical Package for the Social Sciences (SPSS) software for Windows (v 24.0).

RESULT

At baseline, the average 24-h kitchen PM2.5 concentrations were 482 μg/m3 (95% CI: 408, 557) for the control and 405 μg/m3 (95% CI: 318, 492) for the intervention groups. Despite remaining elevated at 449 μg/m3 (95% CI: 401, 496) in the control group, PM2.5 concentrations reduced to 104 μg/m3 (95% CI: 90,118) in the intervention group, indicating a statistically significant difference (t = 6.97, p < 0.001). All three statistical analyses delivered remarkably consistent results, estimating a PM2.5 reductions of 74% with the before-and-after approach, 76% when comparing groups, and 74% for difference in difference analysis. Beyond the overall reduction, homes with primary school completed women, larger kitchens, smaller family size, and those specifically baking Injera (the traditional energy-intensive staple food), witnessed even greater drops in PM2.5 levels.

CONCLUSION

Pregnant women in our study encountered dangerously high PM2.5 exposures in their kitchens. While the intervention achieved a significant PM2.5 reductions, unfortunately remained above the WHO's safe limit, highlighting the need for further interventions.

Addressing unforeseen public health risks via the use of sustainable system and process management

During the coronavirus disease 2019 (COVID-19) pandemic, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was designated by the World Health Organization in January 2020 as a newly emerging coronavirus in 2019, and its variants have placed unbearable strain on the healthcare systems of various countries, with serious implications for sustainable development worldwide. Researchers have proposed several solutions, such as the use of digital technologies to improve prevention systems. However, the challenges of epidemic prevention and control failures have not been addressed fundamentally, as the key causes of epidemic failures (i.e., outbreaks) and strategies for process management have been neglected. The purpose of the current study is to address these issues by exploring the causes of epidemic prevention and control failure and targeting improvement strategies that combine system structure of epidemic prevention and process management. Specifically, following an exploration of the main reasons for COVID-19 prevention and control failures through a case study of two tertiary hospitals, this paper outlines a targeted prevention and control system based on triangular validation and a loosely coupled process management framework and verifies the expected results using simulation methods together with statistical data on the spread of SARS-CoV-2 in Wuhan, China. The findings not only advance the development of epidemic risk prevention and control theory, especially the complementary nature of IT applications and process management in the field of epidemic risk prevention and control, but also provide guidance on the innovation and implementation of epidemic prevention and control systems and process management and recommendations for countries to promote sustainable development from a health-focused perspective.

Pregnant women's perception on the health effects of household air pollution in Rural Butajira, Ethiopia: a phenomenological qualitative study

BACKGROUND

Household air pollution is the major public health problem in developing countries. Pregnant women spent the majority of their time at home and are the most affected population by household air pollution. Exploring the perception of pregnant women on adverse health effects is important to enhance the mitigation strategies. Therefore, this study aim to explore the pregnant women's perceptions about health effects of household air pollution in rural Butajira, Ethiopia.

METHODS

A phenomenological qualitative study design was conducted among 15 selected pregnant women. All interviews were carried out at the participants´ house and audio-recorded while housing and cooking conditions were observed and appropriate notes were taken for each. The collected data were transcribed verbatim and translated into the English language. Then, the data were imported into Open code software to manage the overall data coding processes and analyzed thematically.

RESULTS

Study participants perceived that respiratory problems such as coughing, sneezing and asthma and eye problem were the major health problem caused by household air pollution among pregnant women. Study participants also mentioned asphyxiated, abortion, reduces weight, and hydrocephalus was caused by household air pollution on the foetus. Study participants perceived that financial inability, spouse negligence, autonomy and knowledge level of the women were the barriers to tackling household air pollution. Study participant also suggested that opening the door and window; using improved cookstove and reduce workload were the perceived solution for household air pollution.

CONCLUSIONS

This study explores pregnant women's perceptions on health effects of household air pollution. The finding of this study was important to deliver suitable intervention strategies to mitigate household air pollution. Therefore, educating the women on way of mitigating household air pollution, improving existing structure of the house and minimize the time to stay in the kitchen is important to mitigate household air pollution exposure.

Thermal performance of gasifier cooking stoves: A systematic literature review

A systematic literature review was conducted to summarize the overall thermal performance of different gasified cooking stoves from the available literature. For this purpose, available studies from the last 14 years (2008 to 2022) were searched using different search strings. After screening, a total of 28 articles were selected for this literature review. Scopus, Google Scholar, and Web of Science databases were used as search strings by applying "Gasifier cooking stove" AND "producer gas cooking stove" AND "thermal performance" keywords. This review uncovers different gasified cooking stoves, cooking fuels, and fabrication materials besides overall thermal performances. The result shows that the overall thermal performance of different gasified cooking stoves was 5.88% to 91% depending on the design and burning fuels. The premixed producer gas burner with a swirl vane stove provided the highest overall thermal performance range, which was 84% to 91%, and the updraft gasified stove provided the lowest performance, which was 5.88% to 8.79%. The result also demonstrates that the wood pellets cooking fuel provided the highest thermal performance and corn straw briquette fuel provided the lowest for gasified cooking stoves. The overall thermal performance of wood pellets was 38.5% and corn straw briquette was 10.86%.

Critical review on emerging health effects associated with the indoor air quality and its sustainable management

Indoor air quality (IAQ) is one of the fundamental elements affecting people's health and well-being. Currently, there is a lack of awareness among people about the quantification, identification, and possible health effects of IAQ. Airborne pollutants such as volatile organic compounds (VOCs), particulate matter (PM), sulfur dioxide (SO2), carbon monoxide (CO), nitrous oxide (NO), polycyclic aromatic hydrocarbons (PAHs) microbial spores, pollen, allergens, etc. primarily contribute to IAQ deterioration. This review discusses the sources of major indoor air pollutants, molecular toxicity mechanisms, and their effects on cardiovascular, ocular, neurological, women, and foetal health. Additionally, contemporary strategies and sustainable methods for regulating and reducing pollutant concentrations are emphasized, and current initiatives to address and enhance IAQ are explored, along with their unique advantages and potentials. Due to their longer exposure times and particular physical characteristics, women and children are more at risk for poor indoor air quality. By triggering many toxicity mechanisms, including oxidative stress, DNA methylation, epigenetic modifications, and gene activation, indoor air pollution can cause a range of health issues. Low birth weight, acute lower respiratory tract infections, Sick building syndromes (SBS), and early death are more prevalent in exposed residents. On the other hand, the main causes of incapacity and early mortality are lung cancer, chronic obstructive pulmonary disease, and cardiovascular disorders. It's crucial to acknowledge anticipated research needs and implemented efficient interventions and policies to lower health hazards.

Epidemiology and Outcomes of Cooking- and Cookstove-Related Burn Injuries: A World Health Organization Global Burn Registry Report

Cooking- and cookstove-related burns (CSBs) comprise a large proportion of burn injuries globally, but there are limited data on cooking behavior patterns to inform prevention and advocacy. Therefore, we aimed to describe the epidemiology, risk factors, and outcomes of these injuries and highlight the potential of the World Health Organization (WHO) Global Burn Registry (GBR). Patients with cooking-related burns were identified in the WHO GBR. Patient demographics, cooking arrangement, injury characteristics, and outcomes were described and compared. Bivariate regression was performed to identify risk factors associated with CSBs. Analysis demonstrated that 25% of patients in the GBR sustained cooking-related burns (n = 1723). The cooking environment and cooking fuels used varied significantly by country income level ([electricity use: LIC 1.6 vs MIC 5.9 vs HIC 49.6%; P < .001] [kerosene use: LIC 5.7 vs MIC 10.4 vs HIC 0.0%; P < .001]). Of cooking-related burns, 22% were cookstove-related burns (CSBs; 311 burns). Patients with CSBs were more often female (65% vs 53%; P < .001). CSBs were significantly larger in TBSA size (30%, IQR 15-45 vs 15%, IQR 10-25; P < .001), had higher revised Baux scores (70, IQR 46-95 vs 28, IQR 10-25; P < .001) and more often resulted in death (41 vs 11%; P < .001) than other cooking burns. Patients with CSBs were more likely to be burned by fires (OR 4.74; 95% CI 2.99-7.54) and explosions (OR 2.91, 95% CI 2.03-4.18) than other cooking injuries. Kerosene had the highest odds of CSB compared to other cooking fuels (OR 2.37, 95% CI 1.52-3.69). In conclusion, CSBs specifically have different epidemiology than cooking-related burns. CSBs were more likely caused by structural factors (eg, explosion, fire) than behavioral factors (eg, accidental movements) when compared to other cooking burns. These differences suggest prevention interventions for CSBs may require distinctive efforts than typically deployed for cooking-related injuries, and necessarily involve cookstove design and safety regulations to prevent fires and explosions.

Impact of smokeless cooking fuel use on health status of women in a rural setting of eastern India

The sustainable development goals (SDG 7.1) reinforce to ensure that everyone has access to affordable, safe and renewable energy. In India, women are typically responsible for cooking and are most vulnerable to household air contaminants. We conducted a descriptive cross-sectional comparative study in Odisha, India between exclusive LPG (liquefied petroleum gas) users and non-LPG users. A total of 900 women, 450 from each group, were randomly selected. The LPG-users had a better predictor of physical, psychological, social, and environmental wellbeing than non-LPG users. We found the ophthalmic disorders (adjusted odds ratio (AOR) 2.87, 95% CI 1.16-7.10, p = .023), asthma (AOR 2.05, 95% CI 1.15-3.65, p = .015), and ALRI (acute lower respiratory infections) (AOR 9.19, 95% CI 2.06-40.96, p < .004) were significantly higher in non-LPG users in comparison to LPG users. Access to smokeless cooking fuel will improve women's quality of life by eliminating the consumption of biofuel and thereby providing a healthier cooking environment.

Associations between cooking fuels and hypertension prevalence in Chinese adults: A prospective cohort analysis focusing on fuel transitioning

BACKGROUND

Using polluting cooking fuels is a suggested risk factor for hypertension. Transitioning to clean cooking fuels has occurred widely in China in the past 30 years. This provides an opportunity to examine whether the transition could reduce hypertension risk and to ascertain the inconsistent literature on the relationship between cooking fuels and hypertension prevalence.

METHODS

Initiated in 1989, the China Health and Nutrition Survey (CHNS) enrolled participants from 12 provinces in China. By 2015, nine waves of follow-up have been conducted. Based on self-reported cooking fuels, participants were classified into persistent clean fuel users, persistent polluting fuel users and those who transitioned from polluting fuels to clean fuels. Hypertension was defined as having systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or self-reported current use of antihypertension medication.

FINDINGS

Among 12,668 participants, 3963 (31.28%) were persistent polluting fuel users; 4299 (33.94%) transitioned to clean fuels; and 4406 (34.78%) were persistent clean fuel users. During the period of follow-up (7.8 ± 6.1 years), hypertension was diagnosed in 4428 participants. Compared to persistent clean fuel users, persistent polluting fuel users had a higher risk for hypertension (hazard ratio [HR] 1.69, 95%CI 1.55-1.85), while those transitioned to clean fuels did not. The effects were consistent by gender and urbanicity, respectively. The HRs for hypertension were 1.99 (95%CI 1.75-2.25), 1.55 (95%CI 1.32-1.81) and 1.36 (95%CI 1.13-1.65) among those persistent polluting fuel users aged 18-44, 45-59 and ≥60 years old, respectively.

INTERPRETATION

Transitioning from using polluting fuels to clean fuels prevented an increase in hypertension risk. The finding highlights the importance of promoting the fuel transition as a risk-reduction strategy for reducing the disease burden from hypertension.

Joint Effects of Indoor Air Pollution and Maternal Psychosocial Factors During Pregnancy on Trajectories of Early Childhood Psychopathology

Background

Prenatal indoor air pollution and maternal psychosocial factors have been associated with adverse psychopathology. We used environmental exposure mixture methodology to investigate joint effects of both exposure classes on child behavior trajectories.

Methods

For 360 children from the South African Drakenstein Child Health Study, we created trajectories of Child Behavior Checklist scores (24, 42, 60 months) using latent class linear mixed effects models. Indoor air pollutants and psychosocial factors were measured during pregnancy (2 nd trimester). After adjusting for confounding, single-exposure effects (per natural log-1 unit increase) were assessed using polytomous logistic regression models; joint effects using self-organizing maps (SOM), and principal component (PC) analysis.

Results

High externalizing trajectory was associated with increased particulate matter (PM 10 ) exposure (OR [95%-CI]: 1.25 [1.01,1.55]) and SOM exposure profile most associated with smoking (2.67 [1.14,6.27]). Medium internalizing trajectory was associated with increased emotional intimate partner violence (2.66 [1.17,5.57]), increasing trajectory with increased benzene (1.24 [1.02,1.51]) and toluene (1.21 [1.02,1.44]) and the PC most correlated with benzene and toluene (1.25 [1.02, 1.54]).

Conclusions

Prenatal exposure to environmental pollutants and psychosocial factors was associated with internalizing and externalizing child behavior trajectories. Understanding joint effects of adverse exposure mixtures will facilitate targeted interventions to prevent childhood psychopathology.

A systematic review on mitigation of common indoor air pollutants using plant-based methods: a phytoremediation approach

Environmental pollution, especially indoor air pollution, has become a global issue and affects nearly all domains of life. Being both natural and anthropogenic substances, indoor air pollutants lead to the deterioration of the ecosystem and have a negative impact on human health. Cost-effective plant-based approaches can help to improve indoor air quality (IAQ), regulate temperature, and protect humans from potential health risks. Thus, in this review, we have highlighted the common indoor air pollutants and their mitigation through plant-based approaches. Potted plants, green walls, and their combination with bio-filtration are such emerging approaches that can efficiently purify the indoor air. Moreover, we have discussed the pathways or mechanisms of phytoremediation, which involve the aerial parts of the plants (phyllosphere), growth media, and roots along with their associated microorganisms (rhizosphere). In conclusion, plants and their associated microbial communities can be key solutions for reducing indoor air pollution. However, there is a dire need to explore advanced omics technologies to get in-depth knowledge of the molecular mechanisms associated with plant-based reduction of indoor air pollutants.

Does labor transfer affect rural household cooking fuel choice? Examining the role of income

It's the direction of all humankind's joint efforts to develop clean cooking fuels and reduce carbon emissions vigorously. While most studies found that householder and family characteristics influence household cooking fuel choice, few studies focus on the relationship between labor transfer and the choice of clean cooking fuels. Based on the three-phase survey data of the China Labor-Force Dynamic Survey in 2012, 2014, and 2016, this paper analyzes the influence of labor transfer on rural households' cooking fuel choice. It focuses on the mediating role of income and the heterogeneity of labor transfer on household cooking fuel choice under different educational levels and location conditions. The results show that (1) from 2012 to 2016, there are regional differences in the development of clean cooking fuels; (2) labor transfer can promote households to choose clean cooking fuels, and this result remains robust after controlling for endogeneity; (3) labor transfer indirectly influences household cooking fuel choice through affecting family income; and (4) the impact of labor transfer on household cooking fuel choice varies with different education levels and location conditions. Therefore, analyzing the optimization of rural cooking energy structure from the perspective of labor transfer plays an important role in ensuring the sustainable development of clean cooking fuels in rural areas.

Between Policy and Risk Communication: Coverage of Air Pollution in Ghanaian Newspapers

Mass media plays an increasingly persuasive role in orienting political decisions, shaping social agendas, influencing individuals' actions, and interpreting scientific evidence for the public. With growing scientific understanding of the health, social and environmental consequences of air pollution, there is an urgent need to understand how media coverage frames these links, particularly in Low- and Middle-Income Countries. This paper examines how the Ghanaian print and electronic media houses are covering air pollution issues given increased efforts at reducing air pollution within the country. The main goal of this work is to track the progress of policies to reduce air pollution. We used a qualitative content analysis of selected newspapers (both traditional and online) between the periods 2016 and 2021 and we found that articles on air pollution have been increasing, with more reportage on impact and policy issues compared to causes of air pollution. A focus group with six members of the media confirmed an interest in covering health and environmental issues, particularly coverage of specific diseases and human-interest pieces. This increasing attention is likely associated with intensifying local, national, and international action to improve air quality in Ghana, and growing awareness of the health impacts of air pollution.

Risk of functional disability associated with solid fuel use and population impact of reducing indoor air pollution in China: A national cohort study

Background

In China, numerous people still rely on solid fuel for household use. To date, the association between household solid fuel use and functional disability, and what benefit reducing household solid fuel usage could bring at the population level to China remain unclear.

Method

Data were from the China Health and Retirement Longitudinal Study. Household fuel was classified as clean or solid for cooking or heating. Functional disability was defined as difficulties in any item of activities of daily living (ADL) or instrumental activities of daily living (IADL). The associations of household fuel use in 2011 and its transitions between 2011 and 2013 with subsequent ADL or IADL disability were assessed with Cox proportional-hazards models. The number of events prevented in a population (NEPP) was generated to estimate how many functionally disabled patients could be prevented by reducing solid fuel usage.

Results

A total of 6,216 and 9,716 participants without prior ADL or IADL disability in 2011 were included. Solid (vs. clean) fuel users were more likely to develop ADL and IADL disability, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.37 (1.28~1.45) and 1.38 (1.31~1.46) for using both solid cooking and heating fuel. Furthermore, participants that switched heating fuel from solid to clean (vs. keep solid) were about 20% less likely to develop functional disability. Cooking fuel use switching from solid to clean (vs. keep solid) was also negatively associated with IADL disability (HR = 0.84, 95% CI 0.74~0.96). Over the next 7 years, raising clean fuel usage to 80% could prevent about 4.9 million ADL disability and 2.6 million IADL disability among Chinese aged 45 and older.

Conclusion

Household solid fuel use was a risk factor for functional disability. Reducing solid fuel usage could help reduce the burden of functional disability in the current aging society of China.

Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18: a geospatial modelling study

BACKGROUND

More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.

METHODS

We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution.

FINDINGS

Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000-257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution.

INTERPRETATION

Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution.

FUNDING

Bill & Melinda Gates Foundation.

Impact of prenatal maternal psychological distress on fetal biometric parameters in household air pollution-exposed Nigerian women

Rationale

Studies identify prenatal household air pollution (HAP) exposure and maternal psychological distress (PMPD) as independent factors contributing to gestational ill-health and adverse birth outcomes.

Objective

We investigated the impact of PMPD on fetal biometric parameters (FBP) in HAP-exposed pregnant Nigerian women.

Methods

The randomized controlled trial (RCT; ClinicalTrials.gov NCT02394574) investigated effects of HAP exposure in pregnant Nigerian women (n = 324), who customarily cooked with polluting fuels (firewood or kerosene). Half of the women (intervention group) were given CleanCook ethanol stoves to use for 156 days during the study. Once a month, all women were administered an abridged version of the SF-12v2TM health-related quality of life questionnaire to assess psychological distress. Using mixed effects linear regression models, adjusted for relevant covariates, we analyzed associations between the women’s exposure to PM2·5 (particulate matter with an aerodynamic diameter<2·5 microns) from HAP, their PMPD scores, and FBP (ultrasound estimated fetal weight [UEFW], head circumference [HC], abdominal circumference [AC], femur length [FL], biparietal diameter [BPD], estimated gestational age [GA] and intrauterine growth restriction [IUGR]), and birth anthropometric measures (birth weight [BW] and birth length [BL]).

Results

PMPD negatively impacted UEFW, HC, FL, BPD and BL (p<0·05). Controls (kerosene/firewood users) experienced significantly higher PMPD compared with ethanol-stove users (p<0·05). The mediation analysis revealed that the proportion of the outcome (fetal biometrics, birth anthropometrics, IUGR and GA), which can be explained via PMPD by groups (intervention vs. control) after adjusting for confounding variables was 6·2% (0·062). No significant correlation was observed between levels of PM2.5 exposure and PMPD scores.

Conclusions

PMPD was an independent mediator of adverse fetal biometric parameters in pregnant women, who were exposed to HAP from burning of firewood/kerosene. Formulating preventative measures to alleviate maternal distress during pregnancy and reducing exposure to HAP is important from public health perspectives.

A New Perspective on Cooking Stove Loss Coefficient Assessment by Means of the Second Law Analysis

The chimney effect taking place in biomass cooking stoves results from a conversion process between thermal and mechanical energy. The efficiency of this conversion is assessed with the stove loss coefficient. The derivation of this quantity in cooking stove modelling is still uncertain. Following fluid mechanics, this loss coefficient refers to an overall pressure drop through stove geometry by performing an energy balance according to the first law of thermodynamics. From this approach, heat-transfer processes are quite ignored yet they are important sources of irreversibilities. The present work takes a fresh look at stove loss coefficient assessment relying on the second law of thermodynamics. The purpose in this paper is to identify the influence of operating firepower level on flow dynamics in biomass natural convection-driven cooking stoves. To achieve that, a simplified analytical model of the entropy-generation rate in the flow field is developed. To validate the model, experiments are conducted first on a woodburning stove without cooking pot to better isolate physical processes governing the intrinsic behaviour of the stove. Then, for the practical case of a stove operating with a cooking pot in place, data from published literature have served for validation. In particular, mass-flow rate and flue gas temperature at different firepower levels have been monitored. It turns out that losses due to viscous dissipations are negligible compared to the global process dissipation. Exergy analysis reveals that the loss coefficient should rather be regarded from now as the availability to generate flow work primarily associated with the heat-transfer Carnot factor. In addition, the energy flux applied as flow work has to be considered as pure exergy that is lost through consecutive energy-transfer components comprising the convective heat transfer to the cooking pot. Finally, this paper reports a satisfactory agreement that emerged between the exergy Carnot factor and the experimental loss coefficient at different fuel-burning rates.

Understanding burn injuries in children-A step toward prevention and prompt first aid

This study was designed to examine knowledge, attitude and practices with regards to burns prevention and first aid in the Indian community. A total of 83 caregivers aged 19 and 40 years (mean 29 years) participated in survey. Sixty-one percent of those who responded to the survey had some knowledge of first aid, mostly through health education at schools (59%). Very few (2%) received first aid education from health workers. Approximately 2/3 of responders (66-70%) were aware of applying cool running water to a burn and to stop drop and roll in case of a flame burn. However, the same number also listed a myriad of household remedies that they would use as first aid. 66-71% responders were aware of some situational risks in the home and community but only 27% considered young children to be at greater risk. 31% responders had an enclosed kitchen and 16% were still cooking on the floor. A large percentage (83%) cooked outside on a traditional wooden open fire. A quarter of the responders still used oil lamps on the floor and had little regard for the flammability of clothes. There was a weak positive correlation between knowledge and attitude (r-square 0.379) and attitude and practice (r-square 0.373), but no correlation between knowledge and practice (r-square 0.089). Our survey suggests that many responders have limited knowledge of effective first-aid techniques and live in high-risk environments. The major sources of first aid information were from school-based health education, social and electronic media. These resources can be utilized to further disseminate knowledge on first aid and practical prevention techniques.

Protocol for a cluster randomised controlled trial of LPG cookstoves compared to usual cooking practices to reduce perinatal mortality and morbidity in rural Bangladesh called Poriborton: the CHANge trial

Background

Household air pollution is a leading health risk for global morbidity and mortality and a major health risk in South Asia. However, there are no prospective investigations of the impact of household air pollution on perinatal morbidity and mortality. Our trial aims to assess the impact of liquefied petroleum gas (LPG) for cooking to reduce household air pollution exposure on perinatal morbidity and mortality compared to usual cooking practices in Bangladesh.

Hypothesis

In a community-based cluster randomised controlled trial of pregnant women cooking with LPG throughout pregnancy, perinatal mortality will be reduced by 35% compared with usual cooking practices in a rural community in Bangladesh.

Methods

A two-arm community-based cluster randomised controlled trial will be conducted in the Sherpur district, Bangladesh. In the intervention arm, pregnant women receive an LPG cookstove and LPG in cylinders supplied throughout pregnancy until birth. In the control or usual practice arm, pregnant women continue their usual cooking practices, predominately traditional stoves with biomass fuel. Eligible women are pregnant women with a gestational age of 40–120 days, aged between 15 and 49 years, and permanent residents of the study area. The primary outcome is the difference in perinatal mortality between the LPG arm and the usual cooking arm. Secondary outcomes include (i) preterm birth and low birth weight, (ii) personal level exposure to household air pollution, (iii) satisfaction and acceptability of the LPG stove and stove use, and (iv) cost-effectiveness and cost-utility in reducing perinatal morbidity and mortality. We follow up all women and infants to 45 days after the birth. Personal exposure to household air pollution is assessed at three-time points in a sub-sample of the study population using the MicroPEM™. The total required sample size is 4944 pregnant women.

Discussion

This trial will produce evidence of the effectiveness of reduced exposure to household air pollution through LPG cooking to reduce perinatal morbidity and mortality compared to usual cooking practices. This evidence will inform policies for the adoption of clean fuel in Bangladesh and other similar settings.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12618001214224. Prospectively registered on 19 July 2019

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06146-7.

Indoor solid fuel use and renal function among middle-aged and older adults: A national study in rural China

Solid fuel use is the main source of indoor air pollution, especially in rural areas of developing countries. Nevertheless, the evidence linking indoor solid fuel use and renal function is very limited. Therefore, we investigated the association between indoor solid fuel use and renal function among middle-aged and older adults in rural China. Cystatin C (CysC) concentration of each participant was used to calculate the estimated glomerular filtration rate (eGFR). We used the baseline data to investigate the associations between solid fuel use for cooking and heating and eGFR through a linear-mixed effects model. Then, we applied the generalized linear-mixed effects model with binary distribution to examine the relationship between renal function decline and cooking fuel switching from 2011 to 2015. A total of 4959 participants were included at baseline, and 3536 participants were included in the follow-up analysis. Compared to participants who used clean fuel for both cooking and heating, the eGFR was significantly lower among participants who cooked with solid fuel and heated with clean fuel (β: -2.81; 95% CI: -5.53, -0.09). In the follow-up analysis, the risks of renal function decline for participants using solid fuel for cooking were significantly higher in males (OR: 2.74; 95% CI: 1.68, 4.49), smokers (OR: 5.70; 95% CI: 2.82, 11.55), and drinkers (OR: 7.11; 95% CI: 3.15, 16.02) compared to females, non-smokers, and non-drinkers. Moreover, 45-65 years aged participants (OR: 0.54; 95% CI: 0.33, 0.89) and non-drinkers (OR: 0.61; 95% CI: 0.41, 0.92) who switched from solid to clean cooking fuel had a lower risk of renal function decline. In conclusion, our findings show that household solid fuel use is likely to be an important risk factor for renal function decline in rural China. And switching to cleaner fuel may provide significant public health benefits.

Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data

In utero exposure to household air pollution (HAP) from polluting cooking fuels has been linked to adverse pregnancy outcomes including low birthweight (LBW). No previous study in Uganda has attempted to investigate the association between the different types of biomass cooking fuels and LBW. This study was conducted to investigate the association between wood and other biomass cooking fuel use with increased risk of LBW, using the 2016 Uganda Demographic and Health Survey for 15,270 live births within five years prior to interview. LBW, defined as birthweight of <2500 g, was estimated from maternal recall and health cards. Association between household exposure to the different solid biomass cooking fuels and LBW was determined using multivariable logistic regression. Biomass cooking fuels were used in 99.6% of the households, with few (0.3%) using cleaner fuels and 0.1% with no cooking, while the prevalence of LBW was 9.6% of all live-births. Although the crude analysis suggested an association between wood fuel use and LBW compared to other biomass and kerosene fuel use (AOR: 0.82; 95% CI: 0.67−1.00), after adjusting for socio-demographic and obstetric factors, no association was observed (AOR: 0.94; 95% CI: 0.72−1.22). LBW was significantly more likely among female neonates (AOR: 1.32 (95% CI: 1.13−1.55) and neonates born to mothers living in larger households (AOR: 1.03; 95% CI: 1.00−1.07). LBW was significantly less likely among neonates delivered at term (AOR: 0.39; 95% CI: 0.31−0.49), born to women with secondary or tertiary level of education (AOR: 0.80; 95% CI: 0.64−1.00), living in households with a higher wealth index (AOR: 0.69; 95% CI: 0.50−0.96), Eastern (AOR: 0.76; 95% CI:0.59−0.98) and Northern (AOR: 0.75; 95% CI: 0.57−0.99) regions. The study findings suggest inconclusive evidence regarding the association between the use of wood compared to other biomass and kerosene cooking fuels and risk of LBW. Given the close observed association between socioeconomic status and LBW, the Ugandan government should prioritize public health actions which support female education and broader sustainable development to improve household living standards in this setting.

Adverse birth outcomes associated with household air pollution from unclean cooking fuels in low- and middle-income countries: A systematic review

Approximately 3.8 billion people in low- and middle-income countries use unclean fuels as a source of primary cooking fuel as well as for heating. For pregnant women, the toxic chemicals produced by combustion of unclean fuels not only affect women's health directly, but particulate matter and carbon monoxide are absorbed in maternal blood and cross the placental barrier impairing fetal tissue growth. PRISMA 2009 guidelines were used for this systematic review. The inclusion criteria were quantitative, peer reviewed journal articles published within a date range of May 1, 2013-June 12, 2021 examining birth outcomes related to household air pollution from type of cooking fuel in low- and middle-income countries. The quality of available evidence was evaluated using the Office of Health Assessment and Translation (OHAT) risk of bias rating tool. Of the 553 studies screened, 23 satisfied the inclusion criteria. Of the studies that met the inclusion criteria, 14 were cross-sectional, 5 cohort, 1 case-control and 3 randomized control trials conducted across 15 different countries. A range of birth outcomes are reported across studies including birthweight (19), small for gestational age (6), spontaneous abortion (3), preterm birth (6), stillbirth (7) and neonatal mortality (6). The reviewed studies presented evidence for an increased risk of low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), stillbirth, neonatal mortality and reduction in birthweight with solid fuel and kerosene use compared to cleaner fuels like gas and LPG. Systematically reviewing the evidence and risk of bias ratings illuminated several gaps in the current literature related to exposure assessment, outcome measurement and adequacy of adjustment for confounding.

The association between biomass fuel use for cooking and linear growth in young children in Bhaktapur, Nepal

BACKGROUND

There are still many people in the world who prepare their meals on open fires or stoves using solid fuels from biomass, especially in low-and middle-income countries. Although biomass cooking fuels have been associated with adverse health impacts and diseases, the association with child linear growth remains unclear.

OBJECTIVES

In a cohort design, we aimed to describe the association between the use of biomass cooking fuels and linear growth in children aged 18-23 months living in the urban and peri-urban community of Bhaktapur, situated in the Kathmandu valley in Nepal.

METHODS

Caretakers of 600 marginally stunted children aged 6-11 months were interviewed about their source of cooking fuel and other socio-demographic characteristics at enrolment into a randomized controlled trial. Children's body length was measured when children were 18-23 months old. In linear regression models, we estimated the association between the use of biomass fuel and length-for-age Z-scores (LAZ), adjusted for relevant confounders. We repeated these analyses in pre-defined sub-groups and different percentiles of LAZ using quantile regression models.

RESULTS

Among study participants, 101 (18%) used biomass as cooking fuel. The association between biomass fuel and LAZ was not statistically significant in the full sample (adjusted regression coefficient: -0.14, 95% CI: -0.28, 0.00). The association was stronger in some of the sub-groups and in the lower tail of the LAZ distribution (those who are stunted), but neither reached statistical significance.

DISCUSSION

Children from households in poor, urban neighborhoods in Nepal which used biomass fuel for cooking were on average slightly shorter than other children, although the association only approached statistical significance. As this was an observational study, residual confounding cannot be excluded. Further studies are needed to confirm these associations, in particular those seen in certain sub-groups.

Vitamin D intake modifies the association of household air pollution exposure with maternal disorders of pregnancy

To date, only three studies have investigated the association of household air pollution (HAP) exposure with pregnancy disorders. The ameliorating role of diet and nutrition in the association has never been explored. We conducted a cross-sectional study among 799 mothers who had recently given singleton birth in the Cape Coast Metropolis, Ghana. Structured questionnaire and semi-quantitative food frequency questionnaire were used to assess HAP exposure (from use of biomass fuels for cooking and garbage burning at home) and vitamin D (vitD) intake, respectively. Multivariable binary logistic regression was used to investigate the association between HAP exposure and pregnancy disorders. HAP exposure due to cooking with biomass fuels and garbage burning at home was associated with two fold (AOR = 2.15; 95% confidence interval [CI]: 1.05, 4.43) and six fold (AOR = 6.35; 95% CI: 2.43, 16.58) increased odds of hypertensive disorders of pregnancy (HDP). For gestational diabetes (GDM), the increased odds were two folds for both exposures but the 95% CI included the null value. Stove stacking was also associated with two folds increased odds of GDM (AOR = 1.83; 95% CI: 0.91, 3.68). In stratified analysis, the odds of HDP and GDM associated with biomass fuels use decreased with increasing vitD intake. All the interaction p values were, however, greater than 0.05. We provide the first evidence on the ameliorating role of vitD intake on the effect of HAP exposure on pregnancy disorders. In LMICs where solid fuel use and garbage burning at home is widespread, health workers should advise mothers during antenatal care visits to increase intake of vitamin D rich foods.

Association between indoor air pollution and cognitive function among nationally representative sample of middle-aged and older adults in India-A multilevel modelling approach

We have used a nationally representative sample of middle-aged and older adults in India to study the association between indoor air pollution and cognitive function. Longitudinal aging study in India (LASI) Wave-I data was utilized for this study. A two-level mixed-effects linear regression model was used to study the association between indoor air pollution and cognitive function and interpreted as adjusted beta coefficient (ꞵ) with 95% confidence interval (CI). In total, 56,179 participants aged ≥45 years were included in the analysis. The proportion of participants living in households with indoor air pollution were 30.6% (95%CI: 30.0%-31.3%). After adjusting for all the potential confounders (age, gender, education, region, religion, separate kitchen, socioeconomic status, marital status, residence, smoking, alcohol consumption, body mass index, self-rated health, and sleep problems), participants living in households with indoor air pollution had significant decline in the cognitive function when compared to those living in households without indoor air pollution (ꞵ = -0.57; 95%CI: -0.69 to -0.45). Since the LASI survey is being conducted as a biennial panel survey, assessing the impact of indoor air pollution on cognitive decline using the follow-up data can provide further insights into the pathogenesis of condition.

Genotoxic effect of microplastics and COVID-19: The hidden threat

Microplastics (MPs) are ubiquitous anthropogenic contaminants, and their abundance in the entire ecosystem raises the question of how far is the impact of these MPs on the biota, humans, and the environment. Recent research has overemphasized the occurrence, characterization, and direct toxicity of MPs; however, determining and understanding their genotoxic effect is still limited. Thus, the present review addresses the genotoxic potential of these emerging contaminants in aquatic organisms and in human peripheral lymphocytes and identified the research gaps in this area. Several genotoxic endpoints were implicated, including the frequency of micronuclei (MN), nucleoplasmic bridge (NPB), nuclear buds (NBUD), DNA strand breaks, and the percentage of DNA in the tail (%Tail DNA). In addition, the mechanism of MPs-induced genotoxicity seems to be closely associated with reactive oxygen species (ROS) production, inflammatory responses, and DNA repair interference. However, the gathered information urges the need for more studies that present environmentally relevant conditions. Taken into consideration, the lifestyle changes within the COVID-19 pandemic, we discussed the impact of the pandemic on enhancing the genotoxic potential of MPs whether through increasing human exposure to MPs via inappropriate disposal and overconsumption of plastic-based products or by disrupting the defense system owing to unhealthy food and sleep deprivation as well as stress. Overall, this review provided a reference for the genotoxic effect of MPs, their mechanism of action, as well as the contribution of COVID-19 to increase the genotoxic risk of MPs.

Air Quality in Africa: Public Health Implications

This review highlights the importance of air quality in the African urban development process. We address connections between air pollution and (a) rapid urbanization, (b) social problems, (c) health impacts, (d) climate change, (e) policies, and (f) new innovations. We acknowledge that air pollution levels in Africa can be extremely high and a serious health threat. The toxic content of the pollution could relate to region-specific sources such as low standards for vehicles and fuels, cooking with solid fuels, and burning household waste. We implore the pursuit of interdisciplinary research to create new approaches with relevant stakeholders. Moreover, successful air pollution research must regard conflicts, tensions, and synergies inherent to development processes in African municipalities, regions, and countries. This includes global relationships regarding climate change, trade, urban planning, and transportation. Incorporating aspects of local political situations (e.g., democracy) can also enhance greater political accountability and awareness about air pollution.

Association of heating fuel types with mortality and cardiovascular events among non-smokers in China

Only a few prospective studies have investigated the relationship between solid fuel use and cardiovascular disease (CVD) and mortality, and they have reported inconsistent conclusions. This study aimed to investigate the effect of solid fuel heating on the risk of CVD events and all-cause mortality among non-smokers. Data of this sub-study were obtained from the China Hypertension Survey (CHS), and 13,528 non-smoking participants aged 35 or above without self-reported medical history of CVD were enrolled between October 2012 and December 2015. CVD events and all-cause mortality were followed up in 2018 and 2019. The type of primary heating fuel was categorized as clean fuel (natural gas and electricity) and solid fuel (coal, wood, and straw). Cox regression was applied to evaluate the relationship between solid fuel use and CVD events and all-cause mortality. Of the 13,528 non-smoking participants, the mean age was 55.4 ± 13.1 years. During the median follow-up of 4.93 years, 424 participants developed fatal or nonfatal CVD (stroke, 273; coronary heart disease, 119; and other cardiovascular events, 32) and 288 died from all causes. The cumulative incidence of fatal and nonfatal CVD and all-cause mortality were 6.78 and 4.62 per 1000 person-years, respectively. Solid fuel heating was independently associated with an increased risk of fatal or nonfatal stroke and all-cause mortality compared with the use of clean fuels, the fully adjusted hazard ratios (HRs), and 95% confidence intervals (CI) were 1.44 (1.00-2.08) and 1.55 (1.10-2.17), respectively. The relationship between solid fuel heating and fatal and nonfatal CVD events was non-significant (HR = 1.19; 95% CI: 0.89-1.59). Solid fuel heating is longitudinally associated with a higher risk of stroke and all-cause mortality in non-smoking Chinese. Switching to cleaner energy sources for heating may be important for reducing the risk of CVD and mortality.

Housing and Health: Here We Go Again

Housing is one of the major determinants of human health and the current COVID-19 pandemic has highlighted its relevance. The authors summarize the main issues, including dimensional standards, indoor air quality, safety, accessibility, neighborhoods, and area characteristics. The authors propose an operating scheme in order to implement actions to improve residential wellbeing on a local, national, and international level.

A cross sectional study to assess tobacco use and its correlates among patients attending non-communicable disease clinics of a Northern Jurisdiction in India

Background:

Non-Communicable Diseases (NCDs) continue to rise unabated globally and the existing evidence has unequivocally established the relationship between tobacco use and NCDs. In 2010 the Government of India (GOI) introduced NCD clinics under the National Program for Prevention and Control of Cancer, Diabetes, Cardio Vascular Diseases and Stroke (NPCDCS) with the purpose of preventing and combating the NCD epidemic. This study was undertaken with an objective to comprehensively determine tobacco use and its correlates among patients attending these NCD clinics.

Methods:

A descriptive cross-sectional study was carried out among 1172 patients attending NCD clinics at district level, in Punjab, India between May to October 2018. Using systematic sampling every fourth patient was interviewed and equal numbers of visits were made to both the clinics.

Results:

Overall, the current tobacco use in any form was reported to be 10.2% among the study respondents. Majority of the tobacco users were males (23.3%), in 40–49 year age group, (18.7%), residing in urban area (15%), educated up to secondary school (18%) and non-government occupation bracket (27.4%) and hypertension disease category (41.6%). More SLT users had thought of quitting in past in comparison to smokers (46.6% vs 40%) and had higher quit attempts in past (42.5% vs 38.3%). In the binary logistic regression analysis, odds of tobacco use increased with increasing age, three times higher among participants who were employed (OR 3.75; CI 1.41-10.02),6 times higher in COPD disease category (OR 6.88; CI 2.1-20.59).

Conclusion:

Higher tobacco use among the NCD clinic attendees with increasing age predisposes them to develop grave complications. This calls for the need to administer intensive behaviour change interventions for tobacco cessation at the existing NCD clinics. This could further strengthen existing health systems and thereby improving health outcomes followed by achieving Sustainable Development Goals.

Impacts of firewood burning for cooking on respiratory health and healthcare utilisation: Empirical evidence from Sri Lankan micro-data

Despite escalating income levels of Sri Lankan households, 70.3% of them still depend on firewood for cooking. This might lead to bad respiratory health and thereby, increased healthcare utilisation. With this backdrop, this paper examines how firewood burning for cooking influences respiratory health and healthcare utilisation of Sri Lankans. The study proposes a theoretical model to explain effects of firewood burning on respiratory health and healthcare utilisation and empirically tests it using nation-wide micro-data of 79,170 individuals belonging to 21,748 households. The data are drawn from the most recent wave of Sri Lankan household income and expenditure survey. After addressing potential endogeneity by applying instrumental variable regression models, the study finds that firewood burning increases households' probability of asthma prevalence by 10.9 percentage points (P < 0.001), out-patient care utilisation by 33.1 percentage points (P < 0.001), and in-patient care utilisation by 17.5 percentage points (P < 0.001), on average. Our individual level analysis demonstrates that females are more vulnerable to bad respiratory health induced by firewood burning (β = 0.055, P < 0.001) compared to males (β = 0.008, P > 0.1). The results imply policies on promoting improved-cooking stoves, separated-kitchen designs, and switching more towards cleaner energy sources, including LP gas and solar power.

The association of cooking fuels with cataract among adults aged 50 years and older in low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE)

Reducing household air pollution and protecting eye health are essential to achieve the Sustainable Development Goals (SDGs). There is contradictory evidence about the association between cooking fuels and cataract among adults aged 50 years and older. WHO Study on global AGEing and adult health (SAGE) was conducted in six low- and middle-income countries (LMICs). We used propensity-score method (inverse probability of weighting) and logistic regression to examine the association between cooking fuels and self-reported cataract. Odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated. Overall, use of unclean fuels was associated with an adjusted OR of cataract of 1.42 (95%CIs, 1.29-1.56). In subgroup analysis, unclean cooking fuels increased 1.71 (95%CI, 1.46-2.01) and 1.53 (95%CI, 1.30-1.79) times the risk of cataract in India and China, respectively, whereas no association was found in other countries. In gender-stratified analyses, unclean fuel use was associated with a 1.27 (95%CI, 1.13-1.44) times risk for males and 1.67 (95%CI, 1.44-1.94) times risk for females. Higher cataract risk attributed to unclean fuels was observed among those aged over 60 (1.45; 95%CI, 1.28-1.64) than people aged under 60 (1.39; 95%CI, 1.20-1.62). OR was higher in rural area (1.74; 95%CI, 1.51-2.00) than urban area (1.24; 95%CI, 1.09-1.41). Our results indicate that unclean fuels may be associated with self-reported cataract, but it varied among different LMICs. Higher risk was found in females, people older than 60 years old and those who live in rural areas. The result of this study provides useful information to support transition to clean household energy and eye health promotion in LMICs. Greater efforts should be taken to protect vulnerable populations.

Time to be nosy: Evaluating the impact of environmental and sociocultural changes on maxillary sinusitis in the Middle Nile Valley (Neolithic to Medieval periods)

OBJECTIVE

To investigate the prevalence of maxillary sinusitis in people who lived in the Middle Nile Valley across different periods, cultures, and environmental conditions.

MATERIALS

481 skeletons from 13 sites, curated at the British Museum, London, were analysed. The sites ranged in date from the Neolithic to Medieval periods (c. 4900 BCE-CE 1500).

METHODS

Bony changes within the maxillary sinuses, associated with sinusitis and oroantral fistulae were systematically recorded according to pre-established criteria.

RESULTS

There were significant differences in the prevalence of maxillary sinusitis between time period/subsistence economy groups. The Neolithic hunter-gatherer/early agricultural group had the lowest prevalence, whilst the urban group demonstrated the highest frequency of the disease.

CONCLUSIONS

Factors involved in the development of maxillary sinusitis are manifold and complex. However, the results indicate that increased aridity in Sudan in later periods and intensification of agricultural practices may have played a role in increasing prevalence of the disease. Urban environments, including crowding, poor sanitation, and industrial air pollution, could also have influenced susceptibility to maxillary sinusitis.

SIGNIFICANCE

Prior to this paper, the impact of arid environments on respiratory health in the past had received little attention despite growing clinical research on the topic. Both arid and urban environments are predicted to expand in the future. This paper provides a deep-time perspective on an issue of increasing concern today.

LIMITATIONS

Poor preservation of skeletons and a lack of archaeological settlement data for some sites.

FUTURE RESEARCH

Investigation of a greater range of populations from different environments/climates.

Prospective Cohort Study on the Effect of an Intervention to Reduce Household Air Pollution Among Sudanese Women and Children

BACKGROUND

Exposure to household air pollution through the burning of biomass fuels is a global health concern and can lead to negative health outcomes such as asthma and lung disease.

OBJECTIVES

The goal of this four-year study was to determine whether an intervention to reduce household air pollution (HAP) which included health education and a new well-ventilated cooking location would reduce exposure to HAP, lower carbon monoxide (CO) levels and improve the health of women and children in Port Sudan, Sudan.

METHODS

In 2016, 115 women of low socioeconomic status and their children were invited to participate in the study at two women's centers. One hundred and eleven women consented to participate and were divided into study and control groups on the basis of home ownership. Women who owned their homes learned about the adverse effects of HAP and a well-ventilated outside cooking location (rakoobah) was provided. Control women did not receive HAP education or a rakoobah. Questionnaires were used to assess the effect of education and a new well-ventilated cooking location for a group of Sudanese women who cook with biomass fuels. CO-oximetry was performed. Each year from 2017-2019, the questionnaires and CO-oximetry were repeated.

RESULTS

Sixty-five women and 33 children were assigned to the study group and 46 women and 19 children were assigned to the control group in 2016. Women were enrolled in 2016 with CO levels of 17.8% and 17.4%, respectively. One year later some of the study group women had lower CO levels and others higher, while the CO levels of the controls were stable. An intensive HAP education program was started for the study group women. By 2019, the last study year, the CO levels of both the study and control group women had dropped to normal levels of 2.9% and 3.1%, respectively. Control group women may have benefited from the HAP education and modeled behavior of those in the study group.

CONCLUSIONS

The health impact of the change in cooking location was unclear, yet both groups reported fewer health care visits in 2019. Education and an outside cooking location resulted in lower CO levels of Sudanese women and children.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

The study was approved by the Penn State Milton S. Hershey Medical Center Institutional Review Board and the Ethics Committee of the Red Sea University Faculty of Medicine located in Port Sudan, Sudan.

COMPETING INTERESTS

The authors declare no competing financial interests.

The Adverse Impact of Air Pollution on China’s Economic Growth

This study empirically evaluates the impact of air pollution on China’s economic growth, based on a province-level sample for the period 2002–2017. Air pollution is measured by the concentration of fine particulate matter (PM2.5), and economic growth is measured by the annual growth rate of gross domestic product (GDP) per capita. A panel data fixed-effects regression model is built, and the instrumental variables estimation method is utilized for quantitative analyses. The study reports a significant negative impact of air pollution on the macroeconomic growth of China. According to our instrumental variables estimation, holding other factors constant, if the concentration of PM2.5 increases by 1%, then the GDP per capita growth rate will decline by 0.05818 percentage points. In addition, it is found that the adverse effect of atmospheric pollution is heterogeneous across different regions. The effect is stronger in the eastern region and in provinces with smaller state-owned enterprise shares, fewer governmental expenditures for public health services, and fewer medical resources. The study results reveal that air pollution poses a substantial threat to the sustainable economic growth of China. Taking actions to abate air pollution will generate great economic benefits, especially for those regions which are heavily damaged by pollution.

Global Crises: Gendered Vulnerabilities of Structural Inequality, Environmental Performance, and Modern Slavery

Climate change and modern slavery are two of the most significant human rights crises of our time. Women and children are disproportionately vulnerable to such crises, which are intensified under inequitable social conditions and driven by structural barriers to female equality. No research has yet looked at the complex relationship between climate crisis, structural gender inequality, human insecurity, and vulnerability to modern slavery. Our research examined the relationship between environmental stressors associated with climate change, selected structural inequalities, and the estimated prevalence of modern slavery cases across 180 countries. Regression analysis revealed significant results. These findings suggest that indicators of poor environmental health may exacerbate structural social inequalities and increase women’s risk of falling victim to modern slavery. Results showed that women’s share of seats in parliament, education for women, tree cover loss, agricultural management, and air quality assumed more substantial roles in this prediction. Awareness of the unique relationship between environmental indicators of climate change, gender inequality, and modern slavery provides a meaningful contribution to our understanding of factors driving human exploitation. Additionally, we propose a gender analysis of environmental stressors to address both the climate crisis and structural inequalities that increases female vulnerability to insecurity.

Household Smoke-Exposure Risks Associated with Cooking Fuels and Cooking Places in Tanzania: A Cross-Sectional Analysis of Demographic and Health Survey Data

Household smoke-exposure risk (SER) can be defined through the assessment of cooking fuels (smoke and no smoke-producing) and cooking places (indoor and outdoor) related information, which represent different levels of household air pollution. This study aimed to explore the prevalence and geographical variations in smoke-exposure risks (SERs) associated with indoor and outdoor cooking practices and use of smoke-producing and non-smoke-producing cooking fuels in Tanzania. We further investigated the social and spatial features associated with household SERs. We defined an indicator variable, the household SER, using country-level, cross-sectional data on cooking fuels and cooking places obtained from the 2015–2016 Tanzania Demographic and Health Survey and then estimated zone-level average SERs. We used an ordered logistic regression model to assess the social and spatial characteristics associated with household SER. We identified 76.4% of the 12,425 households that practiced indoor cooking using smoke-producing fuels as having a high SER. High-level SER was more prevalent in the Central, Southern highland, and Southwest highland zones. Overall, wealthier households, female-headed households, and households with higher education attainments were more likely to be categorized as households with very low SER. Meanwhile, households headed by older individuals and with larger family sizes were less likely to be in the very low SER category. The prevalence of high SER is a major public health concern in Tanzania. Improved cooking stoves and cleaner fuels should be adopted simultaneously to minimize the adverse effects associated with household SER.

Survey-based inventory for atmospheric emissions from residential combustion in Vietnam

Local questionnaire surveys were conducted to collect representative activity data for calculation of annual emissions from residential combustion in Red River Delta (RRD), Vietnam, for 2010-2015. Multistage statistical sampling was implemented in the surveys for Hanoi Metropolitan Region (HMR) and deep rural area of Ninh Binh province (Con Thoi, Ninh Binh (CTNB)). Emission factors were scrutinized to select relevant ranges and central values for typical cookstoves in RRD. Large differences in the activity data (cooking activities, fuel-stove types, and fuel consumption) were found between three HMR strata (urban, suburban, and rural populations) and CTNB, respectively, which resulted in distinctly different annual emissions per capita. Annual 2010 emissions from residential combustion in RRD were estimated for toxic pollutants, in Gg/year, of 217 for CO, 1.5 NO_x, 7.4 SO₂, 33 NMVOC, 3.7 NH₃, 16.9 PM_2.5, 1.4 BC, and 7.1 OC, along with 171 t/year of total PAHs with 0.7 t/year of BaP, and greenhouse gases of 5395 CO₂, 17.2 CH₄, and 0.7 N₂O Gg/year. Emissions increased by 1.5-7.8%, varying with species, over the 6-year period. Prevalent use of crop residue in CTNB induced its dominant shares in the residential combustion emissions not only in this deep rural area but also in the entire RRD domain. Spatial emission distribution exhibited high intensities over districts having high rural population density. Global warming potential results indicated the dominant role of black carbon, especially over the 20-year horizon. Switching from solid fuels to liquefied petroleum gas would reduce the emissions from this sector and bring in multiple benefits.

Independent and combined associations of solid-fuel use and smoking with obesity among rural Chinese adults

Although solid-fuel use or smoking is associated with obesity measured by body mass index (BMI), research on their interactive effects on general and central obesity is limited. Data of 20,140 individuals in the Henan Rural Cohort Study was examined the independent and combined associations of solid-fuel use and smoking with prevalent obesity, which was measured by BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and visceral fat index (VFI). Multiple adjusted logistic regression models showed that the OR (95% CI) of prevalent obesity measured by BMI associated with exposure to solid fuels alone or with smoking was 0.78 (0.70, 0.86) or 0.46 (0.32, 0.66), compared with neither smoking nor solid-fuel exposure. Similar results had been found in other obese anthropometric indices and in the results of linear regression analysis. The results indicated that solid-fuel use and smoking have a synergistic effect on reduction in obesity indices. The effects of household air pollution from solid-fuel use and smoking on obesity should be considered when exploring the influencing factors of obesity.

Impact of the COVID-19 pandemic on clean fuel programmes in India and ensuring sustainability for household energy needs

Clean cooking energy strategies are critical for reducing air pollution, improving health, and achieving related Sustainable Development Goals. The recent COVID-19 lockdowns may impact the transition towards clean cooking fuels. The nationwide lockdown is likely to affect key factors such as energy access, income, transportation, etc., that play a role in decisions influencing household fuel use. The rural population already bears the burden of poverty and may not be able to afford and access clean cooking fuels during the lockdown. They are thus vulnerable to reversion to their traditional cooking methods using solid biomass fuels. The household air pollution caused due to the use of polluting fuels increases their susceptibility to non-communicable diseases, and thus may intensify the risk and severity of COVID-19 infection. Hence, there is an urgent need to expand sustainable energy solutions worldwide. The present study applies the DPSIR modeling framework to establish a set of comprehensive indicators for addressing the transition towards clean cooking fuels during the COVID-19 pandemic. The study also provides insights on various strategies adopted in India in response to the COVID-19 pandemic for maintaining continuity of delivering benefits under a clean cookstove program. The study offers future directions to ensure the transition towards cleaner fuels and sustainability.

The effects of indoor air pollution from solid fuel use on cognitive function among middle-aged and older population in China

OBJECTIVES

Growing evidence has linked outdoor air pollution exposure with higher risk of cognitive impairments. However, the role of indoor air pollution in cognitive decline is not well elaborated. By using nationally representative longitudinal data, this study aimed to explore the effects of indoor air pollution from solid fuel use on cognitive function among middle-aged and older individuals in China.

METHODS

Data were obtained from 2011 to 2015 waves of CHARLS (China Health and Retirement Longitudinal Study). Scores from the Telephone Interview of Cognitive Status and figure drawing/word recall tests were used to measure cognitive function in 39,482 individuals. Exposure to indoor air pollution was measured as use of solid fuel for cooking. Solid fuel was defined as coal, biomass charcoal, wood, and straw; clean fuel was defined as liquefied gas, natural gas, and electricity. Linear mixed effect models were applied to examine the effect of indoor air pollution from solid fuel use on cognitive function.

RESULTS

Participants had an average global cognitive function of 9.67 (SD = 4.13). Solid fuel users made up 49.71% of participants, but this proportion was much greater among those living in rural areas (64.22%). Compared with clean fuel users, solid fuel users had worse cognitive function. On average, solid fuel users had a 0.81 (95%CI: -0.89, -0.73) lower global cognition score, 0.63 (95%CI: -0.69, -0.57) lower mental health score, and 0.16 (95%CI: -0.22, -0.14) lower episodic memory score. These effects were stronger among participants who are female, aged 65 years old and above, have education level of primary school and below, or have cardiovascular diseases.

CONCLUSIONS

These results provide evidence for the role of indoor air pollution in neurobehavioral disorders in China. Promotion of practices like expanded use of clean fuel and improved stoves in households may be crucial to significantly reduce indoor air pollution and protect mental health.

Exposure levels to PM2.5 and black carbon for people with disabilities in rural homes of Colombia

Indoor exposure to air pollutants emitted by solid fuels used for cooking or heating homes remains as a problem to solve. The most affected people are newborns, mothers, children, and people with disabilities, due to the time they spend at home. This study is the first in a rural area of South America, which measures indoor air pollutants (PM_2.5 and black carbon) in different environments, inhabited by people with disabilities. The research was supported through a sociodemographic characterization, a methodology useful for future studies, continuous monitoring for 72 h of pollutants, and emission sources, cooking habits, and pre-existing diseases were identified. The primary sources of emissions are improved wood-burning stoves and their chimney. In households where firewood is used, the average concentrations of PM_2.5 were the highest (between 10.9 and 3302.5 μg/m³), as were the average concentrations of BC (average 72 h between 2.6 and 51.2 μg/m³) compared with the houses that use gas (average 72 h between 2.6 and 6 μg/m³). In 57% of the households visited, the World Health Organization (WHO) guidelines for PM_2.5 (25 μg/m³ for 24 h) were exceeded. The results reveal that rural concentrations of BC can be up to 2.5 times higher than those of an urban area with high vehicular traffic and high population density and could be used to establish a baseline that allows the implementation of control mechanisms to reduce pollution of indoor air.

Biomass-fuelled improved cookstove intervention to prevent household air pollution in Northwest Ethiopia: a cluster randomized controlled trial

Background

Household air pollution from biomass fuels burning in traditional cookstoves currently appeared as one of the most serious threats to public health with a recent burden estimate of 2.6 million premature deaths every year worldwide, ranking highest among environmental risk factors and one of the major risk factors of any type globally. Improved cookstove interventions have been widely practiced as potential solutions. However, studies on the effect of improved cookstove interventions are limited and heterogeneous which suggested the need for further research.

Methods

A cluster randomized controlled trial study was conducted to assess the effect of biomass-fuelled improved cookstove intervention on the concentration of household air pollution compared with the continuation of an open burning traditional cookstove. A total of 36 clusters were randomly allocated to both arms at a 1:1 ratio, and improved cookstove intervention was delivered to all households allocated into the treatment arm. All households in the included clusters were biomass fuel users and relatively homogenous in terms of basic socio-demographic and cooking-related characteristics. Household air pollution was determined by measuring the concentration of indoor fine particulate, and the effect of the intervention was estimated using the Generalized Estimating Equation.

Results

A total of 2031 household was enrolled in the study across 36 randomly selected clusters in both arms, among which data were obtained from a total of 1977 households for at least one follow-up visit which establishes the intention-to-treat population dataset for analysis. The improved cookstove intervention significantly reduces the concentration of household air pollution by about 343 μg/m³ (Ḃ = − 343, 95% CI − 350, − 336) compared to the traditional cookstove method. The overall reduction was found to be about 46% from the baseline value of 859 (95% CI 837–881) to 465 (95% CI 458–472) in the intervention arm compared to only about 5% reduction from 850 (95% CI 828–872) to 805 (95% CI 794–817) in the control arm.

Conclusions

The biomass-fuelled improved cookstove intervention significantly reduces the concentration of household air pollution compared to the traditional method. This suggests that the implementation of these cookstove technologies may be necessary to achieve household air pollution exposure reductions.

Trial registration

The trial project was retrospectively registered on August 2, 2018, at the clinical trials.gov registry database (https://clinicaltrials.gov/) with the NCT03612362 registration identifier number.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12199-020-00923-z.

Implementing a context-driven awareness programme addressing household air pollution and tobacco: a FRESH AIR study

Most patients with chronic respiratory disease live in low-resource settings, where evidence is scarcest. In Kyrgyzstan and Vietnam, we studied the implementation of a Ugandan programme empowering communities to take action against biomass and tobacco smoke. Together with local stakeholders, we co-created a train-the-trainer implementation design and integrated the programme into existing local health infrastructures. Feasibility and acceptability, evaluated by the modified Conceptual Framework for Implementation Fidelity, were high: we reached ~15,000 Kyrgyz and ~10,000 Vietnamese citizens within budget (~€11,000/country). The right engaged stakeholders, high compatibility with local contexts and flexibility facilitated programme success. Scores on lung health awareness questionnaires increased significantly to an excellent level among all target groups. Behaviour change was moderately successful in Vietnam and highly successful in Kyrgyzstan. We conclude that contextualising the awareness programme to diverse low-resource settings can be feasible, acceptable and effective, and increase its sustainability. This paper provides guidance to translate lung health interventions to new contexts globally.

Household air pollution from cooking and heating and its impacts on blood pressure in residents living in rural cave dwellings in Loess Plateau of China

Cave dwelling is an ancient and unique type of residence in the Loess Plateau of Northern China, where the economics are less-developed. The majority of the local dwellers rely on traditional solid fuels for cooking and heating, which can emit large amounts of particles into both indoor and outdoor environments. In this study, we measured the real-time household concentrations of PM_2.5 and explored the association between personal daily PM_2.5 exposure and blood pressure (BP). Cooking and heating activities with different energies made a great variation in the household PM_2.5 air pollution, and residents using biomass had the highest personal PM_2.5 exposure. Temperature and relative humidity are both significantly linear correlated with household PM_2.5 air pollution. Besides, systolic blood pressure (SBP) was demonstrated to be positively associated with personal PM_2.5 exposure: with each 10-μg/m³ incremental PM_2.5 concentration when controlling all the other factors, SBP will increase by 0.36 mmHg (95% confident interval (CI) 0.05-0.0.77 mmHg). If solid fuels could be replaced with clean energies, personal PM_2.5 exposure and SBP would reduce by more than 21% and 3.7%, respectively, calling for efficient intervention programs to mitigate household air pollution of cave dwellings and protect health of those residents.

Adoption and impact of improved cookstoves in Lambayeque, Peru, 2017

INTRODUCTION

Approximately three billion people in Asia, Africa, and the Americas cook with biomass, cleaner cooking technologies with the potential to reduce household air pollution exposure. It is necessary to assess the adoption and long-term use of these stoves, measure perceived benefits among users, and use this information to provide feedback to programs that are implementing new cooking technologies. The aim of this study is to determine the level of adoption and impact of improved biomass cookstoves in the rural area of Lambayeque, Peru, in 2017.

METHODS

A descriptive cross-sectional study was conducted. A total of 52 homes were surveyed in the districts of Pacora and Íllimo where improved biomass stoves were introduced between 2005 and 2013. A questionnaire for the assessment of adoption and impact indexes proposed by the Global Alliance for Clean Cookstoves was applied. The STROBE checklist was used.

RESULTS

The mean number of years with the improved biomass cookstove was 9.1 (standard deviation: 2.9); 51.9% always used the improved stove, and 34.6% never used it due to destruction during the El Niño phenomenon in 2017. The median impact index was 5.62; 19.2% had a very good/good adoption. The median adoption index was 6.5; 25% had a very high/high impact. The use of the traditional or open fire biomass stove persisted in 61.5% of the houses.

CONCLUSION

The adoption and impact of improved biomass cookstoves were acceptable, but traditional stove use persisted in more than half of the houses. Households used a mix of different stove technologies. Gas stoves were used more frequently for breakfast or dinner, while the traditional biomass stoves were used for larger lunchtime meals.

Valorisation of agricultural biomass-ash with CO2

This work is part of a study of different types of plant-based biomass to elucidate their capacity for valorisation via a managed carbonation step involving gaseous carbon dioxide (CO₂). The perspectives for broader biomass waste valorisation was reviewed, followed by a proposed closed-loop process for the valorisation of wood in earlier works. The present work newly focusses on combining agricultural biomass with mineralised CO₂. Here, the reactivity of selected agricultural biomass ashes with CO₂ and their ability to be bound by mineralised carbonate in a hardened product is examined. Three categories of agricultural biomass residues, including shell, fibre and soft peel, were incinerated at 900 ± 25 °C. The biomass ashes were moistened (10% w/w) and moulded into cylindrical samples and exposed to 100% CO₂ gas at 50% RH for 24 h, during which they cemented into hardened monolithic products. The calcia in ashes formed a negative relationship with ash yield and the microstructure of the carbonate-cementing phase was distinct and related to the particular biomass feedstock. This work shows that in common with woody biomass residues, carbonated agricultural biomass ash-based monoliths have potential as novel low-carbon construction products.

Solid fuel use and early child development disparities in Ghana: analyses by gender and urbanicity

In Ghana, more than 77% of the population depends on biomass fuels for cooking. Previous studies show that solid fuel use (SFU) has adverse effects on pregnancy and child health outcomes. Yet, no previous study considered potential effects on early child development indicators (ECDI), nor how SFU effects may vary by gender, and rural and urban areas. We investigated the associations of SFU with ECDI measures, and whether these associations exhibited sex and urban/rural differences. We used the 2011-2012 Ghana's Multiple Indicator Cluster Surveys-UNICEF (N = 3326 children; 3-4 years). We derived a binary ECDI measure reflecting whether the child is developmentally on track or not from a caregiver-report of ten yes/no/do not know questions designed specifically to assess four domains of early child development: learning-cognition, literacy-numeracy, socio-emotional, and physical. We used multilevel Poisson regressions adjusting for neighborhood, household, mother, and child's characteristics to estimate covariate-adjusted prevalence ratios (PRs) of the associations between SFU and ECDI and its four dimensions. We run stratified analyses and used z-score tests of differences to evaluate effect modification by sex and urbanicity. Overall, 85% of children were exposed to SFU and 28% of children were not developmentally on track. After adjustment for confounders, children exposed to SFU were more likely to be not developmentally on track in comparison with nonexposed children (PR = 1.16; 95% confidence interval, [95% CI]: 1.10,1.22). These associations were stronger in girls (PR = 1.36; 95% CI: 1.03,1.79) in comparison with boys (PR = 0.87; 95% CI: 0.73,1.04). No difference in associations was observed between urban and rural children. Overall, these associations were mainly driven by the literacy-numeracy dimension. In this study, we show that SFU was associated with developmental delays in Ghanaian girls. Policy efforts which tackle SFU should be mindful of gender disparities in susceptibility to indoor pollution.