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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
8
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/).
13
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
14
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.