Oct 2, 2013 geo hub workshop_air_luke naeher_final for u chile

July 22, 2013

Luke P. Naeher, Associate ProfessorEnvironmental Health Science, College of Public

HealthUniversity of Georgia

October 2, 2013Indoor air pollution in developing countries:

Challenges and opportunities in Chile and Peru

Luke P. Naeher, Profesor Asociado Ciencias de la Salud Ambiental de la Facultad de

Salud Pública de la Universidad de Georgia02 de octubre 2013

Contaminación intradomiciliaria en países en desarrollo:

desafíos y oportunidades en Chile y Perú

Outline of Presentation

1. Household Air Pollution (HAP) in the developing world – Introduction and Background

2. Our current HAP project in Ayacucho, Peru

3. Future directions of/opportunities for HAP research in Chile and Peru

Outline of Presentation

1. Household Air Pollution (HAP) in the developing world – Introduction and Background

2. Our current HAP project in Ayacucho, Peru

3. Future directions of/opportunities for HAP research in Chile and Peru

Globally, approximately 3 billion people rely on solid fuels as their main source of domestic

energy

6Picture source: WHO Household Energy Database (2010)

Household Air Pollution

Biomass smoke contains 1000s of chemicals in the form of incomplete combustion products

(Naeher et al. 2007; Smith and Mehta 2003; Smith 1987)

7

Picture source: http://burningissues.org/images/smokehouse1top-a.jpg

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DISTRIBUTION OF DISEASE BURDEN: DEVELOPING COUNTRIES

Picture source: WHO 2002

4th leading risk factor of disease burden

Health Effects Biomass smoke exposure is

associated with: Acute lower respiratory infections (ALRI),

chronic obstructive pulmonary disease (WHO 2011; Bruce et al. 2005; Orozco-Levi et al. 2006; Regalado et al. 2006).

Increasing evidence: low birth weight, asthma, acute upper

respiratory infections, tuberculosis and cataracts (McCracken et al. 2011; Naeher et al. 2007; Smith and Mehta 2003).

Emerging evidence: Oxidative stress and inflammation, adverse

respiratory health, cardiovascular disease (Banerjee et al. 2011; Adetona et al. 2011; Romieu et al. 2009; Clark et al. 2012; McCracken et al. 2011). 10

Sensitive subpopulations Women and children in developing

nations Spend more time at home and in the

kitchen1

Children < 5 years of age 56% of all indoor air pollution-attributable

deaths2

1. Smith, K. R. "Deadly Household Pollution: A Call to Action," Indoor Air 16 (2006): 2.

2. Rehfuess, E., Mehta, S., and Prüss-Üstün, A. "Assessing Household Solid Fuel Use: Multiple Implications for the Millennium Development Goals," Environmental Health Perspectives 114 (2006): 373-378.

Global Alliance for Clean Cookstoves Launched in September 2010 with the goal of installing

100 million improved stoves by the year 2020

Peru’s National Stove Program In Peru almost 93% of the rural population rely on biomass fuels for cooking and heating (INEI, 2007).

In 2009, the Peruvian government launched a “500,000 improved cookstoves national campaign for a smokeless Peru” (http://www.ityf.org.pe/en/).

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http://energy.gov/articles/department-energy-planning-cookstoves-research-releases-biomass-technical-meeting-summary: Improved cookstove in village of Santa Cruz de Lanchi, installed through Peru’s national cookstove program. | Photo credit: Ranyee Chiang, DOE

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WHO 24hr air quality guideline of 25 µg/m3

Outline of Presentation

1. Household Air Pollution (HAP) in the developing world – Introduction and Background

2. Our current HAP project in Ayacucho, Peru

3. Future directions of/opportunities for HAP research in Chile and Peru

Briefly, I will discuss one of our recent household air pollution studies from Peru, and then I will discuss our current project in Ayacucho, Peru Santiago de Chuco – HAP exposure

assessment following the installation of an improved stove with chimney

Ayacucho – HAP in homes where wood is used to fuel cooking stoves, and low birth weight in a group of over 100 pregnant women

Peru

La Libertad Region

Santiago de Chuco Province

Santiago de Chuco

0 5 10 20 km

Before Afte

r

Stove 2

48 4

8

Kitchen PM2.5 DUSTTRAK™ Aerosol Monitor

(realtime) SKC AirChek® 2000 Pump with

Cyclone (gravimetric)

Personal PM2.5 SKC AirChek® XR5000 Pump with

Cyclone

CO Drӓger Pac III

Air Sampling

Results

After three weeks of using the new stoves, reductions in indoor air pollution were seen across the board in all study communities, with: Larger reduction in Kitchen vs. Personal

Consistent with other studies

Kitchen Exposure to PM2.5

05

101520253035404550

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM

Time

mg/

m3

Pre-Intervention

Personal Exposure to CO

0102030405060708090

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM

ppm

Kitchen Exposure to CO

0102030405060708090

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM

ppm

Kitchen Exposure to PM2.5

05

101520253035404550

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM

Time

mg/

m3

Pre-Intervention

Personal Exposure to CO

0102030405060708090

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM

ppm

Kitchen Exposure to CO

0102030405060708090

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM

ppm

Home 14 – Stove 1

Kitchen Exposure to PM2.5

0102030405060708090

100

9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

Time

mg/

m3

Post-Intervention

Personal Exposure to CO

0102030405060708090

100

9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

ppm

Kitchen Exposure to CO

0102030405060708090

100

9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

ppm

Kitchen Exposure to PM2.5

0102030405060708090

100

9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

Time

mg/

m3

Post-Intervention

Personal Exposure to CO

0102030405060708090

100

9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

ppm

Kitchen Exposure to CO

0102030405060708090

100

9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

ppm

Home 14 – Stove 1

Kitchen Exposure to PM2.5

0102030405060708090

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

Time

mg/

m3

Pre-Intervention Post-Intervention

Personal Exposure to CO

0

10

20

30

40

50

60

70

80

90

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

ppm

Kitchen Exposure to CO

0102030405060708090

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

ppm

Kitchen Exposure to PM2.5

0102030405060708090

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

Time

mg/

m3

Pre-Intervention Post-Intervention

Personal Exposure to CO

0

10

20

30

40

50

60

70

80

90

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

ppm

Kitchen Exposure to CO

0102030405060708090

100

4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM 12:00 AM 4:48 AM 9:36 AM 2:24 PM 7:12 PM

ppm

Home 14 – Stove 1

Relationship between household air pollution related exposure and

birth weight in Ayacucho, Peru

Subject Recruitment Subjects were recruited by Peruvian researchers and

students through local clinics (goal: 100+ subjects) Subjects recruited after home visit Subjects had to be in third trimester of pregnancy and cook

with wood exclusively

Exposure Assessment Done by Peruvian graduate students who

were lab and field trained for two weeks Kitchen and personal CO and PM2.5

measurements CO measurement – Draeger PAC III single

gas monitor (electrochemical sensor)

PM2.5 measurement – RTI Inc. MicroPEM v 3.2 (laser photometer)

Exposure Assessment

Reasons for instrument choice Real time capabilities + gravimetry for MicroPEM Portability Wearing compliance measure (on-board MicroPEM) Capability to run for 48 hours Simple to learn (learned within two weeks in the lab and field by

Peruvian research graduate students)

Instrument operated very well within first two months Collection of measurements were mostly complete

Performance degraded over the last month of sampling Many measurements were incomplete

Exposure Assessment

Kitchen: Samplers were set up in kitchen beside cooking stoves at breathing height

Personal: Subjects wore both samplers in vests in breathing zone

Other Study Information/Data Pre- and post-exposure measurement

questionnaire Demographics Health related information Wearing compliance issues

Field notes house characteristics

Clinics: birth weight birth related information

Strengths

Both kitchen and personal exposure measurements with measure of wearing compliance

Both real time and gravimetry measurements for PM2.5

Relatively homogeneous population

Relatively wide range of exposure with same fuel type

Limitations

Incomplete exposure measurements for some subjects

Exposure measurement was conducted once and only in the third trimester

Sample size

Outline of Presentation

1. Household Air Pollution (HAP) in the developing world – Introduction and Background

2. Our current HAP project in Ayacucho, Peru

3. Future directions of/opportunities for HAP research in Chile and Peru

Heart Disease and Combustion Particle Doses

Solid FuelZone

From “Mind the Gap,” Smith/Peel, 2010 and Popeet al., 2009

0

5

10

15

20

25

30

35

0 200 400 600 800 1000

Annual mean PM2.5 - ug/m3

Hea

rt D

isea

se I

mp

act

From “Mind the Gap,” Smith/Peel, 2010 and Popeet al., 2009

Smith et al. 2011

Physician-diagnosed severe pneumonia

Plancha (Chimney)

stoveOpen fire

Kenya the jiko stove

http://hopebuilding.pbworks.com/w/page/19222589/Kenyan-stove-manufacturer-provides-energy-efficient-cooking,-encourages-tree-planting

IndiaChulah

Opportunities for future household air pollution research in Chile and Peru Investigate the implementation of super low emissions

stoves (example: gas stoves), and study:

Grant currently in review at NIH/Fogarty: TRANSFERRING ECAPACITY TO CHILE We propose to build eCapacity in Chile by developing technological capacity that

will improve the sophistication of environmental health research there. This effort will build on our current Fogarty planning grant “Planning for a Global Environmental Health

Hub in Chile” (1R24TW009545-01), a decade-long collaboration with University of Chile researchers funded by the Fogarty International Training in Environmental and Occupational Health (ITREOH) program (D43TW005746), and our current support from Fogarty through the Human Health Impacts of Climate Change program (1R21TW009032).

By e-Capacity we refer to transferring expertise from the US to Chile regarding information and communication technology (ICT) techniques and software, in particular pertaining to the areas of: exposure measurement, epidemiology, and geospatial technology tools for addressing health impacts.

We propose to teach courses and participate in collaborative research in Chile in four key areas: 1) Climate Change Research, 2) Geospatial Analysis, 3) Household Air Pollution Measurement, and 4) New Epidemiologic Methods.