Indoor Air Quality Updates
The Use of Behaviour Change Techniques in Clean Cooking Interventions to Achieve Health, Economic and Environmental Impact
The Use of Behaviour Change Techniques in Clean Cooking Interventions to Achieve Health, Economic
and Environmental Impact: A review of the evidence and scorecard of effectiveness, 2014. (Executive summary)
Authors: Nicholas J. Goodwin, Sarah Ellen O’Farrell, Kirstie Jagoe, et al.
The aim of this study was to review the use of behaviour change approaches in clean cooking interventions in resource-poor settings. Using publicly available data, the report synthesises the evidence of the use of behaviour change techniques (BCTs) for human and environmental outcomes and impact. The report includes a set of case studies on selected interventions that use BCTs and applies a scorecard to assess the effectiveness of each intervention’s approach to behaviour change. The report then discusses the findings from the review and case studies and includes a set of recommendations for the clean cooking sector to consider. A planned task was to compare interventions through an economic return on investment (cost-benefit) lens, however the availability and consistency of data did not make this possible.
Behavioral Attitudes and Preferences in Cooking Practices with Traditional Open-Fire Stoves in Peru, Nepal, and Kenya
Behavioral Attitudes and Preferences in Cooking Practices with Traditional Open-Fire Stoves in Peru, Nepal, and Kenya: Implications for Improved Cookstove Interventions. Int. J. Environ. Res. Public Health 2014, 11(10).
Authors: Evelyn L. Rhodes, Robert Dreibelbis, Elizabeth M. Klasen, et al.
Global efforts are underway to develop and promote improved cookstoves which may reduce the negative health and environmental effects of burning solid fuels on health and the environment. Behavioral studies have considered cookstove user practices, needs and preferences in the design and implementation of cookstove projects; however, these studies have not examined the implications of the traditional stove use and design across multiple resource-poor settings in the implementation and promotion of improved cookstove projects that utilize a single, standardized stove design.
We conducted in-depth interviews and direct observations of meal preparation and traditional, open-fire stove use of 137 women aged 20–49 years in Kenya, Peru and Nepal prior in the four-month period preceding installation of an improved cookstove as part of a field intervention trial. Despite general similarities in cooking practices across sites, we identified locally distinct practices and norms regarding traditional stove use and desired stove improvements. Traditional stoves are designed to accommodate specific cooking styles, types of fuel, and available resources for maintenance and renovation. The tailored stoves allow users to cook and repair their stoves easily. Women in each setting expressed their desire for a new stove, but they articulated distinct specific alterations that would meet their needs and preferences.
Improved cookstove designs need to consider the diversity of values and needs held by potential users, presenting a significant challenge in identifying a “one size fits all” improved cookstove design. Our data show that a single stove design for use with locally available biomass fuels will not meet the cooking demands and resources available across the three sites. Moreover, locally produced or adapted improved cookstoves may be needed to meet the cooking needs of diverse populations while addressing health and environmental concerns of traditional stoves.
Household Air Pollution Causes Dose-dependent Inflammation and Altered Phagocytosis in Human Macrophages.
Household Air Pollution Causes Dose-dependent Inflammation and Altered Phagocytosis in Human Macrophages. Am J Respir Cell Mol Biol. 2014 Sep 25.
Authors: Rylance J1, Fullerton DG, Scriven J, Aljurayyan AN, Mzinza D, Barrett S, Wright AK, Wootton DG, Glennie SJ, Baple K, Knott A, Mortimer K, Russell DG, Heyderman RS, Gordon SB.
1Liverpool School of Tropical Medicine, Respiratory Infection , Pembroke Place , Liverpool, United Kingdom, L3 5QA , 0044 1517053712 , Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi, University of Liverpool, Respiratory Medicine, University Hospital Aintree, Liverpool, United Kingdom ; email@example.com.
Background – Three billion people are exposed to household air pollution from biomass fuel use. Exposure is associated with higher incidence of pneumonia, and possibly tuberculosis. Understanding mechanisms underlying these defects would improve preventive strategies.
Methods – We used human alveolar macrophages obtained from healthy Malawian adults exposed naturally to household air pollution, and compared with human monocyte-derived macrophages exposed in vitro to respirable-sized particulates. Cellular inflammatory response was assessed by: IL-6 and IL-8 production in response to particulate challenge; phagocytosis of fluorescent-labelled beads and intraphagosomal oxidative burst capacity; ingestion and killing of Streptococcus pneumoniae and Mycobacterium tuberculosis measured by microscopy and quantitative culture. Particulate ingestion was quantified by digital image analysis.
Results – We were able to reproduce the carbon loading of naturally exposed alveolar macrophages by in vitro exposure of monocyte derived macrophages. Fine carbon black induced IL-8 release from monocyte derived and alveolar macrophages (p<0.05), with similar magnitude responses (log10 increases of 0.93 [SEM 0.2] vs 0.74 [SEM 0.19] respectively). Phagocytosis of pneumococci and mycobacteria was impaired with higher particulate loading. High particulate loading corresponded with a lower oxidative burst capacity (p=0.0015). There was no overall effect on killing of M. tuberculosis.
Conclusion Alveolar macrophage function is altered by particulate loading. Our macrophage model is comparable morphologically to the in vivo uptake of particulates. Wood smoke exposed cells demonstrate reduced phagocytosis but unaffected mycobacterial killing, suggesting defects related to chronic wood smoke inhalation limited to specific innate immune functions.
Impacts of household energy programs on fuel consumption in Benin, Uganda, and India. Energy for Sustainable Development, Available online 16 September 2014, In Press, Corrected Proof — Note to users
Charity Garland-a, Kirstie Jagoe-a, Emmy Wasirwa-b, Raphael Nguyen-c, Christa Roth-d, Ashwin Patel-e, Nisha Shah-f, Elisa Derby-g, John Mitchell-h, David Pennise-a, Michael A. Johnson-a,
a Berkeley Air Monitoring Group, 2124 Kittredge St #57, Berkeley, CA 94704, USA
b Wana Energy Solutions, Uganda
c Gesellschaft für Internationale Zusammenarbeit (GIZ), FABEN Project, Benin
d Food and Fuel Consultants, Germany
e Alpha Renewable Energy, Pvt. Ltd., India
f Self Employed Women’s Association, India
g Winrock International, USA
h United States Environmental Protection Agency, USA
This paper presents results of three United States Environmental Protection Agency (U.S. EPA) sponsored field studies which assessed the fuel consumption impacts of household energy programs in Benin, Uganda, and Gujarat, India. These studies expand on a previous round of U.S. EPA supported efforts to build field testing capacity and collect stove performance data in Peru, Nepal, and Maharashtra, India. Daily fuel consumption estimates of traditional and intervention technologies were made using the Kitchen Performance Test (KPT) protocol to determine the potential fuel savings associated with the respective programs.
The programs in Benin and Gujarat, India resulted in significant fuel savings of approximately 29% and 61%, respectively. In Uganda, the homes using liquefied petroleum gas (LPG) consumed approximately 31% less charcoal than those not using LPG, although the total energy consumption per household was similar between the baseline and LPG user groups.
Published on Sep 16, 2014 – http://www.24Hoursofreality.org. Watch to see how a simple solution can improve life for the nearly 3 billion people who rely on wood- or coal-powered open cookstoves, and reduce carbon pollution along the way.
We are pleased to announce the upcoming Q&A session next Tuesday-Wednesday, brought to you by Clean Stove Initiative and WASHplus!
A biochar-producing, dung-burning cookstove for humanitarian purposes. Humanitarian Technology: Science, Systems and Global Impact, 2014, HumTech2014
Cristian Birzer*, Paul Medwell, Gregory MacFarlane, Matthew Read, Josh Wilkey, Matthew Higgins, Tomas West
The School of Mechanical Engineering, The University of Adelaide, Adelaide, 5005, Australia
Over three billion people worldwide cook with traditional stoves, which typically consist of three stones and an open fire. The harmful emissions produced from these types of stoves are known to cause fatal illnesses. Traditional stoves claim the lives of up to 4 million people every year and cause the death of more children under the age of five than any other single cause. In addition, widespread land degradation and deforestation have resulted from inefficient fuel consumption of traditional stoves. In order to address these issues, investigations into the use of dung-burning top-lit up-draft (TLUD) microgasifier cookstoves, that produces biochar as a byproduct, have been conducted at the University of Adelaide. Results indicate that dung from various grazing
animals burnt in the TLUD stove have similar heating properties, implying that the stove is applicable to a wide client-base. Additionally, biochar from cow-dung combustion is as good, if not better than some commercially available biochar.
Household air pollution and lung cancer in China: a review of studies in Xuanwei. Chinese Journal of Cancer, Ahead of Print, Sept 2014. DOI: 10.5732/cjc.014.10132
Authors: Wei Jie Seow, Wei Hu, Roel Vermeulen, et al.
Over half of the world’s population is exposed to household air pollution from the burning of solid fuels at home. Household air pollution from solid fuel use is a leading risk factor for global disease and remains a major public health problem, especially in low- and mid-income countries. This is a particularly serious problem in China, where many people in rural areas still use coal for household heating and cooking.
This review focuses on several decades of research carried out in Xuanwei County, Yunnan Province, where household coal use is a major source of household air pollution and where studies have linked household air pollution exposure to high rates of lung cancer. We conducted a series of case-control and cohort studies in Xuanwei to characterize the lung cancer risk in this population and the factors associated with it. We found lung cancer risk to vary substantially between different coal types, with a higher risk associated with smoky (i.e., bituminous) coal use compared to smokeless (i.e., anthracite) coal use.
The installation of a chimney in homes resulted in a substantial reduction in lung cancer incidence and mortality. Overall, our research underscores the need among existing coal users to improve ventilation, use the least toxic fuel possible, and eventually move toward the use of cleaner fuels, such as gas and electricity.
Published on Sep 3, 2014
Dr. Bing Gu was interviewed at the Sacramento Solar Cooking Festival sponsored by Solar Cookers International. His Fresnel lens solar thermal cooking device can reach 600 degrees F, can track the sun and can store heat for nighttime cooking. He is seeking investors so California Sunlight can begin mass production.
Published on Sep 22, 2014 – Under the direction of physics professor Dr. Peter Schwartz, a team of physics and engineering students at Cal Poly San Luis Obispo in California are conducting research on solar parabolic reflector technologies that could be used by people in developing countries to heat water and cook food using only the light of the sun. They are also researching hybrid technologies that combine the use of a solar reflector and a rocket stove for uninterrupted indoor cooking.
Children’s Respiratory Health After an Efficient Biomass Stove (Patsari) Intervention. Ecohealth. 2014 Sep 9.
Authors: Schilmann A1, Riojas-Rodríguez H, Ramírez-Sedeño K, Berrueta VM, Pérez-Padilla R, Romieu I.
1Environmental Health Department, National Institute of Public Health (INSP), Av. Universidad 655, Santa María Ahuacatitlán, 62100, Cuernavaca, Morelos, Mexico.
Household use of fuelwood represents a socio-ecological condition with important health effects mainly in rural areas from developing countries. One approach to tackle this problem has been the introduction of efficient wood-burning chimney stoves. The aim of this study was to assess the impact of the introduction of Patsari stoves on the respiratory health of young children in highlands Michoacán, Mexico. A total of 668 households in six rural communities in a fuelwood using region were selected and randomized to receive an improved stove (Patsari) or rely entirely on the traditional wood fire until the end of the follow-up including 10 monthly visits.
Adherence to the intervention was variable over the follow-up time. The actual use of the Patsari stove as reported by the mother showed a protective effect mainly on the upper and lower respiratory infection duration (IRR URI 0.79, 95% CI 0.70-0.89, and LRI 0.41, 95% CI 0.21-0.80) compared to households that used only an open fire. Fewer days of child’s ill health represents saved time for the woman and avoided disease treatment costs for the family, as well as a decrease in public health costs due to a reduction in the frequency of patient visits.
Results of Laboratory Testing of 15 Cookstove Designs in Accordance with the ISO/IWA Tiers of Performance
Results of Laboratory Testing of 15 Cookstove Designs in Accordance with the ISO/IWA Tiers of Performance. Ecohealth. 2014 Sep 12.
Authors: Still D1, Bentson S, Li H.
1 – Aprovecho Research Center, 76132 Blue Mountain School Rd, Cottage Grove, OR, 97424, USA, firstname.lastname@example.org.
The widespread adoption and sustained use of modern cookstoves has the potential to reduce harmful effects to climate, health, and the well-being of approximately one-third of the world’s population that currently rely on biomass fuel for cooking and heating. In an effort to understand and develop cleaner burning and more efficient cookstoves, 15 stove design and fuel/loading combinations were evaluated in the laboratory using the International Workshop Agreement’s five-tiered (0-4) rating system for fuel use and emissions.
The designs evaluated include rocket-type combustion chamber models including reduced firepower, sunken pots, and chimneys (three stoves); gasifier-type combustion chambers using prepared fuels in the form of wood pellets (four stoves); forced draft stoves with a small electric fan (five stoves); and a single insulated charcoal stove with preheated secondary air.
It was found that a charcoal burning stove was the only stove to meet all the Tier 4 levels of performance. Achieving over 40% thermal efficiency at high power was made possible by reducing firepower and gaps around the pot, although batch-fed stoves generally do not “turn down” for optimal low power performance. While all stoves met Tier 4 for carbon monoxide, only stoves equipped with electrical fans reduced respirable particulate matter to Tier 4 levels. Finally, stoves with chimneys and integrated pots were fuel efficient and virtually eliminated indoor emissions. It is hoped that these design techniques will be useful in further development and evolution of high-performance cookstove designs.
The Critical Importance of Cleaner Fuels | Source: S Patel and S Mehta, Global Alliance for Clean Cookstoves, Aug 2014.
Preliminary exposure results from Alliance-supported child survival research studies in Ghana, Nigeria, and Nepal were unveiled at a special symposium held in Seattle at the annual meeting of the International Society for Environmental Epidemiology (ISEE), the premier technical conference for environmental health researchers. Results indicate substantial reductions in exposure associated with the adoption of cleaner cookstoves and fuels. Moreover, researchers reported high rates of study compliance, and solid evidence that study participants were actively using the intervention stoves. There were also discussions on the implication of these results for achieving the World Health Organizations (WHO) indoor air quality guidelines for household fuel combustion, with a special emphasis on estimating the impact of ‘stove stacking’, or continued use of traditional cookstoves, on the ability to meet air quality guidelines.
These study results will have far reaching implications for Alliance focus countries such as Ghana, Kenya, China, and India, where policy makers and health professionals are well-positioned to increase awareness of the links between household air pollution, fuel switching, and health. For example, given Ghana’s commitment to scaling adoption of clean cookstoves, and providing 50% of the population with access to clean fuels by 2020, the study will provide policy-relevant information for Ghana and the broader global public health community.
Respiratory risks from household air pollution in low and middle income countries. Lancet Respir Med. 2014 Sep 2. pii: S2213-2600(14)70168-7. doi: 10.1016/S2213-2600(14)70168-7.
Authors: Gordon SB, Bruce NG, et al.
A 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.
In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described.
We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.
Household Cooking with Solid Fuels Contributes to Ambient PM2.5 Air Pollution and the Burden of Disease
Household Cooking with Solid Fuels Contributes to Ambient PM2.5 Air Pollution and the Burden of Disease. Environ Health Perspect. 2014 Sep 5.
Authors: Chafe ZA1, Brauer M2, Klimont Z3, Van Dingenen R4, Mehta S5, Rao S3, Riahi K3, Dentener F4, Smith KR6.
1Energy and Resources Group; and Environmental Health Sciences, University of California, Berkeley, California, USA.
2School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
3International Institute for Applied Systems Analysis, Laxenburg, Austria.
4European Commission Joint Research Centre, Institute for Environment and Sustainability, Air and Climate Unit, Ispra, Italy.
5Global Alliance for Clean Cookstoves, Washington, DC, USA.
6Environmental Health Sciences, University of California, Berkeley, California, USA.
Background: Approximately 2.8 billion people cook with solid fuels. Research has focused on the health impacts of indoor exposure to fine particulate pollution. Here, for the 2010 Global Burden of Disease project (GBD 2010), we evaluate the impact of household cooking with solid fuels on regional population-weighted ambient PM2.5 pollution (APM2.5).
Objectives: We estimated the proportion and concentrations of APM2.5 attributable to household cooking with solid fuels (PM2.5-cook) for the years 1990, 2005, and 2010 in 170 countries; and associated ill-health.
Methods: We used an energy supply-driven emissions model (GAINS) and source-receptor model (TM5-FASST) to estimate the proportion of APM2.5 produced by households and the proportion of household PM2.5 emissions from cooking with solid fuels. We estimated health effects using GBD 2010 data on ill-health from APM2.5 exposure.
Results: In 2010, household cooking with solid fuels accounted for 12% of APM2.5 globally, varying from 0% of APM2.5 in five higher-income regions to 37% (2.8 µg/m3 of 6.9 µg/m3 total) in Southern sub-Saharan Africa. PM2.5-cook constituted >10% of APM2.5 in seven regions housing 4.4 billion people. South Asia showed the highest regional concentration of APM2.5 from household cooking (8.6 µg/m3). Based on GBD 2010, we estimate that exposure to APM2.5 from cooking with solid fuels caused the loss of 370,000 lives and 9.9 million disability-adjusted life years globally in 2010.
Conclusions: PM2.5 emissions from household cooking constitute an important portion of APM2.5 concentrations in many places, including India and China. Efforts to improve ambient air quality will be hindered if household cooking conditions are not addressed.
WHO Indoor air quality guidelines on household fuel combustion: Strategy implications of new evidence on interventions and exposure-risk functions
WHO Indoor air quality guidelines on household fuel combustion: Strategy implications of new evidence on interventions and exposure-risk functions. Atmospheric Environment, 27 August 2014, In Press.
Nigel Brucea, b, , , Dan Popea, Eva Rehfuessc, Kalpana Balakrishnand, Heather Adair-Rohanib, Carlos Dorab
a Department of Public Health and Policy, University of Liverpool, UK
b Department of Public Health, Environmental and Social Determinants of Health, World Health Organisation, Geneva
c Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
d Department of Environmental Health Engineering, Sri Ramachandra University, Chennai, India
• New WHO air quality guidelines will address household air pollution (HAP).
• Action on HAP could lower risk of multiple child and adult diseases by 20-50%.
• New evidence shows levels at or below 35 μg/m3 PM2.5 (WHO IT-1) are needed.
• Most improved solid fuel stoves result in PM2.5 levels well above IT-1.
• Intervention strategy must shift towards accelerating access to clean fuels.
Background - 2.8 billion people use solid fuels as their primary cooking fuel; the resulting high levels of household air pollution (HAP) were estimated to cause more than 4 million premature deaths in 2012. The people most affected are among the world’s poorest, and past experience has shown that securing adoption and sustained use of effective, low-emission stove technologies and fuels in such populations is not easy. Among the questions raised by these challenges are (i) to what levels does HAP exposure need to be reduced in order to ensure that substantial health benefits are achieved, and (ii) what intervention technologies and fuels can achieve the required levels of HAP in practice? New WHO air quality guidelines are being developed to address these issues.
Aims – To address the above questions drawing on evidence from new evidence reviews conducted for the WHO guidelines.
Methods – Discussion of key findings from reviews covering (i) systematic reviews of health risks from HAP exposure, (ii) newly developed exposure-response functions which combine combustion pollution risk evidence from ambient air pollution, second-hand smoke, HAP and active smoking, and (iii) a systematic review of the impacts of solid fuel and clean fuel interventions on kitchen levels of, and personal exposure to, PM2.5 and carbon monoxide (CO).
Findings – Evidence on health risks from HAP suggest that controlling this exposure could reduce the risk of multiple child and adult health outcomes by 20-50%. The new integrated exposure-response functions (IERs) indicate that in order to secure these benefits, HAP levels require to be reduced to the WHO IT-1 annual average level (35 μg/m3 PM2.5), or below. The second review found that, in practice, solid fuel ‘improved stoves’ led to large percentage and absolute reductions, but post-intervention kitchen levels were still very high, at several hundreds of μg/m3 of PM2.5, although most solid fuel stove types met the WHO 24-hr average guideline for CO of 7 mg/m3 Clean fuel user studies were few, but also did not meet IT-1 forPM2.5, likely due to a combination of continuing multiple stove and fuel use, other sources in the home (e.g. kerosene lamps), and pollution from neighbours and other outdoor sources.
Conclusions – Together, this evidence implies there needs to be a strategic shift towards more rapid and widespread promotion of clean fuels, along with efforts to encourage more exclusive use and control other sources in and around the home. For households continuing to rely on solid fuels, the best possible low-emission solid fuel stoves should be promoted, backed up by testing and in-field evaluation.
Highway proximity and black carbon from cookstoves as a risk factor for higher blood pressure in rural China
Highway proximity and black carbon from cookstoves as a risk factor for higher blood pressure in rural China. Proc Natl Acad Sci U S A. 2014 Aug 25.
Baumgartner J1, Zhang Y2, Schauer JJ3, Huang W2, Wang Y2, Ezzati M4.
1Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada H3A 1A3; Institute on the Environment, University of Minnesota, St. Paul, MN 55108; email@example.com.
2College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China;
3Environmental Chemistry and Technology Program, Department of Civil and Environmental Engineering, University of Wisconsin-Madison, Madison, WI 53706; and.
4MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, United Kingdom.
Air pollution in China and other parts of Asia poses large health risks and is an important contributor to global climate change. Almost half of Chinese homes use biomass and coal fuels for cooking and heating. China’s economic growth and infrastructure development has led to increased emissions from coal-fired power plants and an expanding fleet of motor vehicles. Black carbon (BC) from incomplete biomass and fossil fuel combustion is the most strongly light-absorbing component of particulate matter (PM) air pollution and the second most important climate-forcing human emission. PM composition and sources may also be related to its human health impact. We enrolled 280 women living in a rural area of northwestern Yunnan where biomass fuels are commonly used. We measured their blood pressure, distance from major traffic routes, and daily exposure to BC (pyrolytic biomass combustion), water-soluble organic aerosol (organic aerosol from biomass combustion), and, in a subset, hopane markers (motor vehicle emissions) in winter and summer. BC had the strongest association with systolic blood pressure (SBP) (4.3 mmHg; P < 0.001), followed by PM mass and water-soluble organic mass. The effect of BC on SBP was almost three times greater in women living near the highway [6.2 mmHg; 95% confidence interval (CI), 3.6 to 8.9 vs. 2.6 mmHg; 95% CI, 0.1 to 5.2]. Our findings suggest that BC from combustion emissions is more strongly associated with blood pressure than PM mass, and that BC’s health effects may be larger among women living near a highway and with greater exposure to motor vehicle emissions.
Sustained high incidence of injuries from burns in a densely populated urban slum in Kenya: An emerging public health priority.
Sustained high incidence of injuries from burns in a densely populated urban slum in Kenya: An emerging public health priority. Burns. 2014 Sep;40(6):1194-200.
Authors: Wong JM1, Nyachieo DO1, Benzekri NA1, Cosmas L1, Ondari D1, Yekta S2, Montgomery JM1, Williamson JM1, Breiman RF3.
1Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration.
2Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.
3Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration. Electronic address: firstname.lastname@example.org.
INTRODUCTION: Ninety-five percent of burn deaths occur in low- and middle-income countries (LMICs); however, longitudinal household-level studies have not been done in urban slum settings, where overcrowding and unsafe cook stoves may increase likelihood of injury.
METHODS: Using a prospective, population-based disease surveillance system in the urban slum of Kibera in Kenya, we examined the incidence of household-level burns of all severities from 2006-2011.
RESULTS: Of approximately 28,500 enrolled individuals (6000 households), we identified 3072 burns. The overall incidence was 27.9/1000 person-years-of-observation. Children <5 years old sustained burns at 3.8-fold greater rate compared to (p<0.001) those ≥5 years old. Females ≥5 years old sustained burns at a rate that was 1.35-fold (p<0.001) greater than males within the same age distribution. Hospitalizations were uncommon (0.65% of all burns).
CONCLUSIONS: The incidence of burns, 10-fold greater than in most published reports from Africa and Asia, suggests that such injuries may contribute more significantly than previously thought to morbidity in LMICs, and may be increased by urbanization. As migration from rural areas into urban slums rapidly increases in many African countries, characterizing and addressing the rising burden of burns is likely to become a public health priority.