Measuring the exposure of infants and children to indoor air pollution from biomass fuels in The Gambia

Indoor air pollution (IAP) from biomass fuels contains high concentrations of health damaging pollutants and is associated with an increased risk of childhood pneumonia. We aimed to design an exposure measurement component for a matched case-control study of IAP as a risk factor for pneumonia and severe pneumonia in infants and children in The Gambia. We conducted co-located simultaneous area measurement of carbon monoxide (CO) and particles with aerodynamic diameter <2.5 microm (PM(2.5)) in 13 households for 48 h each. CO was measured using a passive integrated monitor and PM(2.5) using a continuous monitor. In three of the 13 households, we also measured continuous PM(2.5) concentration for 2 weeks in the cooking, sleeping, and playing areas. We used gravimetric PM(2.5) samples as the reference to correct the continuous PM(2.5) for instrument measurement error. Forty-eight hour CO and PM(2.5) concentrations in the cooking area had a correlation coefficient of 0.80. Average 48-h CO and PM(2.5) concentrations in the cooking area were 3.8 +/- 3.9 ppm and 361 +/- 312 microg/m3, respectively. The average 48-h CO exposure was 1.5 +/- 1.6 ppm for children and 2.4 +/- 1.9 ppm for mothers. PM(2.5) exposure was an estimated 219 microg/m3 for children and 275 microg/m3 for their mothers. The continuous PM(2.5) concentration had peaks in all households representing the morning, midday, and evening cooking periods, with the largest peak corresponding to midday. The results are used to provide specific recommendations for measuring the exposure of infants and children in an epidemiological study. PRACTICAL IMPLICATIONS: Measuring personal particulate matter (PM) exposure of young children in epidemiological studies is hindered by the absence of small personal monitors. Simultaneous measurement of PM and carbon monoxide suggests that a combination of methods may be needed for measuring children's PM exposure in areas where household biomass combustion is the primary source of indoor air pollution. Children's PM exposure in biomass burning homes in The Gambia is substantially higher than concentrations in the world's most polluted cities.     

Exposure to indoor air pollutants (polycyclic aromatic hydrocarbons, toluene, benzene) in Mexican indigenous women

Indoor air pollution is considered to be a serious public health issue in Mexico; therefore, more studies regarding this topic are necessary. In this context, we assessed exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds in: (i) women who use firewood combustion (indoor) for cooking and heating using traditional open fire; (ii) women who use firewood combustion (outdoor) for cooking and heating using traditional open fire; and (iii) women who use LP gas as the principal energy source. We studied 96 healthy women in San Luis Potosi, México. Urine samples were collected, and analyses of the following urinary exposure biomarkers were performed by high-performance liquid chromatography: 1-hydroxypyrene (1-OHP), trans, trans-muconic acid, and hippuric acid (HA). The highest levels of 1-OHP, trans, trans-muconic acid, and HA were found in communities where women were exposed to indoor biomass combustion smoke (or products; geometric mean ± s.d., 3.98 ± 5.10 μmol/mol creatinine; 4.81 ± 9.60 μg/l 1-OHP; 0.87 ± 1.78 mg/g creatinine for trans, trans-muconic acid; and 1.14 ± 0.91 g/g creatinine for HA). Our findings indicate higher exposure levels to all urinary exposure biomarkers studied in women who use indoor firewood combustion for cooking and heating (using traditional open fire). PRACTICAL IMPLICATIONS: High mean levels of 1-hydroxypyrene, t,t-muconic acid, and hippuric acid were found in women who use firewood combustion (indoor) for cooking and heating using traditional open fire and taking into account that millions of women and children in Mexico are living in scenarios similar to those studied in this report, the assessment of health effects in women and children exposed to polycyclic aromatic hydrocarbons and volatile organic compounds is urgently needed. Moreover, it is immediately necessary an intervention program to reduce exposure.     

Airborne particulate matter and gaseous air pollutants in residential structures in Lodi province, Italy

The province of Lodi is located in northern Italy on the Po River plain, where high background levels of air pollutants are prevalent. Lodi province is characterized by intensive agriculture, notably animal husbandry. This paper assesses indoor levels of selected airborne pollutants in 60 homes in the province, with special attention to size-fractionated particulate matter (PM). Indoor PM?.? concentrations are frequently higher than current guidelines. PM?? and nitrogen dioxide also exceed the respective guideline recommendations in some cases, noting that 24-h nitrogen dioxide levels were compared with an annual limit value. All other studied pollutant levels are below current international guidelines. Among indoor PM size fractions, PM?.? is predominant in terms of mass concentrations corresponding to 57% of PM?? in summer and 71% in winter. A strong seasonal trend is observed for all studied pollutants, with higher levels in winter corresponding to changes in ambient concentrations. The seasonal variation in PM?? is largely due to PM?.? increase from summer to winter. Summer indoor PM levels are mainly from indoor-generated particles, while particles of outdoor origin represent the main contribution to winter indoor PM levels. On average, indoor concentrations of coarse PM are mostly constituted by indoor-generated particles. PRACTICAL IMPLICATIONS: This study presents a comparison between measured indoor concentrations in the study area and indoor air quality guideline criteria. Accordingly, particulate matter (PM) and NO? are identified as key pollutants that may pose health concerns. It is also found that indoor PM in residential units is mainly constituted by particles with aerodynamic diameters <0.5 μm, especially in winter. Risk mitigation strategies should be focused on the reduction in indoor levels of NO? and ultrafine and fine particles, both infiltrated from outdoors and generated by indoor sources.     

Personal exposure to PM2.5 in Chinese rural households in the Yangtze River Delta

High levels of PM_2.5 exposure and associated health risks are of great concern in rural China. For this study, we used portable PM_2.5 monitors for monitoring concentrations online, recorded personal time‐activity patterns, and analyzed the contribution from different microenvironments in rural areas of the Yangtze River Delta, China. The daily exposure levels of rural participants were 66 μg/m³ (SD 40) in winter and 65 μg/m³ (SD 16) in summer. Indoor exposure levels were usually higher than outdoor levels. The exposure levels during cooking in rural kitchens were 140 μg/m³ (SD 116) in winter and 121 μg/m³ (SD 70) in summer, the highest in all microenvironments. Winter and summer values were 252 μg/m³ (SD 103) and 204 μg/m³ (SD 105), respectively, for rural people using biomass for fuel, much higher than those for rural people using LPG and electricity. By combining PM_2.5concentrations and time spent in different microenvironments, we found that 92% (winter) and 85% (summer) of personal exposure to PM_2.5in rural areas was attributable to indoor microenvironments, of which kitchens accounted for 24% and 27%, respectively. Consequently, more effective policies and measures are needed to replace biomass fuel with LPG or electricity, which would benefit the health of the rural population in China.     

Effect of Indoor air pollution from biomass and solid fuel combustion on symptoms of preeclampsia/eclampsia in Indian women

Available evidence concerning the association between indoor air pollution (IAP) from biomass and solid fuel combustion and preeclampsia/eclampsia is not available in developing countries. We investigated the association between exposure to IAP from biomass and solid fuel combustion and symptoms of preeclampsia/eclampsia in Indian women by analyzing cross‐sectional data from India's third National Family Health Survey (NFHS‐3, 2005–2006). Self‐reported symptoms of preeclampsia/eclampsia during pregnancy such as convulsions (not from fever), swelling of legs, body or face, excessive fatigue or vision difficulty during daylight, were obtained from 39 657 women aged 15–49 years who had a live birth in the previous 5 years. Effects of exposure to cooking smoke, ascertained by type of fuel used for cooking on preeclampsia/eclampsia risk, were estimated using logistic regression after adjusting for various confounders. Results indicate that women living in households using biomass and solid fuels have two times higher likelihood of reporting preeclampsia/eclampsia symptoms than do those living in households using cleaner fuels (OR = 2.21; 95%: 1.26–3.87; P = 0.006), even after controlling for the effects of a number of potentially confounding factors. This study is the first to empirically estimate the associations of IAP from biomass and solid fuel combustion and reported symptoms suggestive of preeclampsia/eclampsia in a large nationally representative sample of Indian women and we observed increased risk. These findings have important program and policy implications for countries such as India, where large proportions of the population rely on polluting biomass fuels for cooking and space heating. More epidemiological research with detailed exposure assessments and clinical measures of preeclampsia/eclampsia is needed in a developing country setting to validate these findings.     

Contribution of solid fuel, gas combustion, or tobacco smoke to indoor air pollutant concentrations in Irish and Scottish homes

There are limited data describing pollutant levels inside homes that burn solid fuel within developed country settings with most studies describing test conditions or the effect of interventions. This study recruited homes in Ireland and Scotland where open combustion processes take place. Open combustion was classified as coal, peat, or wood fuel burning, use of a gas cooker or stove, or where there is at least one resident smoker. Twenty-four-hour data on airborne concentrations of particulate matter<2.5 μm in size (PM2.5), carbon monoxide (CO), endotoxin in inhalable dust and carbon dioxide (CO2), together with 2-3 week averaged concentrations of nitrogen dioxide (NO2) were collected in 100 houses during the winter and spring of 2009-2010. The geometric mean of the 24-h time-weighted-average (TWA) PM2.5 concentration was highest in homes with resident smokers (99 μg/m3--much higher than the WHO 24-h guidance value of 25 μg/m3). Lower geometric mean 24-h TWA levels were found in homes that burned coal (7 μg/m3) or wood (6 μg/m3) and in homes with gas cookers (7 μg/m3). In peat-burning homes, the average 24-h PM2.5 level recorded was 11 μg/m3. Airborne endotoxin, CO, CO2, and NO2 concentrations were generally within indoor air quality guidance levels. PRACTICAL IMPLICATIONS: Little is known about indoor air quality (IAQ) in homes that burn solid or fossil-derived fuels in economically developed countries. Recent legislative changes have moved to improve IAQ at work and in enclosed public places, but there remains a real need to begin the process of quantifying the health burden that arises from indoor air pollution within domestic environments. This study demonstrates that homes in Scotland and Ireland that burn solid fuels or gas for heating and cooking have concentrations of air pollutants generally within guideline levels. Homes where combustion of cigarettes takes place have much poorer air quality.     

Maternal exposure to carbon monoxide and fine particulate matter during pregnancy in an urban Tanzanian cohort

Low birthweight contributes to as many as 60% of all neonatal deaths; exposure during pregnancy to household air pollution has been implicated as a risk factor. Between 2011 and 2013, we measured personal exposures to carbon monoxide (CO) and fine particulate matter (PM_2.5) in 239 pregnant women in Dar es Salaam, Tanzania. CO and PM_2.5 exposures during pregnancy were moderately high (geometric means 2.0 ppm and 40.5 μg/m³); 87% of PM_2.5 measurements exceeded WHO air quality guidelines. Median and high (75th centile) CO exposures were increased for those cooking with charcoal and kerosene versus kerosene alone in quantile regression. High PM_2.5 exposures were increased with charcoal use. Outdoor cooking reduced median PM_2.5 exposures. For PM_2.5, we observed a 0.15 kg reduction in birthweight per interquartile increase in exposure (23.0 μg/m³) in multivariable linear regression; this finding was of borderline statistical significance (95% confidence interval 0.30, 0.00 kg; P = 0.05). PM_2.5 was not significantly associated with birth length or head circumference nor were CO exposures associated with newborn anthropometrics. Our findings contribute to the evidence that exposure to household air pollution, and specifically fine particulate matter, may adversely affect birthweight.     

Hypertension with elevated levels of oxidized low-density lipoprotein and anticardiolipin antibody in the circulation of premenopausal Indian women chronically exposed to biomass smoke during cooking

This study aims to investigate whether indoor air pollution (IAP) from biomass fuel use was associated with hypertension, platelet hyperactivity, and elevated levels of oxidized low-density lipoprotein (oxLDL) and anticardiolipin antibody (aCL). We enrolled 244 biomass fuel-using (median age 34 year) and 236 age-matched control women who cooked with liquefied petroleum gas (LPG). Enzyme-linked immunosorbent assay was used to measure oxLDL in plasma and aCL in serum, flow cytometry for P-selectin expression on platelet and reactive oxygen species (ROS) generation by leukocytes, aggregometry for platelet aggregation, spectrophotometry for superoxide dismutase (SOD) in erythrocytes, and laser photometer for particulate matter <10 and 2.5 μm in diameter (PM(10) and PM(2.5), respectively) in cooking areas. Biomass users had three times more particulate pollution in kitchen, had higher prevalence of hypertension (29.5 vs. 11.0% in control, P < 0.05), elevated oxLDL (170.6 vs. 45.9 U/l; P < 0.001), platelet P-selectin expression (9.1% vs. 2.4%), platelet aggregation (23.2 vs. 15.9 Ohm), raised aCL IgG (28.7% vs. 2.1%), IgM (8.6% of vs. 0.4%), and ROS (44%) but depleted (13%) SOD. After controlling potential confounders, the changes were positively associated with PM(10) and PM(2.5) in indoor air, suggesting a positive association between IAP and increased cardiovascular risk. PRACTICAL IMPLICATIONS: The study showing high risk of developing cardiovascular diseases (CVD) among poor, underprivileged women in their reproductive ages in rural India is important from public health perspectives. It may motivate the government and the regulatory agencies of the country to take a serious note of the indoor air pollution (IAP) from biomass fuel use as it threatens the health of millions of women, children, and the elderly who mostly stay indoor. We hope the findings will strengthen the demand for setting up a standard for indoor air quality in the country in the line of national ambient air quality standard. The findings may also inspire the authorities to take measures for the reduction in IAP by improving housing, kitchen ventilation, and cook stoves. Moreover, the parameters used in this study can be utilized for large, population-based studies to identify women at a higher risk of developing CVD so that medical intervention can be taken at the formative stage of a disease.     

Variability of total exposure to PM2.5 related to indoor and outdoor pollution sources Krakow study in pregnant women

The study is a part of an ongoing prospective cohort study on the relationship between the exposure to environmental factors during pregnancy and birth outcomes and health of newborns. We have measured personal PM(2.5) level in the group of 407 non-smoking pregnant women during the 2nd trimester of pregnancy. On average, the participants from the city center were exposed to higher exposure than those from the outer city area (GM=42.0 microg/m(3), 95% CI: 36.8-48.0 vs. 35.8 microg/m(3), 95% CI: 33.5-38.2 microg/m(3)). More than 20% of study subjects were affected by high level of PM(2.5) pollution (above 65 microg/m(3)). PM(2.5) concentrations were higher during the heating season (GM=43.4 microg/m(3), 95% CI: 40.1-46.9 microg/m(3)) compared to non-heating season (GM=29.8 microg/m(3), 95% CI: 27.5-32.2 microg/m(3)). Out of all potential outdoor air pollution sources (high traffic density, bus depot, waste incinerator, industry etc.) considered in the bivariate analysis, only the proximity of industrial plant showed significant impact on the personal exposure (GM=54.3 microg/m(3), 95% CI: 39.4-74.8 microg/m(3)) compared with corresponding figure for those who did not declare living near the industrial premises (GM=36.2 microg/m(3), 95% CI: 34.1-38.4 microg/m(3)). The subjects declaring high exposure to ETS (>10 cigarettes daily) have shown very high level of personal exposure (GM=88.8 microg/m(3), 95% CI: 73.9-106.7 microg/m(3)) compared with lower ETS exposure (< or =10 cigarettes) (GM=46.3 microg/m(3), 95% CI: 40.0-53.5 microg/m(3)) and no-ETS exposure group (GM=33.9 microg/m(3), 95% CI: 31.8-36.1 microg/m(3)). The contribution of the background ambient PM(10) level was very strong determinant of the total personal exposure to PM(2.5) and it explained about 31% of variance between the subjects followed by environmental tobacco smoke (10%), home heating by coal/wood stoves (2%), other types of heating (2%) and the industrial plant localization in the proximity of household (1%).     

Potential health benefit of reducing household solid fuel use in Shanxi province, China

Indoor air pollution from solid fuel use has severe health effects. 60% of the Chinese population lives in rural areas, where most people rely on solid fuels for cooking and heating. We estimate exposure by combining information on the amount of time spent in different microenvironments and estimates of the particle concentrations (PM(10)) in these environments. According to our estimates, 70% of the exposure experienced by the rural population is due to indoor air pollution (IAP). The urban coal using population experience a 17% increase in exposure from IAP. We apply Monte Carlo simulations to quantify variability and uncertainty in the exposure, morbidity and mortality estimates. We find that applying Monte Carlo simulations reduces the estimated uncertainty compared to analytical methods based on approximate distributions and the central limit theorem. We find that annually about 4% (geometric S.D. sigma(g), 3.2) and 35% (sigma(g), 2.6) of the deaths in the urban and rural populations, respectively, could be avoided by switching to clean fuels. Upgrading the stoves in rural areas to the standard found in urban areas is estimated to reduce mortality by 23% (sigma(g), 3.1). Moreover, we estimate that chronic respiratory illness (CRI) in children can be reduced by, respectively, about 9% (sigma(g), 2.5) and 80% (sigma(g) 1.9) by switching to clean fuels in the urban and rural areas. Upgrading the stoves in rural areas is estimated to reduce CRI in children with about 58% (sigma(g) 2.3). For adults the reduction in CRI was estimated to be 6% (sigma(g) 2.4) and 45% (sigma(g) 1.8) for the urban and rural population following a fuel switch, and 31% (sigma(g) 2.4) for the rural population from stove improvements. Contrary to our expectations we find small gender differences in exposure. We ascribe that to comparable kitchen and living area concentrations and similar indoor occupation times for the genders. Young children and the elderly spend the most time indoors, and have the highest daily exposure in the coal using population. The rural population experience higher exposure than the urban population, even though the outdoor air is significantly cleaner in rural areas.     

Long-term exposure to indoor air pollution and risk of tuberculosis

Indoor air pollution (IAP) is a recognized risk factor for various diseases. This paper examines the role of indoor solid fuel exposure in the risk of mycobacterium tuberculosis (TB) in Delhi Metropolitan, India. Using a cross-sectional design, subjects were screened for a history of active TB and lifelong exposure to IAP sources, such as solid fuel burning and kerosene. The TB prevalence rate in the study area was 1117 per 100 000 population. Every year, increase in solid fuel exposure was associated with a three percent higher likelihood of a history of active TB. Subjects exposed to solid fuel and kerosene use for both heating home and cooking showed significant associations with TB. Age, household expenditure (a proxy of income), lung function, and smoking also showed significant associations with TB. Smokers and solid fuel–exposed subjects were four times more likely to have a history of active TB than non-smoker and unexposed subjects. These finding calls strategies to mitigate solid fuel exposure, such as use of clean cookstove and ventilation, to mitigate the risk of TB which aligns with the United Nations’ goal of “End TB by 2030.”     

Urban and rural exposure to indoor air pollution from domestic biomass and coal burning across China

Although indoor air pollution (IAP) from solid fuel use in the households of the developing countries is estimated to be one of the main health risks worldwide, there is little knowledge of the actual exposure experienced by large populations. We have developed a method to estimate exposure to PM(10) from IAP for large populations, applied to different demographic groups in China. On a national basis we find that 80%-90% of exposure in the rural population results from IAP. For the urban population the contribution is somewhat lower, about 50%-60%. Average exposure is estimated at 340 microg/m(3) (SD 55) in southern cities, and 440 microg/m(3) (SD 40) in northern cities. For the rural population we find average exposure to be 750 microg/m(3) (SD 100) and 680 microg/m(3) (SD 65) in the south and north respectively. Quite surprisingly our results indicate that the heavily polluted northern provinces, largely dependent on coal and believed to have the population with the largest exposure burden, turn out to have medium exposure when IAP is included. We find that the largest exposure burden is in counties relying heavily on biomass, and that there are only small gender differences in exposure.     

Reduction in personal exposures to particulate matter and carbon monoxide as a result of the installation of a Patsari improved cook stove in Michoacan Mexico

The impact of an improved wood burning stove (Patsari) in reducing personal exposures and indoor concentrations of particulate matter (PM(2.5)) and carbon monoxide (CO) was evaluated in 60 homes in a rural community of Michoacan, Mexico. Average PM(2.5) 24-h personal exposure was 0.29 mg/m(3) and mean 48-h kitchen concentration was 1.269 mg/m(3) for participating women using the traditional open fire (fogon). If these concentrations are typical of rural conditions in Mexico, a large fraction of the population is chronically exposed to levels of pollution far higher than ambient concentrations found by the Mexican government to be harmful to human health. Installation of an improved Patsari stove in these homes resulted in 74% reduction in median 48-h PM(2.5) concentrations in kitchens and 35% reduction in median 24-h PM(2.5) personal exposures. Corresponding reductions in CO were 77% and 78% for median 48-h kitchen concentrations and median 24-h personal exposures, respectively. The relationship between reductions in median kitchen concentrations and reductions in median personal exposures not only changed for different pollutants, but also differed between traditional and improved stove type, and by stove adoption category. If these reductions are typical, significant bias in the relationship between reductions in particle concentrations and reductions in health impacts may result, if reductions in kitchen concentrations are used as a proxy for personal exposure reductions when evaluating stove interventions. In addition, personal exposure reductions for CO may not reflect similar reductions for PM(2.5). This implies that PM(2.5) personal exposure measurements should be collected or indoor measurements should be combined with better time-activity estimates, which would more accurately reflect the contributions of indoor concentrations to personal exposures. PRACTICAL IMPLICATIONS: Installation of improved cookstoves may result in significant reductions in indoor concentrations of carbon monoxide and fine particulate matter (PM(2.5)), with concurrent but lower reductions in personal exposures. Significant errors may result if reductions in kitchen concentrations are used as a proxy for personal exposure reductions when evaluating stove interventions in epidemiological investigations. Similarly, time microenvironment activity models in these rural homes do not provide robust estimates of individual exposures due to the large spatial heterogeneity in pollutant concentrations and the lack of resolution of time activity diaries to capture movement through these microenvironments.     

Indoor air pollution from particulate matter emissions in different households in rural areas of Bangladesh

Indoor air pollution from the combustion of traditional biomass fuels (wood, cow dung, and crop wastes) is a significant public health problem predominantly for poor populations in many developing countries. It is particularly problematic for the women who are normally responsible for food preparation and cooking, and for infants/young children who spend time around their mothers near the cooking area. Airborne particulate matter (PM) samples were collected from cooking and living areas in homes in a rural area of Bangladesh to investigate the impact of fuel use, kitchen configurations, and ventilation on indoor air quality and to apportion the source contributions of the measured trace metals and BC concentrations. Lower PM concentrations were observed when liquefied petroleum gas (LPG) was used for cooking. PM concentrations varied significantly depending on the position of kitchen, fuel use and ventilation rates. From reconstructed mass (RCM) calculations, it was found that the major constituent of the PM was carbonaceous matter. Soil and smoke were identified as components from elemental composition data. It was also found that some kitchen configurations have lower PM concentrations than others even with the use of low-grade biomass fuels. Adoption of these kitchen configurations would be a cost-effective approach in reducing exposures from cooking in these rural areas.     

Residents' particle exposures in six different communities in Taiwan

Exposure assessment studies for particulates have been conducted in several U.S. and European cities; however, exposure data remain sparse for Asian populations whose cultural practices and living styles are distinct from those in the developed world. This study assessed personal PM(10) exposure in urban residents and evaluated PM(10) indoor/outdoor levels in communities with different characteristics. Important factors of personal PM(10) exposure in Taiwan were explored. Sampling was conducted in 6 communities in Taiwan, two in each of the three major metropolitan areas. Up to nine non-smoking volunteers in each community carried personal samplers for 24 h. The geometric means (GM) of PM(10) in personal, indoor and outdoor samples were 76.3 microg/m(3) (geometric standard deviation, GSD=1.8), 73.4 microg/m(3) (GSD=1.5), and 85.8 microg/m(3) (GSD=1.7), respectively. It was found that outdoor levels rather than indoor levels contributed significantly to personal exposure. The important exposure factors include the time spent outdoors and on transportation, riding a motorcycle, passing by factories, cooking or being in the kitchen, and incense burning at home. Motorcycle riding and the proximity to factories are related to the special living and housing characteristics in Taiwan, while incense burning and Chinese cooking are culture-related. Motorcyclists experienced an average of 27.7 microg/m(3) higher PM(10) than others, while subjects passing by a factory were exposed to an average of 38.4 microg/m(3) higher PM(10) than others. Effective control and public education should be applied to reduce the contribution of these PM exposure sources.     

Impact of a cleaner‐burning cookstove intervention on blood pressure in Nicaraguan women

Few studies have evaluated the cardiovascular‐related effects of indoor biomass burning or the role of characteristics such as age and obesity status, in this relationship. We examined the impact of a cleaner‐burning cookstove intervention on blood pressure among Nicaraguan women using an open fire at baseline; we also evaluated heterogeneity of the impact by subgroups of the population. We evaluated changes in systolic and diastolic blood pressure from baseline to post‐intervention (range: 273–383 days) among 74 female cooks. We measured indoor fine particulate matter (PM_2.5; N = 25), indoor carbon monoxide (CO; N = 32), and personal CO (N = 30) concentrations. Large mean reductions in pollutant concentrations were observed for all pollutants; for example, indoor PM_2.5 was reduced 77% following the intervention. However, pollution distributions (baseline and post‐intervention) were wide and overlapping. Although substantial reductions in blood pressure were not observed among the entire population, a 5.9 mmHg reduction [95% confidence interval (CI): ?11.3, ?0.4] in systolic blood pressure was observed among women aged 40 or more years and a 4.6 mmHg reduction (95% CI: ?10.0, 0.8) was observed among obese women. Results from this study provide an indication that certain subgroups may be more likely to experience improvements in blood pressure following a cookstove intervention.     

Chimney stoves modestly improved Indoor Air Quality measurements compared with traditional open fire stoves: results from a small‐scale intervention study in rural Peru

Nearly half of the world's population depends on biomass fuels to meet domestic energy needs, producing high levels of pollutants responsible for substantial morbidity and mortality. We compare carbon monoxide (CO) and particulate matter (PM_2.5) exposures and kitchen concentrations in households with study‐promoted intervention (OPTIMA‐improved stoves and control stoves) in San Marcos Province, Cajamarca Region, Peru. We determined 48‐h indoor air concentration levels of CO and PM_2.5 in 93 kitchen environments and personal exposure, after OPTIMA‐improved stoves had been installed for an average of 7 months. PM_2.5 and CO measurements did not differ significantly between OPTIMA‐improved stoves and control stoves. Although not statistically significant, a post hoc stratification of OPTIMA‐improved stoves by level of performance revealed mean PM_2.5 and CO levels of fully functional OPTIMA‐improved stoves were 28% lower (n = 20, PM_2.5, 136 μg/m³ 95% CI 54–217) and 45% lower (n = 25, CO, 3.2 ppm, 95% CI 1.5–4.9) in the kitchen environment compared with the control stoves (n = 34, PM_2.5, 189 μg/m³, 95% CI 116–261; n = 44, CO, 5.8 ppm, 95% CI 3.3–8.2). Likewise, although not statistically significant, personal exposures for OPTIMA‐improved stoves were 43% and 17% lower for PM_2.5 (n = 23) and CO (n = 25), respectively. Stove maintenance and functionality level are factors worthy of consideration for future evaluations of stove interventions.     

Lower tract respiratory infection in children younger than 5 years of age and adverse pregnancy outcomes related to household air pollution in Bariloche (Argentina) and Temuco (Chile)

The main objective of this study was to evaluate the association between household air pollution with lower tract respiratory infection (LRTI) in children younger than 5 years old and adverse pregnancy outcomes. This retrospective cohort study took place in two cities in Patagonia. Using systemic random sampling, we selected households in which at least one child <5 years had lived and/or a child had been born alive or stillborn. Trained interviewers administered the questionnaire. We included 926 households with 695 pregnancies and 1074 children. Household cooking was conducted indoors in ventilated rooms and the use of wood as the principal fuel for cooking was lower in Temuco (13% vs. 17%). In exposed to biomass fuel use, the adjusted OR for LRTI was 1.87 (95% CI 0.98–3.55; P = 0.056) in Temuco and 1.12 (95% CI 0.61–2.05; P = 0.716) in Bariloche. For perinatal morbidity, the OR was 3.11 (95% CI 0.86–11.32; P = 0.084) and 1.41 (95% CI 0.50–3.97; P = 0.518), respectively. However, none of the effects were statistically significant (P > 0.05). The use of biomass fuel to cook in traditional cookstoves in ventilated dwellings may increase the risk of perinatal morbidity and LRTI.     

Analysis of indoor PM2.5 exposure in Asian countries using time use survey

Most household fuels used in Asian countries are solid fuels such as coal and biomass (firewood, crop residue and animal dung). The particulate matter (PM), CO, NOx and SOx produced through the combustion of these fuels inside the residence for cooking and heating has an adverse impact on people's health. PM 2.5 in particular, consisting of particles with an aerodynamic diameter of 2.5 μm or less, penetrates deep into the lungs and causes respiratory system and circulatory system diseases and so on. As a result, the World Health Organization (WHO) established guideline values for this type of particulate matter in 2005. In this study, the authors focused on PM 2.5 and estimated indoor exposure concentrations for PM 2.5 in 15 Asian countries. For each environment used for cooking, eating, heating and illumination in which people are present temporarily (microenvironment), exposure concentrations were estimated for individual cohorts categorized according to sex, age and occupation status. To establish the residence time in each microenvironment for each of the cohorts, data from time use surveys conducted in individual countries were used. China had the highest estimate for average exposure concentration in microenvironment used for cooking at 427.5 μg/m³ , followed by Nepal, Laos and India at 285.2 μg/m³, 266.3 μg/m³ and 205.7 μg/m³ , respectively. The study found that, in each country, the PM2.5 exposure concentration was highest for children and unemployed women between the ages of 35 and 64. The study also found that the exposure concentration for individual cohorts in each country was greatly affected by people's use of time indoors. Because differences in individual daily life activities were reflected in the use of time and linked to an assessment of exposure to indoor air-polluting substances, the study enabled detailed assessment of the impact of exposure.     

Size distribution and lung-deposited doses of particulate matter from household exposure to biomass smoke

Exposure to high concentrations of particulate matter (PM) is associated with a number of adverse health effects. However, it is unclear which aspects of PM are most hazardous, and a better understanding of particle sizes and personal exposure is needed. We characterized particle size distribution (PSD) from biomass-related pollution and assessed total and regional lung-deposited doses using multiple-path deposition modeling. Gravimetric measurements of kitchen and personal PM_2.5 (<2.5 µm in size) exposures were collected in 180 households in rural Puno, Peru. Direct-reading measurements of number concentrations were collected in a subset of 20 kitchens for particles 0.3-25 µm, and the continuous PSD was derived using a nonlinear least-squares method. Mean daily PM_2.5 kitchen concentration and personal exposure was 1205 ± 942 µg/m³ and 115 ± 167 µg/m³, respectively, and the mean mass concentration consisted of a primary accumulation mode at 0.21 µm and a secondary coarse mode at 3.17 µm. Mean daily lung-deposited surface area (LDSA) and LDSA during cooking were 1009.6 ± 1469.8 µm²/cm³ and 10,552.5 ± 8261.6 µm²/cm³, respectively. This study presents unique data regarding lung deposition of biomass smoke that could serve as a reference for future studies and provides a novel, more biologically relevant metric for exposure-response analysis compared to traditional size-based metrics.