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      Effectiveness of Six Improved Cookstoves in Reducing Household Air Pollution and Their Acceptability in Rural Western Kenya

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          Abstract

          Background

          Household air pollution (HAP) from biomass fuel burning is linked to poor health outcomes. Improved biomass cookstoves (ICS) have the potential to improve HAP.

          Objectives

          A pre-/post- intervention study assessed the impact of six ICS on indoor air quality and acceptability of ICS to local users in rural Western Kenya.

          Methods

          We measured mean personal and kitchen level concentrations of particulate matter <2.5μm in diameter (PM 2.5, μg/m 3) and carbon monoxide (CO, ppm) during the 48-hour period of each ICS use in 45 households. We compared these levels to those observed with traditional 3-stone fire (TSF) use. We assessed ICS acceptability through interviews and focus groups. We evaluated association of stove type, fuel use, and factors related to cooking practices with mean kitchen PM 2.5 and CO using multivariable regression.

          Results

          Stove type, exclusive ICS use (vs. concurrent TSF use), and the amount of fuel used were independently associated with kitchen PM 2.5 and CO levels. Reductions (95%CI) in mean PM 2.5 compared to TSF, ranged by ICS from 11.9% (-2.8–24.5) to 42.3% (32.3–50.8). Reductions in kitchen CO compared to TSF, ranged by ICS from -5.8% (-21.9–8.2) to 34.5% (23.2–44.1). Mean kitchen PM 2.5 ranged from 319μg/m 3 to 518μg/m 3 by ICS. Women thought ICS were easy to use, more efficient, produced less smoke, and cooked faster, compared to TSF. Women also reported limitations for each ICS.

          Conclusions

          We documented reductions in HAP from ICS compared to TSF. The PM 2.5 levels with ICS use were still considerably higher than WHO indoor air quality guidelines. Achieving maximal potential of ICS requires adherence to more exclusive use and addressing user reported ICS limitations.

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          Most cited references10

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          Millions dead: how do we know and what does it mean? Methods used in the comparative risk assessment of household air pollution.

          In the Comparative Risk Assessment (CRA) done as part of the Global Burden of Disease project (GBD-2010), the global and regional burdens of household air pollution (HAP) due to the use of solid cookfuels, were estimated along with 60+ other risk factors. This article describes how the HAP CRA was framed; how global HAP exposures were modeled; how diseases were judged to have sufficient evidence for inclusion; and how meta-analyses and exposure-response modeling were done to estimate relative risks. We explore relationships with the other air pollution risk factors: ambient air pollution, smoking, and secondhand smoke. We conclude with sensitivity analyses to illustrate some of the major uncertainties and recommendations for future work. We estimate that in 2010 HAP was responsible for 3.9 million premature deaths and ∼4.8% of lost healthy life years (DALYs), ranking it highest among environmental risk factors examined and one of the major risk factors of any type globally.
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            Respiratory disease associated with solid biomass fuel exposure in rural women and children: systematic review and meta-analysis.

            Numerous studies with varying associations between domestic use of solid biomass fuels (wood, dung, crop residue, charcoal) and respiratory diseases have been reported. To present the current data systematically associating use of biomass fuels with respiratory outcomes in rural women and children. Systematic searches were conducted in 13 electronic databases. Data were abstracted from original articles that satisfied selection criteria for meta-analyses. Publication bias and heterogeneity of samples were tested. Studies with common diagnoses were analysed using random-effect models. A total of 2717 studies were identified. Fifty-one studies were selected for data extraction and 25 studies were suitable for meta-analysis. The overall pooled ORs indicate significant associations with acute respiratory infection in children (OR 3.53, 95% CI 1.94 to 6.43), chronic bronchitis in women (OR 2.52, 95% CI 1.88 to 3.38) and chronic obstructive pulmonary disease in women (OR 2.40, 95% CI 1.47 to 3.93). In contrast, no significant association with asthma in children or women was noted. Biomass fuel exposure is associated with diverse respiratory diseases in rural populations. Concerted efforts in improving stove design and lowering exposure to smoke emission may reduce respiratory disease associated with biomass fuel exposure.
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              Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis.

              Reduction of indoor air pollution (IAP) exposure from solid fuel use is a potentially important intervention for childhood pneumonia prevention. This review updates a prior meta-analysis and investigates whether risk varies by etiological agent and pneumonia severity among children aged less than 5 years who are exposed to unprocessed solid fuels. Searches were made of electronic databases (including Africa, China and Latin America) without language restriction. Search terms covered all sources of IAP and wide-ranging descriptions of acute lower respiratory infections, including viral and bacterial agents. From 5317 studies in the main electronic databases (plus 307 African and Latin American, and 588 Chinese studies, in separate databases), 25 were included in the review and 24 were suitable for meta-analysis. Due to substantial statistical heterogeneity, random effects models were used. The overall pooled odds ratio was 1.78 (95% confidence interval, CI: 1.45-2.18), almost unchanged at 1.79 (95% CI: 1.26-2.21) after exclusion of studies with low exposure prevalence (< 15%) and one high outlier. There was evidence of publication bias, and the implications for the results are explored. Sensitivity subanalyses assessed the impact of control selection, adjustment for confounding, exposure and outcome assessment, and age, but no strong effects were identified. Evidence on respiratory syncytial virus was conflicting, while risk for severe or fatal pneumonia was similar to or higher than that for all pneumonia. Despite heterogeneity, this analysis demonstrated sufficient consistency to conclude that risk of pneumonia in young children is increased by exposure to unprocessed solid fuels by a factor of 1.8. Greater efforts are now required to implement effective interventions.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 November 2016
                2016
                : 11
                : 11
                : e0165529
                Affiliations
                [1 ]Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                [2 ]Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GB, United Kingdom
                [3 ]Safe Water and AIDS Project, Kisumu, Kenya
                Tsinghua University, CHINA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: TP SS RQ NB.

                • Data curation: JDL RN BC.

                • Formal analysis: TP JDL BC FY.

                • Funding acquisition: MS NB.

                • Investigation: TP JDL BC RN.

                • Methodology: TP DS FY NB.

                • Project administration: TP JDL BC RN.

                • Resources: MS NB SS.

                • Supervision: SS NB.

                • Writing – original draft: TP JDL.

                • Writing – review & editing: TP SS DS FY RQ NB.

                Article
                PONE-D-16-02059
                10.1371/journal.pone.0165529
                5112915
                27846224
                01c13677-6728-49bc-bd23-da6204199d87

                This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                : 25 January 2016
                : 13 October 2016
                Page count
                Figures: 0, Tables: 7, Pages: 17
                Funding
                Funding for the study was provided by the Centers for Disease Control and Prevention and The Morgan Stanley Foundation. The study was approved by the Institutional Review Boards of the Kenya Medical Research Institute (protocol number 2075) and the Centers for Disease Control and Prevention (protocol number 6155).
                Categories
                Research Article
                Engineering and Technology
                Energy and Power
                Fuels
                Physical Sciences
                Materials Science
                Materials by Attribute
                Fuels
                Engineering and Technology
                Environmental Engineering
                Pollution
                Air Pollution
                Earth Sciences
                Atmospheric Science
                Atmospheric Chemistry
                Air Quality
                Physical Sciences
                Chemistry
                Environmental Chemistry
                Atmospheric Chemistry
                Air Quality
                Ecology and Environmental Sciences
                Environmental Chemistry
                Atmospheric Chemistry
                Air Quality
                Ecology and Environmental Sciences
                Wildfires
                Biology and Life Sciences
                Behavior
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Food Consumption
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Food Consumption
                Physical Sciences
                Materials Science
                Materials by Structure
                Mixtures
                Particulates
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Custom metadata
                All relevant data are within the paper and its Supporting Information files. For any specific questions please contact a corresponding author at tdp4@ 123456cdc.gov .

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