HOUSEHOLD AIR POLLUTION FROM BIOMASS COOKSTOVES AND A LIQUEFIED PETROLEUM GAS INTERVENTION IN RURAL PERU
Johns Hopkins University
Problem Statement: Approximately 3 billion people worldwide, mostly from low and middle-income countries, use biomass fuels such as wood and dung for cooking. Household air pollution (HAP) from biomass cookstoves is recognized as one of the largest environmental risk factors for preventable disease. Previous interventions to reduce HAP from biomass cookstoves have shown limited health improvements. As a result, recent efforts are focusing on cleaner fuels such as liquefied petroleum gas (LPG). This dissertation aimed to 1) characterize HAP concentrations from biomass cookstoves, 2) examine the exposure-response relationships between HAP and markers of inflammation, and 3) evaluate the longitudinal impact of an LPG stove intervention on HAP. Methods: We conducted a randomized, controlled field trial with 180 female participants that use biomass cookstoves in rural Peru, randomizing half of them to receive free LPG stoves and free fuel delivery for one year. We collected kitchen area concentrations and personal exposures to carbon monoxide (CO), fine particulate matter (PM2.5) and black carbon (BC), as well as dried blood samples. In the first manuscript, we determined the associations between household characteristics and HAP at baseline. In the second manuscript, we developed exposure-response models between HAP and markers of inflammation at baseline. In the third manuscript, we assessed the longitudinal impact of the LPG stove intervention on HAP concentrations at baseline and 3-, 6- and 12-months post-intervention. Results: In our first study, we observed that roof type has an important impact in kitchen ventilation of households in rural Peru. In our second study, we found statistically significant associations between kitchen area BC concentrations and inflammatory markers that were robust to adjustment for PM2.5 concentrations. In our third study, we found that our LPG stove intervention significantly reduced PM2.5, BC, and CO concentrations by at least 62%, to levels comparable with health-based guidelines. Conclusions: HAP concentrations from biomass cookstoves in rural Peru were well above recommended guidelines. The kitchen area concentrations were associated with inflammation markers. The success of an LPG stove intervention in reducing HAP is encouraging for future LPG programs to potentially improve health in resource-limited settings such as Peru.
Cookstoves, indoor air pollution, household air pollution, personal exposure, biomass fuel, markers of inflammation, liquefied petroleum gas, rural Peru