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8/2/2019 Kirstie Jagoe and Gaia Association Presents on WB Madagascar Study at 13th World Congress on Public Health
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Ethanol as a Household Fuel in
Madagascar
Kirstie Jagoe
13th World Congress on Public Health
Addis Ababa
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Overview
The challenge
Aim of study
Study sites and design
Methods of data collection
ResultsStove use and perceptions
Impacts on household air pollution
Impacts on personal exposure levelsHealth related impacts
Conclusions
Next steps
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The Challenge
80% natural forested areas
have been lost.
If rate of forest reductions
remains at current rate all
forests will be lost in 40 years.95% of households rely on
woody biomass- primarily fuel
wood and charcoal for their
household energy.
Huge public health impact-
particularly for women and
children
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Aim of the study
To evaluate the health and socio-economic impacts
of ethanol as a household cooking fuel and
alternative interventions in the context Madagascar.
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Study sites
Ambositra
Vatomandry
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Overview of study design
11 months 12 months 16 months
Control
Awareness only
Charcoal
Ethanol
Wood
INT
Round 2monitoring
Wet
Round 3monitoring
Dry
Baselinemonitoring
Wet
Approximately 30 HH in each intervention group
Each group received the awareness raising
information except the control group
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Intervention stoves and fuels
Charcoal stove
Ethanol (Cleancook)Fantana pipa wood stove
Ethanol fuel
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Methods of data collection
Questionnaire collected information on
Demographic characteristics
Aspects related to stove and fuel use
Health symptoms and perceptions
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Indoor Air Pollution Monitoring
Household kitchenconcentrations of fineparticulate matter
(PM2.5) and carbonmonoxide (CO)measured in kitchenarea.
Monitoring periodslasted 24 hours
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Personal Exposure Monitoring
24hr measurements of CO in main cook and on onechild
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Personal Exposure Monitoring
PM2.5 best measure of combustion-related healthdamaging pollutants but expensive and difficult tomonitor.
Relationship between PM2.5 and CO variesbetween different fuel/stove combinations
Used kitchen PM2.5 and CO to derive fuel specific
regression equations. Used these equations to predict PM2.5 exposure
from individuals CO monitor.
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Results
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Ventilation and location in kitchens
0
1020
30
40
50
60
70
8090
100
Enclosed Semi-open
Percentage
Ambositra
Vatomandry
Kitchen Ambositra (%) Vatomandry (%)In building separate from house 6.3 54.4
Separate kitchen attached to house 44.8 18.9
Kitchen in living area of house 49.0 26.7
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Stove use patterns: Primary Stove
Stove Intervention Groups
Ethanol Charcoal Wood
Ambositra Round 2 80% (n=26) 90% (n=28) -
Round 3 97% (n=30) 100% (n=31) -
Vatomandry Round 2 91% (n=29) 91% (n=29) 100% (n=33)
Round 3 77% (n=24) 100% (n=30) 94% (n=31)
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Stove use patterns: Secondary Stove
Stove Intervention Groups
Ethanol Charcoal Wood
Ambositra Round 2 84% (n=27) 52% (n=16) -
Round 3
81% (n=25) 42% (n=13) -Vatomandry Round 2 75% (n=24) 47% (n=15) 42% (n=14)
Round 3 84% (n=26) 27% (n=8) 36% (n=12)
Higher proportion of secondary stove use in the ethanolgroup- No real difference between sites.
After 5 months no-one had abandoned their ethanolstove
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Impacts on Air Pollution
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Impacts on Air Pollution: Vatomandry
24-hr average kitchen CO (ppm)
0
10
20
30
40
50
60
70
80
90
100
Ethanol (All) Imp. Wood Imp. Charcoal Awar. Raising Only (All) Control (All)
1 2 3 1 2 3 1 2 3 1 2 3 1 2 3
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HAP reductions in ethanol group
Baseline Fuel Ambositra
CO (ppm) PM2.5(ug/m3)
Base Round 3 % change Base Round 3 % change
Charcoal42 (30) 8(9) -79% 389(489) 142(83) -57%
Baseline Fuel Vatomandry
CO (ppm) PM2.5(ug/m3)
Base Round 3 %change
Base Round 3 %change
Wood 14(21) 1(1) -93% 665(500) 98(55) -85%
Charcoal 15(26) 0.7(1) -93% 251(226) 89 (56) -72%
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Impact on Personal Exposure
Lack of precision and smallrange of CO made results insome groups unreliable
Regression equations used topredict mothers/childs
exposure to PM2.5 for
All groups in Ambositra
Wood stove interventiongroup only in Vatomandry
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Baseline personal exposure
For adults the overall levels of personal exposure to CO
were much higher in Ambostira (8.45ppm (4.64-14.7))
compared to Vatomandry ( 0.82ppm (0.42-1.65)
Consistent with kitchen levels and household design.
VatomandryAmbositra
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Impacts on personal exposure: Vatomandry
AdultsVatomandry had much
lower levels of exposure
than Ambositra
Reductions in CO 45%-wood stove and 54%
ethanol.
Reductions in predicted
PM2.5 relative to controls
60% in wood stove group.
ChildrenRelative to the control
group; 30% reduction in
wood group. 14% (non-
sig) reduction in ethanol.Small reduction could
be due to the fact that
the CO levels were very
low at start of study inthis community.
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Perceptions of stoves
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Perceptions of ethanol stove
Round 2It is clean (56.2%
Ambositra and 40.6% in
Vatomandry)
It saves time (40.6%Ambositra, 34.3%
Vatomandry)
It is easy to use (50.0%(n=16) Ambositra).
Makes life easier 53.1%
in Vatomandry
Round 3 Good impacts on their
daily lives (100%)
Key percieved
advantages of ethanolstove;
Ease of use
Time saved incooking
Clean kitchen
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Health Impacts
Photo: Courtesy Don ONeil HELPS
International
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Baseline health status
For the women, the level of chronic respiratorysymptoms (chronic cough and phlegm),
reported by 20% of wood users.
Headache and eye irritation common.
Burns and scalds to cooks common.
One-quarter of parents reported child 10cm.
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Health Impacts: Ambositra
In the ethanol group, compared to the control group
likelihood of reporting headaches reduced by 93%
(p
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Health Impacts: Vatomandry
All three intervention stoves reduced the prevalence
of headache and eye irritation, with the overall
strongest effects for the ethanol group.
In the ethanol group, the likelihood of reporting
headaches was reduced by 87% (p
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Summary and conclusions
Cleancook ethanol stove performed well, was used
consistently and substantially reduced household air
pollution and personal exposure levels.
Ethanol stove reduced symptoms and burns in
adults but reduction in burns not detectable inchildren.
Locally produced Fantana Pipa wood stove is very
promising as interim household energy
improvement- but needs further design adaptationsand rigorous laboratory testing
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