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Personal child and mother carbon monoxide exposures and kitchen levels: Methods and results from a randomized trial of woodfired chimney cookstoves in Guatemala (RESPIRE)

Journal of Exposure Science & Environmental Epidemiology volume 20, pages 406–416 (2010)Cite this article

Abstract

During the first randomized intervention trial (RESPIRE: Randomized Exposure Study of Pollution Indoors and Respiratory Effects) in air pollution epidemiology, we pioneered application of passive carbon monoxide (CO) diffusion tubes to measure long-term personal exposures to woodsmoke. Here we report on the protocols and validations of the method, trends in personal exposure for mothers and their young children, and the efficacy of the introduced improved chimney stove in reducing personal exposures and kitchen concentrations. Passive diffusion tubes originally developed for industrial hygiene applications were deployed on a quarterly basis to measure 48-hour integrated personal carbon monoxide exposures among 515 children 0-18 months of age and 532 mothers aged 15-55 years and area samples in a subsample of 77 kitchens, in households randomized into control and intervention groups. Instrument comparisons among types of passive diffusion tubes and against a continuous electrochemical CO monitor indicated that tubes responded nonlinearly to CO, and regression calibration was used to reduce this bias. Before stove introduction, the baseline arithmetic (geometric) mean 48-h child (n=270), mother (n=529) and kitchen (n=65) levels were, respectively, 3.4 (2.8), 3.4 (2.8) and 10.2 (8.4) p.p.m. The between-group analysis of the 3355 post-baseline measurements found CO levels to be significantly lower among the intervention group during the trial period: kitchen levels: −90%; mothers: −61%; and children: −52% in geometric means. No significant deterioration in stove effect was observed over the 18 months of surveillance. The reliability of these findings is strengthened by the large sample size made feasible by these unobtrusive and inexpensive tubes, measurement error reduction through instrument calibration, and a randomized, longitudinal study design. These results from the first randomized trial of improved household energy technology in a developing country and demonstrate that a simple chimney stove can substantially reduce chronic exposures to harmful indoor air pollutants among women and infants.

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References

  • Albalak R., and Bruce N., et al. Indoor respirable particulate matter concentrations from an open fire, improved cookstove, and LPG/open fire combination in a rural Guatemalan community. Environ Sci Technol 2001: 35 (13): 2650–2655.

    Article  CAS  Google Scholar 

  • Amendariz-Arnez C., and Edwards R.D., et al. 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. Indoor Air 2008: 18: 93–105.

    Article  Google Scholar 

  • Bhangar S., and Smith K.R., et al. The contribution of stove type to the variability in CO concentration in households in rural Maharashtra, India. International Society of Exposure Science, Annual Meeting, Philadelphia 2004.

    Google Scholar 

  • Bruce N., and McCracken J., et al. Impact of improved stoves, house construction and child location on levels of indoor air pollution exposure in young Guatemalan children. J Expo Anal Environ Epidemiol 2004: 14 (Suppl 1): S26–S33.

    Article  CAS  Google Scholar 

  • Bruce N., and Weber M., et al. Pneumonia case-finding in the Guatemala indoor air pollution trial (RESPIRE): standardizing methods for resource-poor settings. Bulletin of the WHO 2007: 85 (7): 535–544.

    Google Scholar 

  • Chengappa C., Bajpai R., Gusain P.P.S., Edwards R.D., Naumoff Shields K., and Smith K.R. Impact of improved cookstoves on indoor air quality in the Bundelkhand Region in India. Energy Sustainable Dev 2007: XI (2): 33–44.

    Article  Google Scholar 

  • Delfino R.J., and Quintana P.J., et al. Association of FEV1 in asthmatic children with personal and microenvironmental exposure to airborne particulate matter. Environ Health Perspect 2004: 112 (8): 932–941.

    Article  CAS  Google Scholar 

  • Dherani M., and Pope D., et al. Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under 5 years: a systematic review and meta-analysis. Bulletin of the WHO 2008: 86 (5): 390–398.

    Google Scholar 

  • Dutta K., Naumoff Shields K., Edwards R.D., and Smith K.R. Impact of improved cookstoves on indoor air quality in rural homes near Pune, India. Energy Sustainable Dev 2007: XI (2): 19–32.

    Article  Google Scholar 

  • Eilers P.H.C., and Marx B.D. Flexible smoothing using B-splines and penalized likelihood. Statistical Science 1996: 11 (2): 89–121.

    Article  Google Scholar 

  • Hruba F., and Fabianova E., et al. Childhood respiratory symptoms, hospital admissions, and long-term exposure to airborne particulate matter. J Expo Anal Environ Epidemiol 2001: 11 (1): 33–40.

    Article  CAS  Google Scholar 

  • Masera O.R., Edwards R.D., Armendáriz Arnez C., Berrueta V., Johnson M., Rojas Bracho L., Riojas-Rodríguez H., and Smith K.R. Impact of “Patsari” improved cookstoves on indoor air quality in Michoacan, Mexico. Energy Sustainable Dev 2007: XI (2): 45–56.

    Article  Google Scholar 

  • McCracken J.P., and Albalak R., et al. Improved stove or inter-fuel substitution for decreasing indoor air pollution from cooking with biomass fuels in highland Guatemala. Indoor Air 1999: 3: 118–123.

    Google Scholar 

  • McCracken J.P., and Schwartz J., et al. Combining individual- and group-level exposure information: child carbon monoxide in the Guatemala woodstove randomized control trial (RESPIRE). Epidemiology 2009: 20 (1): 127–136.

    Article  Google Scholar 

  • McCracken J.P., and Smith K.R. Emissions and efficiency of improved woodburning cookstovs in highland Guatemala. Environ Int 1998: 24 (7): 739–747.

    Article  Google Scholar 

  • Mehta S., and Gore F., et al. Modeling household fuel use toward reporting of the Millennium Development Goal indicator. Energy for Sustainable Development 2006: 10 (3): 36–45.

    Article  Google Scholar 

  • Naeher L.P., and Brauer M., et al. Woodsmoke health effects: a review. Inhal Toxicol 2007: 19 (1): 67–106.

    Article  CAS  Google Scholar 

  • Naeher L.P., and Leaderer B.P., et al. 2000a Particulate matter and carbon monoxide in highland Guatemala: indoor and outdoor levels from traditional and improved wood stoves and gas stoves. Indoor Air 10 (3): 200–205.

    Article  CAS  Google Scholar 

  • Naeher L.P., and Smith K.R., et al. 2000b Indoor and outdoor PM2.5 and CO in high- and low-density Guatemalan villages. J Expo Anal Environ Epidemiol 10 (6 Part 1): 544–551.

    Article  CAS  Google Scholar 

  • Naeher L.P., and Smith K.R., et al. Carbon monoxide as a tracer for assessing exposures to particulate matter in wood and gas cookstove households of highland Guatemala. Environ Sci Technol 2001: 35 (3): 575–581.

    Article  CAS  Google Scholar 

  • Saksena S., and Thompson L., et al. Indoor Air Pollution and Exposure Database: Household Measurements in Developing Countries. V1.1. Retrieved Apr 18 2009 from http://ehs.sph.berkeley.edu/hem/page.asp?id=33, 2003.

  • Sarnat J.A., and Long C.M., et al. Using sulfur as a tracer of outdoor fine particulate matter. Environ Sci Technol 2002: 36 (24): 5305–5314.

    Article  CAS  Google Scholar 

  • Smith K.R. Biofuels, Air Pollution, and Health: A Global Review. Plenum, New York, 1987.

    Google Scholar 

  • Smith K.R., and Bruce N., et al. Symposium: RESPIRE- the Guatemala Stove Intervention Trial. Epidemiology 2006: 17 (6): S44–S46.

    Article  Google Scholar 

  • Smith K.R., and Mehta S., et al. Indoor smoke from household solid fuels. In: Ezzati, M.R., Lopez, A., Murray, C. (Eds.). Comparative quantification of health risks: Global and regional burden of disease due to selected major risk factors. World Health Organization, Geneva, 2004.

    Google Scholar 

  • Smith K.R., and Samet J.M., et al. Indoor air pollution in developing countries and acute lower respiratory infections in children. Thorax 2000: 55 (6): 518–532.

    Article  CAS  Google Scholar 

  • Venkataraman C., and Maithel S., et al. Biomass-fuel Technologies for Cooking. In: Banerjee, R., Sagar, A. and Smith, K.R. (Eds.). Development Benefits of Clean Energy in India. Indian Institute of Technology, Mumbai, 2007.

    Google Scholar 

  • WHO. Air Quality Guidelines. Global Update 2005. Particulate matter, ozone, nitrogen dioxide and sulfur dioxide, World Health Organization, Copenhagen, 2006.

  • Zanobetti A., and Schwartz J., et al. Airborne particles are a risk factor for hospital admissions for heart and lung disease. Environ Health Perspect 2000: 108 (11): 1071–1077.

    Article  CAS  Google Scholar 

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Acknowledgements

We are grateful for the dedication and cooperation of all study participants as well as colleagues, staff and fieldworkers of RESPIRE, particularly Aura Morales, Anaité Díaz and Byron Arana. We acknowledge also valuable advice for this paper from Joel Schwarz, Ryan Johnson, Barry Ryan and Alisa Jenny. We appreciate the cooperation of the Guatemala Ministry of Health and funding by the US National Institute of Environmental Health Sciences (NIEHS no. R01ES010178), the World Health Organization, Geneva and the AC Griffin Family Trust.

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Authors and Affiliations

  1. Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA

    Kirk R Smith, John P Mccracken, Lisa Thompson & Kyra N Shields

  2. Department of Epidemiology, School of Medicine, University of California, Irvine, California, USA

    Rufus Edwards

  3. Centro de Estudios en Salud, Universidad del Valle, Guatemala City, Guatemala

    Eduardo Canuz

  4. Division of Public Health, University of Liverpool, Liverpool, England

    Nigel Bruce

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  1. Kirk R Smith
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Correspondence to Kirk R Smith.

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Smith, K., Mccracken, J., Thompson, L. et al. Personal child and mother carbon monoxide exposures and kitchen levels: Methods and results from a randomized trial of woodfired chimney cookstoves in Guatemala (RESPIRE). J Expo Sci Environ Epidemiol 20, 406–416 (2010). https://doi.org/10.1038/jes.2009.30

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