The Killer in the Kitchen

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The Killer in the Kitchen
John Borrazzo, GH/HIDN Pam Baldinger,
EGAT/EI/Energy October 27, 2006
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Fraction () of Burden of Disease in High
Mortality Developing Countries(WHO, 2002)
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Percentage of Total Global Exposure to Airborne
Particulate in Eight Settings (WHO, 1997)
Developing
Developed
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Air Pollution Premature Deaths (annual and global)

• Outdoor air pollution
• 800,000
• Indoor air pollution
• 1,500,000

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The Problem

• Half of the worlds population, more than three
  billion people, still rely on traditional solid
  fuels - wood, dung, coal, etc to meet their
  household energy needs.
• Cooking with solid fuels is a major risk factor
  for pneumonia among children and chronic
  respiratory disease among adults.
• More than two thirds of related deaths occur in
  South and East Asia and sub-Saharan Africa.
• To halve, by 2015, the number of people without
  access to such fuels, 485,000 people will need to
  gain access to modern energy services every day
  for the next 10 years.

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Percentage of Population using Solid Fuels, 2003
(WHO 2006)
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Health effects of indoor air pollution

• Fair evidence ALRI, COPD, lung cancer (coal)
• Tentative TB, low birth weight, cataract,
  asthma, other cancer

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Attributable Mortality and DALYs lost from solid
fuel use, by age group
Source World Health Report 2002
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IAP and Low Birth Weight

• Small number of studies, no formal meta-analysis
• Suggestive of important and consistent effects on
  LBW (and also stillbirth)
• Potentially very significant in terms of public
  health impact because of associations of LBW with
  neonatal mortality and pneumonia mortality, and
  because of the large numbers of women of
  child-bearing age exposed to smoke amongst the
  populations most at risk

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• But knowing that indoor smoke is an important
  risk factor does not tell us how much of an
  improvement in health outcomes is possible per
  incremental improvement in air quality
• WHAT IS THE DOSE-REPONSE?

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RESPIRE study (Smith, 2006)

• Randomized intervention trial overcame
  limitations of previous studies
• Explicitly looked at impact on childhood
  pneumonia both viral and bacterial
• Setting was 5365 households in the highlands of
  Guatemala (534 eligible households ½ received
  improved stove at beginnng, ½ at end)

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Improved Stove - Plancha
Source Smith et al., 2006
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Source Smith et al., 2006
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RESPIRE Conclusions to Date

• 40 decline in non-viral severe pneumonia in
  young children
• For women, respiratory symptoms reduced for
  wheeze and chronic phlegm smaller benefits for
  lung function. Impact on respiratory symptoms
  increases over time with reduced exposure.

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Interventions can target...

• Source of pollution (stove,fuel)
• improved cooking devices
• alternative fuels
• reduced need for fire
• Living environment
• improved ventilation
• kitchen design and stove placement
• User behaviors
• improved operation (e.g. pot lids)
• avoiding smoke (e.g. keeping children away)

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Gender issues

• Women have greatest exposure to IAP of all
  household members
• Opportunity cost of time collecting fuel
• Injuries collecting and carrying fuel
• Limited decision-making power in home for new
  fuels and appliances