Background: An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners.Methods: We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method.Results: The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes.Conclusions: HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.

Direct exposure to household fine particulate air pollution (HAP) associated with inefficient combustion of fuels (wood, charcoal, coal, crop residues, kerosene, etc.) for cooking, space-heating, and lighting is estimated to result in 2.3 (1.6–3.1) million premature yearly deaths globally. HAP emitted indoors escapes outdoors and is a leading source of outdoor ambient fine particulate air pollution (AAP) in low- and middle-income countries, often being a larger contributor than well-recognized sources including road transport, industry, coal-fired power plants, brick kilns, and construction dust. We review published scientific studies that model the contribution of HAP to AAP at global and major sub-regional scales. We describe strengths and limitations of the current state of knowledge on HAP’s contribution to AAP and the related impact on public health and provide recommendations to improve these estimates. We find that HAP is a dominant source of ambient fine particulate matter (PM2.5) globally — regardless of variations in model types, configurations, and emission inventories used — that contributes approximately 20 % of total global PM2.5 exposure. There are large regional variations: in South Asia, HAP contributes ∼ 30 % of ambient PM2.5, while in high-income North America the fraction is ∼ 7 %. The median estimate indicates that the household contribution to ambient air pollution results in a substantial premature mortality burden globally of about 0.77(0.54–1) million excess deaths, in addition to the 2.3 (1.6–3.1) million deaths from direct HAP exposure. Coordinated global action is required to avert this burden.

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.

Background Low birthweight, intrauterine growth restriction (IUGR) and perinatal mortality have been associated with air pollution. However, intervention studies that use ultrasound measurements to assess the effects of household air pollution (HAP) on fetal biometric parameters (FBP) are rare. We investigated the effect of a cookstove intervention on FBP and IUGR in a randomized controlled trial (RCT) cohort of HAP-exposed pregnant Nigerian women. Methods We recruited 324 women early in the second trimester of pregnancy. Between 16 and 18 weeks, we randomized them to either continue cooking with firewood/kerosene (control group) or receive a CleanCook stove and ethanol fuel (intervention group). We measured fetal biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and ultrasound-estimated fetal weight (U-EFW) in the second and third trimesters. The women were clinically followed up at six regular time points during their pregnancies. Once during the women’s second trimester and once during the third, we made 72-h continuous measurements of their personal exposures to particulate matter having aerodynamic diameter < 2.5 μm (PM 2.5 ). We adopted a modified intent-to-treat approach for the analysis. Differences between the intervention and control groups on impact of HAP on fetal growth trajectories were analyzed using mixed effects regression models. Results There were no significant differences in fetal growth trajectories between the intervention and control groups. Conclusions Larger studies in a setting of low ambient air pollution are required to further investigate the effect of transitioning to a cleaner fuel such as ethanol on intrauterine growth. Trial registration ClinicalTrials.gov NCT02394574 ; September 2012

BACKGROUND:Maternal exposure to ambient air pollution affects placental growth markers. OBJECTIVES:Investigate impact of household air pollution (HAP) on placental growth markers. METHODS:Two groups of pregnant women were identified: firewood/kerosene stove-users (A, n=33) and bioethanol stove-users (B, n=44) that participated in a randomized control trial in Ibadan, Nigeria. A third group of non-smoking and presumed liquefied petroleum gas-using Chicago women (C, n=19) were included in this exploratory pilot to assess for possible differences between similar racial groups. Levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 (sFlt-1) were measured in maternal and cord plasma using ELISA. RESULTS:Maternal and cord blood sFlt-1 and PlGF did not differ significantly between women of groups A and B. Nevertheless, both groups differed significantly from the Chicago group in that group A women had lower maternal sFlt-1 (1372.50 vs. 3194.19) but higher PlGF (1607.87 vs. 442.80), and higher cord blood sFlt-1 (2925.02 vs. 107.53) and PlGF (223.68 vs. 6.92), all p≤0.001. Group B showed similar trends (all p≤0.002). Maternal PlGF levels were positively correlated to minutes of HAP exposure when PM2.5 concentration was above 100μg/m3 in Nigerian women. CONCLUSIONS:Maternal levels of PlGF and cord blood levels of sFlt-1 and PlGF in Nigerian women with varying HAP exposures were significantly higher than Chicago-based women who had no presumed HAP exposure. It suggests that in-utero exposure to HAP influenced levels of angiogenic factors involved in normal placentation and growth and could represent compensation for pollutants exposure to preserve fetal viability.

Background: Household air pollution (HAP) exposure has been linked to adverse pregnancy outcomes. Objectives: A randomized controlled trial was undertaken in Ibadan, Nigeria to determine the impact of cooking with ethanol on pregnancy outcomes. Methods: Three-hundred-twenty-four pregnant women were randomized to either the control (continued cooking using kerosene/firewood stove, n = 162) or intervention group (received ethanol stove, n = 162). Primary outcome variables were birthweight, preterm delivery, intrauterine growth restriction (IUGR), and occurrence of miscarriage/stillbirth. Results: Mean birthweights for ethanol and controls were 3076 and 2988 g, respectively; the difference, 88 g, (95% confidence interval: - 18 g to 194 g), was not statistically significant (p = 0.10). After adjusting for covariates, the difference reached significance (p = 0.020). Rates of preterm delivery were 6.7% (ethanol) and 11.0% (control), (p = 0.22). Number of miscarriages was 1(ethanol) vs. 4 (control) and stillbirths was 3 (ethanol) vs. 7 (control) (both non-significant). Average gestational age at delivery was significantly (p = 0.015) higher in ethanol-users (39.2 weeks) compared to controls (38.2 weeks). Perinatal mortality (stillbirths and neonatal deaths) was twice as high in controls compared to ethanol-users (7.9% vs. 3.9%; p = 0.045, after adjustment for covariates). We did not detect significant differences in exposure levels between the two treatment arms, perhaps due to large seasonal effects and high ambient air pollution levels. Conclusions: Transition from traditional biomass/kerosene fuel to ethanol reduced adverse pregnancy outcomes. However, the difference in birthweight was statistically significant only after covariate adjustment and the other significant differences were in tertiary endpoints. Our results are suggestive of a beneficial effect of ethanol use. Larger trials are required to validate these findings.

Rationale: Hypertension during pregnancy is a leading cause of maternal mortality. Exposure to household air pollution elevates blood pressure (BP).Objectives: To investigate the ability of a clean cookstove intervention to lower BP during pregnancy.Methods: We conducted a randomized controlled trial in Nigeria. Pregnant women cooking with kerosene or firewood were randomly assigned to an ethanol arm (n = 162) or a control arm (n = 162). BP measurements were taken during six antenatal visits. In the primary analysis, we compared ethanol users with control subjects. In subgroup analyses, we compared baseline kerosene users assigned to the intervention with kerosene control subjects and compared baseline firewood users assigned to ethanol with firewood control subjects.Measurements and Main Results: The change in diastolic blood pressure (DBP) over time was significantly different between ethanol users and control subjects (P = 0.040); systolic blood pressure (SBP) did not differ (P = 0.86). In subgroup analyses, there was no significant intervention effect for SBP; a significant difference for DBP (P = 0.031) existed among preintervention kerosene users. At the last visit, mean DBP was 2.8 mm Hg higher in control subjects than in ethanol users (3.6 mm Hg greater in control subjects than in ethanol users among preintervention kerosene users), and 6.4% of control subjects were hypertensive (SBP ≥140 and/or DBP ≥90 mm Hg) versus 1.9% of ethanol users (P = 0.051). Among preintervention kerosene users, 8.8% of control subjects were hypertensive compared with 1.8% of ethanol users (P = 0.029).Conclusions: To our knowledge, this is the first cookstove randomized controlled trial examining prenatal BP. Ethanol cookstoves have potential to reduce DBP and hypertension during pregnancy. Accordingly, clean cooking fuels may reduce adverse health impacts associated with household air pollution.Clinical trial registered with www.clinicaltrials.gov (NCT02394574).

Black carbon (BC) emissions from household cookstoves consuming solid fuel produce approximately 25 percent of total anthropogenic BC emissions. The short atmospheric lifetime of BC means that reducing BC emissions would result in a faster climate response than mitigating CO2 and other long-lived greenhouse gases. This study presents the results of optical BC measurements of two new cookstove emissions field assessments and 17 archived cookstove datasets. BC was determined from attenuation of 880 nm light, which is strongly absorbed by BC, and linearly related between 1 and 125 attenuation units. A relationship was experimentally determined correlating BC mass deposition on quartz filters determined via thermal optical analysis (TOA) and on PTFE and quartz filters using transmissometry, yielding an attenuation cross-section (sigma(ATN)) for both filter media types. sigma(ATN) relates TOA measurements to optical measurements on PTFE and quartz (sigma(ATN(PTFE)) = 13.7 cm(-2) mu g, R-2 = 0.87, sigma(ATN(Quartz)) = 15.6 cm(-2) mu g, R-2 = 0.87). These filter-specific sigma(ATN), optical measurements of archived filters were used to determine BC emission factors and the fraction of particulate matter (PM) in the form of black carbon (BC/PM). The 19 stoves measured fell into five stove classes; simple wood, rocket, advanced biomass, simple charcoal, and advanced charcoal. Advanced biomass stoves include forced- and natural-draft gasifiers which use wood or biomass pellets as fuel. Of these classes, the simple wood and rocket stoves demonstrated the highest median BC emission factors, ranging from 0.051 to 0.14 g MJ(-1). The lowest BC emission factors were seen in charcoal stoves, which corresponds to the generally low PM emission factors observed during charcoal combustion, ranging from 0.0084 to 0.014 g MJ(-1). The advanced biomass stoves generally showed an improvement in BC emissions factors compared to simple wood and rocket stoves, ranging from 0.0031 to 0.071 g MJ(-1). BC/PM ratios were highest for the advanced and rocket stoves. Potential relative climate impacts were estimated by converting aerosol emissions to CO2-equivalent, and suggest that some advanced stove/fuel combinations could provide substantial climate benefits. (C) 2017 Published by Elsevier Ltd.

Background: Household air pollution (HAP) is associated with adverse pregnancy outcomes. Objectives: Investigate impact of in-utero HAP exposure on placental development and chronic hypoxia. Methods: Markers of chronic placental hypoxia [Hofbauer cells (HBC), syncytial knots (SK), chorionic vascular density(cVD) and hypoxia-inducible factor (HIF)] were stained by hematoxylin-eosin and/or immunohistochemically in placenta samples collected from firewood-/kerosene-users (A, n=16), and ethanol-users (B, n=20) that participated in a randomized controlled intervention trial in Ibadan, Nigeria. A third group of non-smoking and presumed natural gas-using Chicago women (C, n=12) were included in this exploratory pilot to assess for possible differences in placenta histology between similar racial groups. All patients had uncomplicated pregnancies and delivered at term. Results: HBC, SK and cVD were significantly increased among firewood-/kerosene-users compared to ethanolusers and natural gas-using Chicago women (HBC medians 5.5, 3.5, and 2.0, respectively; SK means 55.6, 41.8 and 30.1; cVD means 8.8, 6.2, and 5.2; all p < 0.01). HIF expression was significantly higher in Group A compared to B and C (all p < 0.001). Conclusions: In-utero exposure to HAP is associated with pathologic changes and HIF expression consistent with chronic hypoxia in placenta of firewood/kerosene-users compared to ethanol-users with less HAP exposure and Chicago women with no presumed HAP exposure. Presence of chronic hypoxic signature in placenta of women exposed to HAP has implications for adverse pregnancy complications and future growth and development of the young children. Future larger studies need to focus on HAP exposure and placental disorders like preeclampsia and long-term health impact of in-utero exposure to HAP. (c) 2017 The Authors. Published by Elsevier B.V.

An unbiased assessment of cooking patterns during a cookstove intervention can provide strong evidence for sustained usage of a cookstove among the target population. A bioethanol cookstove was used as an intervention within a randomized controlled trial being conducted in Ibadan, Nigeria to assess the ability of a clean stove to improve birth outcomes. Sustained usage of the intervention was quantified using a newly developed method of analyzing cooking patterns based on time integrated temperature data from Stove Use Monitors (SUMs) installed on household cookstoves. The method accounts for household level variations in ambient temperatures. We report a significant decline of traditional kerosene stove usage, 84% of women in the Bioethanol arm giving away their kerosene stove before the conclusion of the study (56% within the first month of enrollment), suggesting the bioethanol stove replaced the kerosene stove. This is the first study to objectively evaluate a liquid-to-liquid fuel substitution.

Background: Exposure to household air pollution (HAP) has been linked to systemic inflammation. We determined the impact of transition fromtraditional firewood/kerosene stove to bioethanol-burning stove on inflammatory biomarkers in pregnant Nigerian women.Methods: Women (n= 324), cooking with kerosene/firewood, were recruited during their first trimester of pregnancy from June 2013-October 2015 and were randomly allocated to either control (n = 162) or intervention (n = 162) group using web-based randomization. Controls continued to use their own firewood/kerosene stove, while intervention participants received bioethanol CleanCook stoves. Serum concentrations of retinolbinding protein (RBP), malondialdehyde (MDA), tumor necrosis factor alpha (TNF)-alpha, interleukin (IL)-6, and IL-8 were measured by ELISA.Results: After excluding 53 women (loss of follow-up, untimely biomarker assessments, incorrect dates of enrollment), data from 271 women were included in analysis. Mean (SD) change in RBP, MDA, TNF-alpha, IL-6, and IL-8 between baseline and third trimester was -2.16 (4.47), -19.6 (46.4), 3.72 (37.2), 0.51 (14.4), and 13.2 (197), respectively, in intervention and-2.25 (4.30), -24.6 (43.6), 7.17 (32.6), -1.79, (11.4), and 31.3 (296) in control groups. None of these changes differed significantly between the two treatment arms. However, changes from baseline in TNF-a levels were significantly different between intervention and control groups in subset of women (n = 99) using firewood before trial (-7.03 [32.9] vs. + 12.4 [33.6]; 95% CI for group difference: -35.4 to -3.4, p = 0.018).Conclusions: Decrease in TNF-a concentration from baseline to third trimesters in intervention group women could indicate reduced cardiovascular stress and prothrombotic effects fromdecreased HAP. Our findings suggest that ethanol-burning stoves may mitigate cardiovascular health risks. (C) 2016 The Authors. Published by Elsevier Ltd.

The use of biomass fuels as a primary fuel source is widespread and is linked to significant health effects. High blood pressure is a risk factor for cardiovascular effects including myocardial infarction and stroke. Few studies evaluating the health effects of household air pollution (HAP) have included blood pressure measurements. This study evaluated the effects of changes in cookstove-related particulate matter on blood pressure in 28 women head-of-households pre-intervention and 1 year post-intervention of an improved cookstove in a small, indigenous community in rural Bolivia. Blood pressure and kitchen particulate matter (PM) measurements were taken in August and September 2009 (pre-intervention) and in a 1-year follow-up in September and October of 2010 (post-intervention). Mean systolic blood pressure (SBP) decreased from 114.5 ± 13.0 mm Hg to 109.0 ± 10.4 mm Hg, (p = 0.01) after the improved cookstove intervention. Small decreases in diastolic blood pressure (DBP) were also seen, but these changes were not significant (p = 0.50). Decreases in SBP were correlated with reductions in 24-h mean kitchen PM levels (r = 0.59, p = 0.04). Somewhat stronger correlations were found between reductions in cooking PM concentrations and reductions in both SBP (r = 0.66, p = 0.01) and DBP (r = 0.66, p = 0.01). This study finds associations between decreases in both 24-h mean and mean cooking PM levels and decreases in SBP following an improved cookstove intervention.

SESSION TITLE: Occupational and Environmental Lung Diseases Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: More than 40% of the world's population use solid fuels for cooking and energy needs, producing household air pollution (HAP) with elevated levels of particulate matter (PM) and other pollutants. Kerosene, a popular alternative to solid fuels also produces PM levels that exceed WHO standards. HAP is associated with elevated blood pressure (BP), a known risk factor for cardiovascular disease worldwide. Previous studies have examined improved cookstoves as a means to reduce HAP and improve BP. Ours is the first to evaluate the effects of HAP on BP through a randomized controlled intervention (RCT) comparing an ethanol cookstove with solid fuel and kerosene stoves METHODS: As part of a larger study evaluating the associations between pregnancy outcomes and HAP, we recruited 300 pregnant women from selected clinics in Ibadan, Nigeria. Participants were < 18 weeks gestational age and use firewood or kerosene as their primary fuel, did not smoke or have HTN. Those eligible were randomized to the control arm (continued use of firewood or kerosene) or the intervention arm for which they received an ethanol cookstove. The control group participated in an education program, while the ethanol group was encouraged to use it exclusively for cooking. All subjects had six BP measurements during antenatal visits and 6 weeks post-delivery RESULTS: We randomized 294 women with similar mean baseline systolic BP (SBP) and diastolic BP (DBP) between ethanol users and controls. Among women who have already delivered (n = 154), mean SBP in the intervention group at last measurement before delivery was 110.7 mm Hg, significantly lower than control group's mean SBP of 115.1 mm Hg (p = .02). Mean DBP was significantly lower in the intervention group at this time (69.5 vs. 74.5 mm Hg, p = .001). The number of participants with a post-pregnancy BP measurement is small (n = 90), and the difference in mean SBP and DBP between the 2 groups is not significant. Comparing the last BP measurement before delivery between the intervention group (n = 83) and kerosene users alone (n = 54), mean SBP in the ethanol group was significantly lower (110.7 vs 116.2 mm Hg, p = .007). Difference in mean DBP among these groups was again significant (69.5 vs. 75.7 mm Hg, p = .0002) CONCLUSIONS: Our study has found a significant reduction in SBP and DBP with a RCT ethanol cookstove intervention study during pregnancy. CLINICAL IMPLICATIONS: Preliminary results suggest that adoption of ethanol cookstoves has the potential to reduce BP during pregnancy. DISCLOSURE: The following authors have nothing to disclose: Donee Alexander, Amanda Northcross, Rishi Pandya, Damilola Adu, Temitope Ibigbami, John Olajumilo, Theodore Karrison, Oladosu Ojengbede, C Olopade No Product/Research Disclosure Information

SESSION TITLE: Occupational and Environmental Lung Diseases Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: To investigate the impact of replacing biomass or kerosene burning stoves with a bioethanol stove on pulmonary function and exposure-related pulmonary complaints in pregnant women in Ibadan, Nigeria METHODS: We initiated a randomized controlled intervention trial of 300 pregnant women from Ibadan who cooked primarily with biomass or kerosene stoves. Participants were randomized at up to 18 weeks gestational age to one of two treatment groups: an intervention group with a CleanCook stove using bioethanol or a control group made up of kerosene and biomass users (depending upon which type of stove they were using at entry). During two separate 72-hour periods, personal exposure assessments of fine particulate matter less than 2.5 microns (PM2.5) and carbon monoxide (CO) were conducted during the second and third trimesters. Spirometry was performed prior to randomization, at 26 weeks of gestation and 6 weeks post-partum. Periodic surveys were administered to assess exposure-related complaints RESULTS: Three hundred three pregnant women have been randomized into one of the three arms of the study; 154 women to bioethanol, 94 to kerosene and 55 to firewood. Spirometry was performed in 303 women at baseline, 206 at 26 weeks gestational age and 97 at 6 weeks post-partum. Two-sample t test comparing FVC, FEV1 and FEV1/FVC values at the two time points post-intervention did not yield significant differences between the intervention and control group. However, we observed significant reductions in exposure-related frequency of shortness of breath, fast breathing, headache and itchy eyes in the ethanol intervention group CONCLUSIONS: Despite significant improvement in exposure-related pulmonary symptoms, no significant differences were observed in pulmonary function measures between the intervention group and controls. The lack of difference may be due to the relatively short interval between the baseline evaluation and the 6 weeks post partum evaluation, which is less than a year CLINICAL IMPLICATIONS: An estimated one third of COPD deaths and a quarter of pneumonia deaths are attributable to household air pollution, which often results from the combustion of unsafe cooking fuels. This is one of the few, randomized controlled intervention trials using a clean fuel that aims to demonstrate the efficacy of a stove replacement program in improving pulmonary outcomes DISCLOSURE: The following authors have nothing to disclose: Vishan Dhamsania, Donee Alexander, Temitope Ibigbami, Adedayo Adepoju, Theodore Karrison, Oladosu Ojengbede, C Olopade No Product/Research Disclosure Information

Introduction: Household air pollution (HAP) from solid fuel use is causes more than 4 million premature deaths yearly and ambient air pollution causes an additional 100 million premature deaths making air pollution the largest environmental risk factor for ill health. Urban centers in lower and middle income countries (LMICs) face high levels of ambient pollution and HAP. Methods: A randomized control trial in urban Nigeria was conducted to evaluate the ability of an ethanol stove to reduce exposures to HAP and improve pregnancy outcomes. Pregnant women less than 18 weeks of gestation using firewood or kerosene for cooking (n=310) were recruited. Personal exposures to fine particulate matter (PM2.5) and carbon monoxide, integrated polycyclic aromatic hydrocarbons and GPS data was measured for 72-hours in the 2nd and 3rd trimesters. Temperature sensors (SUMS) measured usage of all stoves owned by participants. The coupled GPS, PM2.5, and SUMs data provide the ability to evaluate the impact of the cookstove usage as well as ambient urban air pollution on personal exposures to PM2.5. Multivariate linear regression was used to identify household, environmental and behavioral factors impacting personal exposures to participants. Results and Conclusions: The intervention group was exposed to lower concentrations of PM2.5 compared to the control group 158 (118) g/m3 vs 107 (48) g/m3 respectively. The ethanol stove replaced 92% of the cooking tasks in the intervention group; an almost complete disuse of the kerosene stove. Ambient PM2.5 exposures accounted for 45% of personal exposures in the control group. Key predictors of personal exposures to PM2.5 included stove-type and time spent at home. This urban cookstove intervention study resulted in reduced exposures; however the high ambient concentrations complicate efforts to achieve exposures less than WHO standards guidelines.

High Adoption Rates of an Ethanol Cookstove Associated with Reductions in Exposure to Particulate Matter in a Randomized Controlled Trial in Ibadan, NigeriaAbstract Number:3019 Donee Alexander, Amanda Northcross, Matt Shupler, John Oluseye, Tope Ibigbami, Godson Ana, Morhasson Bello, Oladosu Ojengbede*, and Christopher O Olopade Donee Alexander University of Chicago, United States , Amanda Northcross The George Washington University, School of Public Health and Health Services, United States , Matt Shupler The George Washington University, Sch of Pub Health & Health Services, United States , John Oluseye Healthy Life for All Foundation, Nigeria , Tope Ibigbami Healthy Life for All Foundation, Nigeria , Godson Ana University of Ibadan, Ctr for Population and Reproductive Health, Nigeria , Morhasson Bello University of Ibadan, Ctr for Population and Reproductive Health, Nigeria , Oladosu Ojengbede* University of Ibadan, Ctr for Population and Reproductive Health, Nigeria , and Christopher O Olopade University of Chicago, Center for Global Health, United States AbstractHousehold air pollution (HAP) from inefficient cookstoves is responsible for almost four million premature deaths in developing countries annually, with 95,000 annual deaths in Nigeria attributed to HAP according to the World Health Organization (WHO). In urban areas of Nigeria, 50-55% of the population utilizes kerosene as their primary fuel source. Combustion of kerosene produces a large array of substances, including particulate matter (PM) and carbon monoxide (CO) that can adversely affect health. Studies collecting samples from households burning kerosene have revealed levels of PM2.5 (PM < 2.5 microns) and CO far beyond the WHO-recommended values of 25 µg/m3 (24-hour mean) and 8.7 ppm (8-hour mean), respectively. The greatest exposure burden to HAP in Nigeria is among women and children, as they typically assume the bulk of the cooking duties. Unfortunately, the use of kerosene is perpetuated due to a government subsidy on kerosene in Nigeria, which makes it more affordable than firewood for cooking and household energy needs.Using a randomized controlled trial design, this study evaluates the effectiveness of an ethanol cookstove to reduce exposures to household air pollution and improve birth outcomes. Three hundred women in the early second trimester of pregnancy who use kerosene or wood as their primary fuel for cooking are being recruited from primary healthcare centers (PHCs) in Ibadan, Nigeria, with 50% randomized to the ethanol cookstove group. Personalized exposure monitoring of PM2.5 and CO is conducted for two 72-hour periods, once in the second and third trimesters, respectively. Additionally, all stoves in both the ethanol and control homes are equipped with stove use monitors (SUMs), which are small data-logging temperature sensors that monitor stove use.HAP emitted by burning unclean fuels within the home affects both human health and the environment. Despite this evidence, the adoption of cleaner stoves has been hindered by difficulties surrounding their dissemination and implementation. Households are reluctant to adopt technology that is difficult to maintain, less convenient, or offers fewer options than traditional methods. Moreover, when new stoves are introduced to a household, stove and fuel stacking commonly occur, which may diminish the intended benefits. With the global commitment to distribute 100 million clean cookstoves to vulnerable homes by 2020, more studies showing practice-based evidence of adoption are needed to realize these goals.Here we present data from a small subset of kerosene and ethanol users. Initial SUMs data show that all intervention homes are using their ethanol stove as their primary cookstove. Questionnaire results indicate that women are using their stove on a daily basis. These results are confirmed by the SUMs data, which show that, on average, women who receive the ethanol cookstove use it 2.3 (±0.5) times per day compared to 2.2 (±0.5) times per day for the kerosene group. Only 18% of ethanol cookstove users practice 'stove stacking'. Of those ethanol homes that utilize a second stove, they do so less than 10% of the time.Preliminary exposure results of a small subset of data suggest a 20% reduction 72-hour mean PM during the second trimester and a 35% reduction in the third trimester in the ethanol group compared to kerosene users. Exposures to PM were higher in both groups in the third trimester compared to the second trimester. These results suggest that, even in urban settings with high ambient air pollution, clean cookstove interventions can still reduce personal exposure to PM.

Access to clean water plays a critical role in advancing health in low- and middle-income countries. Over the past decade, Ghana has met United Nations targets for expanding access to clean water. Non-governmental organizations (NGOs) have taken part in this achievement; however, they have done so with varying success. In 2013, researchers from the University of Chicago, accompanied by local partners, visited seven villages in the Ashanti Region in which a Ghanaian NGO had installed boreholes for drinking water access. Household and leader questionnaires were administered to examine the impact of the project on each community. Four additional villages, which utilize surface water, were visited to establish baseline health and sanitation characteristics. Water samples were collected from primary drinking water sources and tested for coliforms. Two out of seven NGO wells were non-functional and over 35% of respondents cited broken pipes as common problems. Nonetheless, over 60% of respondents reported that a borehole had reduced their water collection time by a median of 30 minutes daily. Coliform counts were lower in samples taken from boreholes relative to samples taken from communities using surface water. Finally, we found redundant water services in many communities and no formalized approach to borehole maintenance.

Household air pollution (HAP) from combustion of biomass fuels worldwide is linked to asthma, respiratory infections and chronic pulmonary diseases. Implementation of ventilated cookstoves significantly reduces exposure to HAP. However, improvements in concurrent respiratory health-related quality of life (HRQoL) have not been previously evaluated with a standardized questionnaire.The association between woodsmoke exposure and respiratory HRQoL outcomes was evaluated using an intervention study in a rural community in Bolivia. Indoor carbon monoxide (CO) levels from traditional stoves and from cookstoves with chimneys were analyzed alongside interview results of women heads-of-households using the St. George's Respiratory Questionnaire (SGRQ) in 2009 and 1-year post-intervention.Pronounced improvements in respiratory HRQoL and significant reductions of household CO levels followed installation of ventilated cookstoves. Stove implementation yielded lower indoor CO values and correlated positively with improved SGRQ scores.This is the first use of a standardized respiratory HRQoL assessment to determine the impact of ventilated cookstove implementation on reducing HAP. This preliminary study utilizes the SGRQ as a valuable tool enabling analysis of these health effects in relation to other respiratory disease states.