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Household air pollution: a call to action

2015; Elsevier BV; Volume: 3; Issue: 1 Linguagem: Inglês

10.1016/s2213-2600(14)70288-7

2213-2619

Alison Lee, P R O C Adobamen, Orighomisan Agboghoroma, Fahmi Oumer Ahmed, Adesuwa Queen Aigbokhaode, Ganiyu Adeniyi Amusa, Euripide Frinel G Arthur Avokpaho, Babatunde Awokola, Joy N. Ibeh, Godsent Isiguzo, Jacqueline Kagima, Bankole Peter Kuti, Hervé Lawin, Norman Lufesi, Ndubuisi Mokogwu, Esther Ngadaya, Motto Nganda, Ogonna Nwankwo, Perpetua O. Obiajunwa, Sunday Omokiniovo Oghuvwu, Obianuju B. Ozoh,

Hybrid Renewable Energy Systems

Evidence is mounting that household air pollution is a serious global public health concern, particularly in Africa. As discussed by Gordon and colleagues,1Gordon SB Bruce NG Grigg J et al.Respiratory risks from household air pollution in low and middle income countries.Lancet Respir Med. 2014; 2: 823-860Summary Full Text Full Text PDF PubMed Scopus (520) Google Scholar household air pollution caused by burning of solid fuels accounts for 3·5 million to 4 million premature deaths per year worldwide. Africa, a continent with 13% of the world's population, disproportionately bears 32% of the total attributable burden of disease.2WHOThe world health report 2002. Reducing risks, promoting healthy life. World Health Organization, Geneva2002Google Scholar Early life exposure to household air pollution has been linked to a range of adverse child health outcomes, including low birth weight and pneumonia.1Gordon SB Bruce NG Grigg J et al.Respiratory risks from household air pollution in low and middle income countries.Lancet Respir Med. 2014; 2: 823-860Summary Full Text Full Text PDF PubMed Scopus (520) Google Scholar Continued exposure can lead to chronic obstructive pulmonary disease, lung cancer, and cardiovascular disease.Burning of solid fuels emits a complex mixture of particulate matter less than 2·5 μm in diameter and gases. Convincing evidence exists that links this particulate matter to adverse health effects.3WHO Regional Office for EuropeHealth effects of particulate matter: policy implications for countries in eastern Europe, Caucasus and central Asia. World Health Organization, Denmark2013Google Scholar Personal assessments of exposure to this particulate matter, although deemed the gold standard, need expensive equipment and substantial technical skills and laboratory support. Quality exposure monitoring is necessary to adequately assess personal exposure, define dose–response relationships, and establish the existence and timing of critical and sensitive exposure periods. These data are imperative to establish whether existing, cheap cookstove interventions that offer modest exposure reductions are sufficient, or if expensive interventions that provide large exposure reductions are needed to measurably improve health outcomes.Large, randomised cookstove intervention trials with high-quality, quantitative exposure monitoring assessments are underway in Ghana (NCT01335490) and Malawi to begin to understand dose–response relationships and further define health effects. Studies from other African countries, however, are desperately needed. Regional and temporal differences in cooking practices, ventilation, and fuel type probably alter both the intensity and composition of household air pollution exposure, thereby affecting dose–response relationships and health outcomes. Data from the two large, well-designed cookstove intervention trials in Ghana and Malawi are crucially important, but might not be representative of household air pollution exposure across Africa. More quality data are needed than are currently available.Household air pollution affects the poorest households that are unable to afford clean, efficient cooking practices. Research findings need to translate into public health cookstove distribution policies that allow all households to access clean fuels, not just those that can afford them. This initiation of widespread public health policy will need strong relationships with governmental bodies and an intricate knowledge of local and national governments and cultures. In this regard, African researchers, who frequently have longstanding relationships with their government's Ministry of Health, are uniquely qualified to ensure that these policy changes occur.At the 2014 American Thoracic Society Methods in Epidemiologic, Clinical, and Operations Research conference,4American Thoracic SocietyMethods in Epidemiologic, Clinical and Operations Research (MECOR).http://www.thoracic.org/global-health/mecor-coursesGoogle Scholar African researchers expressed strong interest in investigation of the health effects of household air pollution exposure. 20 researchers representing seven African countries developed exciting research protocols that have the potential to make substantial contributions to the household air pollution literature and, most importantly, public health policy. However, because of the absence of exposure monitoring equipment, technical skills, and laboratory support needed for quality exposure assessments, these researchers face substantial barriers.Without any intervention, 2·7 billion people will be reliant on biomass fuels by 2030.5International Energy AgencyWorld energy outlook 2006. Organisation for Economic Co-operation and Development, Paris2006Google Scholar In view of the enormous burden of disease and the crucial need for quality exposure data, we call on the international scientific biomedical community, along with potential funders, to convene and form partnerships with these and other promising African researchers. Existing research centres, such as those in Ghana and Malawi, should be leveraged to build centres of excellence to train and supervise burgeoning African research sites. Provision of monitoring equipment and on-the-ground technical training and support would build desperately needed capacity and allow African researchers to lead research and public health efforts to combat the devastating health effects of household air pollution.HL, JI, BPK, NM, NL, EN, ONN, GI, EA, GAA, PROCA, AA, BA, OA, OO, SO, and PO report grants from the UK Medical Research Council and the UK Department for International Development (BREATHE Partnership Grant). AL reports grants from the Thrasher Research Fund, the Chest Foundation, and the Respiratory Health Association. MMN, JK, and FOA declare no competing interests. Evidence is mounting that household air pollution is a serious global public health concern, particularly in Africa. As discussed by Gordon and colleagues,1Gordon SB Bruce NG Grigg J et al.Respiratory risks from household air pollution in low and middle income countries.Lancet Respir Med. 2014; 2: 823-860Summary Full Text Full Text PDF PubMed Scopus (520) Google Scholar household air pollution caused by burning of solid fuels accounts for 3·5 million to 4 million premature deaths per year worldwide. Africa, a continent with 13% of the world's population, disproportionately bears 32% of the total attributable burden of disease.2WHOThe world health report 2002. Reducing risks, promoting healthy life. World Health Organization, Geneva2002Google Scholar Early life exposure to household air pollution has been linked to a range of adverse child health outcomes, including low birth weight and pneumonia.1Gordon SB Bruce NG Grigg J et al.Respiratory risks from household air pollution in low and middle income countries.Lancet Respir Med. 2014; 2: 823-860Summary Full Text Full Text PDF PubMed Scopus (520) Google Scholar Continued exposure can lead to chronic obstructive pulmonary disease, lung cancer, and cardiovascular disease. Burning of solid fuels emits a complex mixture of particulate matter less than 2·5 μm in diameter and gases. Convincing evidence exists that links this particulate matter to adverse health effects.3WHO Regional Office for EuropeHealth effects of particulate matter: policy implications for countries in eastern Europe, Caucasus and central Asia. World Health Organization, Denmark2013Google Scholar Personal assessments of exposure to this particulate matter, although deemed the gold standard, need expensive equipment and substantial technical skills and laboratory support. Quality exposure monitoring is necessary to adequately assess personal exposure, define dose–response relationships, and establish the existence and timing of critical and sensitive exposure periods. These data are imperative to establish whether existing, cheap cookstove interventions that offer modest exposure reductions are sufficient, or if expensive interventions that provide large exposure reductions are needed to measurably improve health outcomes. Large, randomised cookstove intervention trials with high-quality, quantitative exposure monitoring assessments are underway in Ghana (NCT01335490) and Malawi to begin to understand dose–response relationships and further define health effects. Studies from other African countries, however, are desperately needed. Regional and temporal differences in cooking practices, ventilation, and fuel type probably alter both the intensity and composition of household air pollution exposure, thereby affecting dose–response relationships and health outcomes. Data from the two large, well-designed cookstove intervention trials in Ghana and Malawi are crucially important, but might not be representative of household air pollution exposure across Africa. More quality data are needed than are currently available. Household air pollution affects the poorest households that are unable to afford clean, efficient cooking practices. Research findings need to translate into public health cookstove distribution policies that allow all households to access clean fuels, not just those that can afford them. This initiation of widespread public health policy will need strong relationships with governmental bodies and an intricate knowledge of local and national governments and cultures. In this regard, African researchers, who frequently have longstanding relationships with their government's Ministry of Health, are uniquely qualified to ensure that these policy changes occur. At the 2014 American Thoracic Society Methods in Epidemiologic, Clinical, and Operations Research conference,4American Thoracic SocietyMethods in Epidemiologic, Clinical and Operations Research (MECOR).http://www.thoracic.org/global-health/mecor-coursesGoogle Scholar African researchers expressed strong interest in investigation of the health effects of household air pollution exposure. 20 researchers representing seven African countries developed exciting research protocols that have the potential to make substantial contributions to the household air pollution literature and, most importantly, public health policy. However, because of the absence of exposure monitoring equipment, technical skills, and laboratory support needed for quality exposure assessments, these researchers face substantial barriers. Without any intervention, 2·7 billion people will be reliant on biomass fuels by 2030.5International Energy AgencyWorld energy outlook 2006. Organisation for Economic Co-operation and Development, Paris2006Google Scholar In view of the enormous burden of disease and the crucial need for quality exposure data, we call on the international scientific biomedical community, along with potential funders, to convene and form partnerships with these and other promising African researchers. Existing research centres, such as those in Ghana and Malawi, should be leveraged to build centres of excellence to train and supervise burgeoning African research sites. Provision of monitoring equipment and on-the-ground technical training and support would build desperately needed capacity and allow African researchers to lead research and public health efforts to combat the devastating health effects of household air pollution. HL, JI, BPK, NM, NL, EN, ONN, GI, EA, GAA, PROCA, AA, BA, OA, OO, SO, and PO report grants from the UK Medical Research Council and the UK Department for International Development (BREATHE Partnership Grant). AL reports grants from the Thrasher Research Fund, the Chest Foundation, and the Respiratory Health Association. MMN, JK, and FOA declare no competing interests. Respiratory risks from household air pollution in low and middle income countriesA third of the world's population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5–4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. Full-Text PDF