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Clean, Affordable and Sustainable Cooking Energy for India: Possibilities and Realities beyond LPG

26 February 2015 10:18 (America/New_York)

Clean, Affordable and Sustainable Cooking Energy for India: Possibilities and Realities beyond LPG, 2015.

Authors: Abhishek Jain, Poulami Choudhury, and Karthik Ganesan. Council on Energy, Environment and Water.

There is a dearth of research and studies which compare different cooking energy options,especially using a multi-dimensional approach. Thus, with the objective of promoting clean,affordable and sustainable cooking energy for all, this study analysed the potential of thealternatives, going beyond LPG. The options which were assessed include the centrally distributed commodities like LPG, PNG, electricity and the decentralised options such as biogas and improved biomass cookstoves.

A multi-criteria comparative analysis was conducted, incorporating various dimensions such as economics, fuel supply assurance,technology resilience, cooking convenience, environmental impacts, etc. The analysis utilised the existing wealth of literature and secondary data, while tapping into the knowledge and experience of technology experts through online surveys and interviews.

Experimentation in Product Evaluation: The Case of Solar Lanterns in Uganda, Africa, 2015. MIT; USAID.

18 February 2015 12:09 (America/New_York)

Experimentation in Product Evaluation: The Case of Solar Lanterns in Uganda, Africa, 2015. MIT; USAID.

Evaluating solar lanterns in Uganda

In summer 2013, a team of MIT faculty and students set off for western Uganda to conduct CITE’s evaluation of solar lanterns. Researchers conducted hundreds of surveys with consumers, suppliers, manufacturers, and nonprofits to evaluate 11 locally available solar lantern models.

To assess each product’s suitability, researchers computed a ratings score from 0 to 100 based on how the product’s attributes and features fared. “Attributes” included characteristics inherent to solar lanterns, such as brightness, run time, and time to charge.

“Features” included less-central characteristics, such as a lantern’s ability to charge a cellphone.

The importance of cellphone charging was a surprising and noteworthy finding, Sanyal says.

“One of the things that stuck with me was that [consumers] were most concerned with whether or not the solar lantern charged their cellphone. It was a feature we never expected would be so important,” Sanyal says. “For some, having connections may be more valuable than having light.”

CITE worked with USAID to select solar lanterns as the product family for its first evaluation. Sanyal says evaluating solar lanterns allowed CITE to learn from USAID’s existing partnership with Solar Sister, a social enterprise that distributes solar lanterns in Uganda, a country where few people have access to light after dark.

CITE researchers also worked closely with Jeffrey Asher, a former technical director at Consumer Reports, to learn from an existing product-evaluation model.

Evaluating products in a laboratory at MIT or Consumer Reports is much different than evaluating them in rural Uganda, but both are important, says Asher, who is a co-author of the CITE report.

“Consumer Reports’ greatest challenge has been evaluating products that are currently in the U.S. marketplace,” Asher says. “CITE has found that, in developing countries, we have to be even more nimble to keep up with an ever-changing market.”

Field-based safety guidelines for solid fuel household cookstoves in developing countries

18 February 2015 12:00 (America/New_York)

Field-based safety guidelines for solid fuel household cookstoves in developing countries. Energy for Sustainable Development, Volume 25, April 2015, Pages 56–66.

Authors: Nathan G. Johnsona, Kenneth M. Bryden


  • Hazard analysis of solid fuel household cookstoves used in the developing world.
  • Ten safety principles for developing world household cookstoves are presented.
  • Field-based testing safety protocols are developed.
  • Standardized safety metrics for solid fuel cookstoves are presented.
  • Low-cost safety testing kits for US$100–150 can be deployed in the field.

The burning of solid fuels for cooking creates significant adverse health, social, and economic consequences for more than three billion people worldwide. Recognizing this issue, many groups have worked to develop improved stoves that increase fuel efficiency, decrease fuel use, and reduce particulate emissions. Less attention has been given to developing a standardized process for rating cookstove safety and reducing cookstove hazards.

This paper identifies common cooking hazards and seeks to reduce cooking injuries by proposing ten field-based safety guidelines for solid fuel stoves. Each guideline describes an underlying safety principle and is accompanied by a test protocol and a metric to rate stove safety. This incremental rating system enables stove designers, donors, and consumers to track and promote stepwise safety improvements. The protocols use low-cost equipment to allow the many manufacturers of handcrafted cookstoves to assess safety without using sophisticated testing facilities and expensive equipment.

National-level differences in the adoption of environmental health technologies: a cross-border comparison from Benin and Togo

18 February 2015 11:53 (America/New_York)

National-level differences in the adoption of environmental health technologies: a cross-border comparison from Benin and TogoHealth Policy Plan. (2015) 30 (2): 145-154.doi: 10.1093/heapol/czt106.

Authors: Kelly J Wendland, Subhrendu K Pattanayak and Erin O Sills. Corresponding author. Department of Conservation Social Sciences, University of Idaho, Moscow, ID 83844, USA. E-mail:

Environmental health problems such as malaria, respiratory infections, diarrhoea and malnutrition pose very high burdens on the poor rural people in much of the tropics. Recent research on key interventions—the adoption and use of relatively cheap and effective environmental health technologies—has focused primarily on the influence of demand-side household-level drivers. Relatively few studies of the promotion and use of these technologies have considered the role of contextual factors such as governance, the enabling environment and national policies because of the challenges of cross-country comparisons.

We exploit a natural experimental setting by comparing household adoption across the Benin–Togo national border that splits the Tamberma Valley in West Africa. Households across the border share the same culture, ethnicity, weather, physiographic features, livelihoods and infrastructure; however, they are located in countries at virtually opposite ends of the institutional spectrum of democratic elections, voice and accountability, effective governance and corruption.

Binary choice models and rigorous non-parametric matching estimators confirm that households in Benin are more likely than households in Togo to plant soybeans, build improved cookstoves and purchase mosquito nets, ceteris paribus. Although we cannot identify the exact mechanism for the large and significant national-level differences in technology adoption, our findings suggest that contextual institutional factors can be more important than household characteristics for technology adoption.

Field Testing of Alternative Cookstove Performance in a Rural Setting of Western India

9 February 2015 12:25 (America/New_York)

Field Testing of Alternative Cookstove Performance in a Rural Setting of Western India. Int. J. Environ. Res. Public Health, Feb 2015, 12(2), 1773-1787; doi:10.3390/ijerph120201773.

Authors: Veena Muralidharan, Thomas E. Sussan, et al.

Nearly three billion people use solid fuels for cooking and heating, which leads to extremely high levels of household air pollution and is a major cause of morbidity and mortality. Many stove manufacturers have developed alternative cookstoves (ACSs) that are aimed at reducing emissions and fuel consumption.

Here, we tested a traditional clay chulha cookstove (TCS) and five commercially available ACSs, including both natural draft (Greenway Smart Stove, Envirofit PCS-1) and forced draft stoves (BioLite HomeStove, Philips Woodstove HD4012, and Eco-Chulha XXL), in a test kitchen in a rural village of western India. Compared to the TCS, the ACSs produced significant reductions in particulate matter less than 2.5 µm (PM2.5) and CO concentrations (Envirofit: 22%/16%, Greenway: 24%/42%, BioLite: 40%/35%, Philips: 66%/55% and Eco-Chulha: 61%/42%), which persisted after normalization for fuel consumption or useful energy.

PM2.5 and CO concentrations were lower for forced draft stoves than natural draft stoves. Furthermore, the Philips and Eco-Chulha units exhibited higher cooking efficiency than the TCS. Despite significant reductions in concentrations, all ACSs failed to achieve PM2.5 levels that are considered safe by the World Health Organization (ACSs: 277–714 μg/m3 or 11–28 fold higher than the WHO recommendation of 25 μg/m3).

El Salvador: Household Electrification and Indoor Air Pollution

9 February 2015 12:16 (America/New_York)

El Salvador: Household Electrification and Indoor Air Pollution, 2015.

Authors: Manuel Barron and Maximo Torero. University of Berkely, IFPRI

This paper provides the first empirical evidence that household electrification leads to direct and substantial welfare improvements via reductions in indoor air pollution. In the setting of a recent electrification program in northern El Salvador, we exploit a unique dataset on minute-by-minute fine particulate matter (PM2.5) concentration within the framework of a clean experimental design.

Two years after baseline, overnight PM2.5 concentration was on average 67% lower among households that were randomly encouraged to connect compared to those that were not. This change is driven by reductions in kerosene use. As a result, the incidence of acute respiratory infections among children under 6 fell by 65% among connected households. Estimates of exposure measures suggest large health gains for all household members, but these gains are unequally distributed by gender. In addition, we show that when the electrification rate among the non-encouraged group caught up with that of the encouraged group, the effects in the former group were similar to those in the latter.

The Potential of Efficient Improved Mud-Brick Cookstove in Cameroon: An Exploratory Study

9 February 2015 12:12 (America/New_York)

The Potential of Efficient Improved Mud-Brick Cookstove in Cameroon: An Exploratory Study, 2015.

Authors: F. H. Abanda, et al.

In most Africa countries, cooking is a dirty and time-consuming job that involves feeding some pieces of fuel such as wood, charcoal, or coal for a fire. Globally, some 500 million households with more than 70% in Africa depend on burning solid fuel to meet their cooking, heating, lighting, and other household energy needs. The wanton exploitation of wood fuel is having so many negative impacts on many households in Cameroon. Some of the impacts include: the depletion of the forest leading to environmental degradation, health impacts, etc. In the Central Africa region including Cameroon about 80-90% of the population has limited access to modern forms of energy such as electricity, and relies on traditional biomass (e.g. wood and agricultural residues) for cooking and heating. There is an urgent need to investigate more efficient cook stove technologies that have very minimal or no impact on the environment and households. In this study, an improved mud-brick cook stove was designed and tested in a typical family house in Cameroon. To ensure the acceptability and sustainability of the technology, the rural dwellers were involved in the design and implementation. The performance of the stove was compared with that of traditional 3-stone fireside common in most rural households in Cameroon. The mud-brick cook stoves are large and permanently built into a kitchen and easy to use. The mud-brick cook stove construction materials are available in communities that have clay soil and can be made using limited tools.

Latest issue of Boiling Point

14 January 2015 13:03 (America/New_York)

Link -

Table of Contents Theme Articles The introduction and uptake of improved cookstoves: Making sense of engineers, social scientists, barriers, markets and participation

Authors: Mike Clifford Sarah Jewitt Charlotte Ray
Drawing on the authors’ previous experience, literature review and preliminary fieldwork, this article discusses some of the existing challenges faced when investigating improved cookstove (ICS)… [more] Adoption of Cleaner Cookstoves

Authors: Debajit Palit Subhes C Bhattacharyya
Globally 2.6 billion people, representing around 38% of the total population, depend on solid biomass fuels to meet their basic energy needs for cooking. While rural communities are shifting to… [more] New Modern Energy Consumers: Challenges for efficient cooking fuels in the Greater Mekong Subregion

Authors: Julia Tomei, Gabrial Anandarajah, Vibol San, Tharith Sriv, Sok Kunthy
The MECON project is investigating the design and implementation of energy efficiency policies targeting New Modern Energy CONsumers (MECON) in the Greater Mekong Subregion. Drawing on the results… [more] A participative approach: A rural community develops, tests and adopts an improved cooking stove in India

Authors: Sandro Pampallona, Paola Bollini
Two villages of the Banjara tribal community, in rural Andhra Pradesh, India, have joined efforts to embark on a common project of experimental learning and action-oriented research, supported and… [more]

Overcoming barriers to clean cookstove and fuel adoption: Why and how women must be integrated throughout the value chain

Authors: Corinne Hart, Genevieve Macfarlane Smith
Women are critical players in the adoption and scale of clean cooking solutions. Barriers to adoption of cleaner cooking solutions start within the home and with the cooks. Without engaging the… [more] General Articles From Artisans to Entrepreneurs: Understanding the role of small business for energy access

Authors: Robert Aitken, Johannes Kruger
The Developing Energy Enterprises Project East Africa (DEEP EA) provides a number of crucial lessons on the nature of support needed to stimulate private sector-led energy access initiatives in… [more] The new Sustainable Energy for All Forum: Shaping the global energy debate

Authors: Minoru Takada
Marking the two-year anniversary of the Rio+20, more than a thousand participants from governments, the private sector, civil society and international organisations gathered for the first annual… [more] The new Poor People’s Energy Outlook: Empowering people must be central to energy access interventions

Authors: Aaron Leopold
The global community is increasingly shining a spotlight on energy as a key component of poverty alleviation and development efforts. Illustrative of this shift is how donors, developing… [more]



14 January 2015 12:18 (America/New_York)


Indonesia has made great strides in moving toward clean cooking solutions, beginning with the highly successful government supported Kerosene-to-LPG Conversion Program (2007–12) and the ongoing BIRU Biogas Program. However, some 24.5 million households in Indonesia continue to depend on traditional biomass as their primary cooking fuel.  The momentum and lessons learned from these successful programs present a significant opportunity to promote and scale up high-quality biomass cookstoves in Indonesia.

In 2012, the World Bank, in collaboration with Indonesia’s Directorate of Bioenergy, Ministry of Energy and Mineral Resources (Indonesia Stove Alliance), launched the Indonesia Clean Stove Initiative (CSI). The broad aim of this initiative is to scale up access to clean cooking solutions for the 40 percent of households who will likely continue using solid fuels beyond 2030.
Join the Winrock and U.S. EPA “Indonesia Clean Stoves Initiative ” webinar on Thursday, January 15, 2015 at 9:00am Eastern Standard Time (EST) to hear results from Phase 1 and to discuss CSI’s integrated approach, using a results-based financing mechanism, to overcome supply- and demand-side barriers and institutional constraints.

About the speakers:

Ms. Christina Aristanti
Christina Aristanti is the manager of the Indonesia Stove Alliance. The Indonesia Stove Alliance is hosted by Yayasan Dian Desa, a local NGO working on appropriate technology, which has been addressing the need for clean stoves since the early 1980’s. Christina was the Asia Regional Cookstove Program (ARECOP) manager from 1991 – 2010.

Mr. Crispin Pemberton-Pigott
Crispin Pemberton-Pigott is an industrial designer and founder of New Dawn Engineering, a Swaziland-based manufacturer of hand-operated production equipment. He was a co-founder of the Eastern Cape Appropriate Technology Unit, the Renewable Energy Association of Swaziland, the Industrial Designers Association of South Africa and most recently the South-South Sustainable Stoves Group. Over 30 years he has designed more than 20 stoves as well as stove projects, laboratories and protocols which test stoves that burn biomass, coal, ethanol, kerosene and LPG. As a co-founder and current technical advisor to the SeTAR Centre, University of Johannesburg, he also serves on the South African Bureau of Standards Technical Committee TC1054 writing national standards and associated test protocols and represents SABS on ISO-TC285.

Ms. Yabei Zhang
Yabei Zhang is Senior Energy Economist in the World Bank’s Energy and Extractives Global Practice.  She joined the World Bank as a Young Professional in 2008 and has worked on energy, urban, and climate-change issues, with a focus on energy efficiency, urban energy, and household energy.  She leads the East Asia and Pacific regional Clean Stove Initiative (CSI) flagship program and manages the China and Indonesia CSI country programs. Prior to joining the World Bank, Yabei worked at the Joint Global Change Research Institute, a joint program of the Pacific Northwest National Lab and the University of Maryland. She holds a PhD in Economics from the University of Maryland, College Park and a Master’s Degree in City Planning from the Massachusetts Institute of Technology (MIT).

Webinar participation is free. For the web portion, a high-speed internet connection is required. Please note that the webinar technology allows attendees to listen to audio through their computer or by phone. Additional log-in information will be provided upon registration.


For more information on this webinar, please contact:


Increased risk of respiratory illness associated with kerosene fuel use among women and children in urban Bangalore, India

14 January 2015 12:07 (America/New_York)

Increased risk of respiratory illness associated with kerosene fuel use among women and children in urban Bangalore, India. Occup Environ Med 2015;72:114-122 doi:10.1136/oemed-2014-102472.

Authors: Jae-Young Choi, Jill Baumgartner, et al.

Correspondence to - Dr Gurumurthy Ramachandran, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, 420 Delaware Street SE, MMC 807, Minneapolis, MN 55455, USA;

Background – Kerosene is a widely used cooking and lighting fuel in developing countries. The potential respiratory health effects of cooking with kerosene relative to cooking with cleaner fuels such as liquefied petroleum gas (LPG) have not been well characterised.

Methods – We sampled 600 households from six urban neighbourhoods in Bangalore, India. Each household’s primary cook, usually the woman of the house, was interviewed to collect information on current domestic fuel use and whether there was any presence of respiratory symptoms or illness in her or in the children in the household. Our analysis was limited to 547 adult females (ages 18–85) and 845 children (ages 0–17) in households exclusively cooking with either kerosene or LPG. We investigated the associations between kerosene use and the likelihood of having respiratory symptoms or illness using multivariate logistic regression models.

Results – Among adult women, cooking with kerosene was associated with cough (OR=1.88; 95% CI 1.19 to 2.99), bronchitis (OR=1.54; 95% CI 1.00 to 2.37), phlegm (OR=1.51; 95% CI 0.98 to 2.33) and chest illness (OR=1.61; 95% CI 1.02 to 2.53), relative to cooking with LPG in the multivariate models. Among children, living in a household cooking with kerosene was associated with bronchitis (OR=1.91; 95% CI 1.17 to 3.13), phlegm (OR=2.020; 95% CI 1.29 to 3.74) and chest illness (OR=1.70; 95% CI 0.99 to 2.90) after adjusting for other covariates. We also found associations between kerosene use and wheezing, difficulty breathing and asthma in adults and cough and wheezing in children, though these associations were not statistically significant.

Conclusions – Women and children in households cooking with kerosene were more likely to have respiratory symptoms and illnesses compared with those in households cooking with LPG. Transitioning from kerosene to LPG for cooking may improve respiratory health among adult women and children in this population.


Interactions between household air pollution and GWAS-identified lung cancer susceptibility markers in the Female Lung Cancer Consortium in Asia

14 January 2015 12:01 (America/New_York)

Interactions between household air pollution and GWAS-identified lung cancer susceptibility markers in the Female Lung Cancer Consortium in Asia (FLCCA). Hum Genet. 2015 Jan 8.

Hosgood HD 3rd, Song M, Hsiung CA, Yin Z, et al.
Author information – 1Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave. Belfer 1309, 10461, Bronx, NY, USA,

We previously carried out a multi-stage genome-wide association study (GWAS) on lung cancer among never smokers in the Female Lung Cancer Consortium in Asia (FLCCA) (6,609 cases, 7,457 controls) that identified novel susceptibility loci at 10q25.2, 6q22.2, and 6p21.32, and confirmed two previously identified loci at 5p15.33 and 3q28. Household air pollution (HAP) attributed to solid fuel burning for heating and cooking, is the leading cause of the overall disease burden in Southeast Asia, and is known to contain lung carcinogens. To evaluate the gene-HAP interactions associated with lung cancer in loci independent of smoking, we analyzed data from studies participating in FLCCA with fuel use information available (n = 3; 1,731 cases; 1,349 controls). Coal use was associated with a 30 % increased risk of lung cancer (OR 1.3, 95 % CI 1.0-1.6).

Among the five a priori SNPs identified by our GWAS, two showed a significant interaction with coal use (HLA Class II rs2395185, p = 0.02; TP63 rs4488809 (rs4600802), p = 0.04). The risk of lung cancer associated with coal exposure varied with the respective alleles for these two SNPs. Our observations provide evidence that genetic variation in HLA Class II and TP63 may modify the association between HAP and lung cancer risk. The roles played in the cell cycle and inflammation pathways by the proteins encoded by these two genes provide biological plausibility for these interactions; however, additional replication studies are needed in other non-smoking populations.

The Lancet: Household air pollution: a call to action

7 January 2015 16:09 (America/New_York)

Household air pollution:a call to action. Lancet Respiratory Medicine, Jan 2015.

Authors: Alison Lee, Paul R O C Adobamen, et al.

Without any intervention,2·7 billion people will be reliant on biomass fuels by 2030.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.

Construction of solar cookers and driers

7 January 2015 16:03 (America/New_York)

Construction of solar cookers and driers, 2014.

The Technical Centre for Agricultural and Rural Cooperation (CTA)

Although improved techniques for using solar energy are not that well-known,they nevertheless provide better results in terms of economy, ecology, quality and simple usage. Solar cookers and driers capture the sun’s rays to heat and dry food.This guide presents simple methods for construction and use of solar cookers and driers: a box cooker, a solar panel cooker, a direct solar drier and an indirect solar drier. Easy to make and use independently, they provide an economical way to meet the food processing needs of diverse populations.The solar cooker saves time, money and energy at no risk for the environment.It can be used to cook all types of food (vegetables, fruits, meat, cereals,bread, etc.).

Envirofit – Launch of Econochar and Econofire cookstoves in Kenya and Nigeria

7 January 2015 15:45 (America/New_York)

Envirofit – Launch of Econochar and Econofire cookstoves in Kenya and Nigeria

“Envirofit is excited to announce the official launch of the EconocharTM and EconofireTM cookstoves in Kenya and Nigeria this holiday season. We spent over 18 months conducting extensive consumer research and user acceptance studies to create a line of affordable cookstoves that safely support large cooking pots while cooking quickly and efficiently.  The arrival of the econoline marks the first low-cost products to compete with traditional stoves on the market without requiring carbon subsidies.  The other major break-through is that these stoves can be assembled very easily in the field. This enables remote distribution partners as well aid/relief channels alike to create skilled labor jobs at the last mile.”

” To ensure stoves are accessible to both urban and rural populations Envirofit is working in partnership with Tower Brand Nigeria and Kaluworks Kenya to create greater access for our dealers and small business owners region-wide. This partnership represents the first major scalable solution for both wood and charcoal users with the potential to impact people that cook over an open fire or use inefficient charcoal stoves – saving them money, time and lives.”


Is mom energy efficient? A study of gender, household energy consumption and family decision making in Indonesia

7 January 2015 13:57 (America/New_York)

Is mom energy efficient? A study of gender, household energy consumption and family decision making in Indonesia. Energy Research & Social Science, Volume 6, March 2015, Pages 78–86

Authors: Ariva Sugandi Permana, Norsiah Abd. Aziz, Ho Chin Siong

This study highlights gender-related factors and attempts to understand their influence in residential energy consumption. This pilot study was done in Bandung City, Indonesia. It employed a questionnaire survey and face to face interviews. Questionnaires were randomly distributed to the households in Bandung City.

In this study, energy consumption included household uses of power for lighting, entertainment, thermal comfort and cooking. Energy consumption was estimated based upon electrical and liquefied petroleum gas (LPG) consumption. The results showed that when the decisions about energy expenditure and control of energy consumption in the household were solely made by a woman, energy consumption tended to be the lowest.

There are three possible ways decision can be made, by the wife, husband and a joint decision. This evidence suggests several things. They are that (1) women are good household energy managers, (2) men may be careless with respect to energy consumption, (3) women may be more cautious about household expenditures, and (4) when joint decisions were made the husband and wife relied-upon-each-other in reaching agreement. This suggests useful entry points for energy efficient initiatives.

Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control

30 December 2014 13:24 (America/New_York)

Protocol – Gestational Age Assessment in the Ghana Randomized Air Pollution and Health Study (GRAPHS): Ultrasound Capacity Building, Fetal Biometry Protocol Development, and Ongoing Quality Control. JMIR Res Proto, OCt-Dec 2-014.

Authors: Ellen A Boamah1, MPH ; KP Asante1, BSc, MPH, PhD ; KA Ae-Ngibise1, BEd, MSc ; Patrick L Kinney2, ScD ; Darby W Jack2, PhD ; Grace Manu1, BA ; Irene T Azindow1, BSc ; Seth Owusu-Agyei1, BSc, MSc, PhD ; Blair J Wylie3, MD, MPH

Corresponding Author: Blair J Wylie, MD, MPHMassachusetts General Hospital Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Harvard Medical School, Email:

Background: Four million premature deaths occur yearly as a result of smoke from cooking fires. The Ghana Randomized Air Pollution and Health Study (GRAPHS) is underway in the Kintampo North municipality and South district of rural Ghana to evaluate the impact of improved cook stoves introduced during pregnancy on birth weight and childhood pneumonia. These hypotheses are being tested in a cluster-randomized intervention trial among 1415 maternal-infant pairs within 35 communities assigned to a control arm (traditional cooking) or one of two intervention arms (cooking with an improved biomass stove; cooking with liquefied petroleum gas stoves).

Objective: The trial is designed to ensure delivery of the stove intervention prior to the period of maximal fetal growth. To answer questions about the impact of household air pollution on pregnancy outcome, accurate gestational age assessment is critical. This manuscript describes in detail the development of the gestational dating protocol, intensive ultrasound training involved, ultrasound capacity building, and ultrasound quality control program.

Methods: Ultrasound training occurred in several phases over the course of 2 years. Training included a basic obstetric ultrasound course offered to all midwives performing antenatal care at the two study hospitals, followed by a more intense period of hands-on training focused on fetal biometry for a select group of providers demonstrating aptitude in the basic course. A standard operating procedure was developed describing how to obtain all fetal biometric measurements. Consensus was obtained on how biometric images are used in the trial to establish gestational age and estimate the delivery date. An ongoing ultrasound quality control program including the use of an image scorecard was also designed.

Results: Publication of trial results is anticipated in late 2016.

Conclusions: Use of ultrasound should be strongly considered in field-based trials involving pregnant women to accurately establish gestational age, as menstrual dates may be incorrect or unknown. The inclusion of ultrasound in areas where ultrasound capacity does not previously exist requires a significant investment of time and resources. Such investment ensures appropriate training, high quality images, and accurate dating pregnancies. We outline our ultrasound training, image acquisition, quality control, and dating protocols in detail.
Trial Registration: NCT01335490; (Archived by WebCite at

Study protocol: Designs of Two randomized, community-based trials to assess the impact of alternative cookstove installation on respiratory illness among young children

30 December 2014 13:15 (America/New_York)

Study protocol: Designs of Two randomized, community-based trials to assess the impact of alternative cookstove installation on respiratory illness among young children and reproductive outcomes in rural Nepal. BMC Public Health, Dec 2014, 14:1271 doi:10.1186/1471-2458-14-1271

Authors: James M Tielsch, Joanne Katz, Scott L Zeger, Subarna K Khatry, Laxman Shrestha, Patrick Breysse, William Checkley, Luke C Mullany and Steven C LeClerq

Background – Acute lower respiratory infections (ALRI) are a leading cause of death among young children in low and middle income countries. Low birthweight is highly prevalent in South Asia and is associated with increased risks of mortality, morbidity, and poor motor and cognitive development. High levels of indoor household air pollution caused by open burning of biomass fuels such as wood, animal dung, and crop waste are common in these settings and are associated with high rates of ALRI and low birthweight. Alternative stove designs that burn biomass fuel more efficiently have been proposed as one method for reducing these high exposures and lowering the rates of these disorders. We designed two randomized trials to test this hypothesis.

Methods – We conducted a pair of community-based, randomized trials of alternative cookstove installation a rural district in southern Nepal. Phase one was a cluster randomized, modified step-wedge design using an alternative biomass stove with a chimney to vent smoke to the exterior. A pre-installation period of morbidity assessment and household environmental assessment was conducted for six months in all households. This was followed by a one year step-wedge phase with 12 monthly steps for clusters of households to receive the alternative stove. The timing of alternative stove introduction was randomized. This step-wedge phase was followed in all households by another six month follow-up phase. Eligibility criteria for phase one included household informed consent, the presence of a married woman of reproductive age (15-30 yrs) or a child < 36 months. Children were followed until 36 months of age or the end of the trial and then discharged. Pregnancies were identified and followed until completion or end of the trial.

Phase two was an individually randomized trial of the same alternative biomass stove versus liquid propane gas stove installation in a subset of households that participated in phase one. Follow-up for phase two was 12 months following stove installation. Eligibility criteria included the same components as phase one except children were only enrolled for morbidity follow-up if they were less than 24 months are the start.

The primary outcomes included: the incidence of ALRI in children and birthweight among newborn infants.

Conclusions – We have presented the design and methods of two randomized trials of alternative cookstoves on rates of acute lower respiratory infection and birthweight in a rural population in southern Nepal.

Genetic modification of the effect of maternal household air pollution exposure on birth weight in Guatemalan newborns

30 December 2014 13:06 (America/New_York)

Genetic modification of the effect of maternal household air pollution exposure on birth weight in Guatemalan newborns. Reproductive Toxicology, Volume 50, December 2014, Pages 19–26

Authors: Lisa M. Thompson, Paul Yousefi, Reneé Peñaloza, John Balmes, Holland Nina

• GSTM1 and GSTT1 genes may modify the association between maternal exposure to wood smoke and birth weight.
• Maternal null GSTM1 was associated with a 144 g (95% CI, −291, 1) decrease in birth weight.
• Combined maternal/infant null GSTT1 was associated with a 155 g (95% CI, −303, −8) decrease in birth weight.
• Effect modification by chimney stove use was not demonstrated.

Low birth weight is associated with exposure to air pollution during pregnancy. The purpose of this study was to evaluate whether null polymorphisms of Glutathione S-transferases (GSTs), specifically GSTM1 and GSTT1 genes in infants or mothers, modify the association between high exposures to household air pollution (HAP) from cooking fires and birth weight. Pregnant women in rural Guatemala were randomized to receive a chimney stove or continue to use open fires for cooking. Newborns were measured within 48 h of birth. 132 mother–infant pairs provided infant genotypes (n = 130) and/or maternal genotypes (n = 116). Maternal null GSTM1 was associated with a 144 g (95% CI, −291, 1) and combined maternal/infant null GSTT1 was associated with a 155 g (95% CI, −303, −8) decrease in birth weight. Although there was a trend toward higher birth weights with increasing number of expressed GST genes, the effect modification by chimney stove use was not demonstrated.

Sustained use of biogas fuel and blood pressure among women in rural Nepal

30 December 2014 13:01 (America/New_York)

Sustained use of biogas fuel and blood pressure among women in rural Nepal. Environmental Research, Volume 136, January 2015, Pages 343–351

Authors: Maniraj Neupane, Buddha Basnyat, Rainald Fischer, Guenter Froeschl, Marcel Wolbers, Eva A Rehfuess

• We study the impact of sustained use of biogas fuel on blood pressure among females.
• Use of biogas is associated with lower SBP and DBP in cooks >50 years.
• Use of biogas is associated with 68% reduced odds of developing high blood pressure in cooks >50 years.
• Effect of biogas use on blood pressure seems to be age dependent.

Background - More than two fifths of the world’s population cook with solid fuels and are exposed to household air pollution (HAP). As of now, no studies have assessed whether switching to alternative fuels like biogas could impact cardiovascular health among cooks previously exposed to solid fuel use. Methods - We conducted a propensity score matched cross-sectional study to explore if the sustained use of biogas fuel for at least ten years impacts blood pressure among adult female cooks of rural Nepal. We recruited one primary cook ≥30 years of age from each biogas (219 cooks) and firewood (300 cooks) using household and measured their systolic (SBP) and diastolic blood pressure (DBP). Household characteristics, kitchen ventilation and 24-h kitchen carbon monoxide were assessed. We matched cooks by age, body mass index and socio-economic status score using propensity scores and investigated the effect of biogas use through multivariate regression models in two age groups, 30–50 years and >50 years to account for any post-menopausal changes. Results - We found substantially reduced 24-h kitchen carbon monoxide levels among biogas-using households. After matching and adjustment for smoking, kitchen characteristics, ventilation status and additional fuel use, the use of biogas was associated with 9.8 mmHg lower SBP [95% confidence interval (CI), −20.4 to 0.8] and 6.5 mmHg lower DBP (95% CI, −12.2 to −0.8) compared to firewood users among women >50 years of age. In this age group, biogas use was also associated with 68% reduced odds [Odds ratio 0.32 (95% CI, 0.14 to 0.71)] of developing hypertension. These effects, however, were not identified in younger women aged 30–50 years. Conclusions - Sustained use of biogas for cooking may protect against cardiovascular disease by lowering the risk of high blood pressure, especially DBP, among older female cooks. These findings need to be confirmed in longitudinal or experimental studies.


Indoor air pollution exposure from use of indoor stoves and fireplaces in association with breast cancer

17 December 2014 11:51 (America/New_York)

Indoor air pollution exposure from use of indoor stoves and fireplaces in association with breast cancer: a case-control study. Environmental Health, Dec 2014, 13:108 doi:10.1186/1476-069X-13-108.

Authors: Alexandra J White (, Susan L Teitelbaum (, et al.

Background – Previous studies suggest that polycyclic aromatic hydrocarbons (PAHs) may adversely affect breast cancer risk. Indoor air pollution from use of indoor stoves and/or fireplaces is animportant source of ambient PAH exposure. However, the association between indoor stove/fireplace use and breast cancer risk is unknown. We hypothesized that indoor stove/fireplace use in a Long Island, New York study population would be positively associated with breast cancer and differ by material burned, and the duration and timing of exposure. We also hypothesized that the association would vary by breast cancer subtype defined by p53 mutation status, and interact with glutathione S-transferases GSTM1, T1, A1and P1 polymorphisms.

Methods – Population-based, case-control resources (1,508 cases/1,556 controls) were used to conduct unconditional logistic regression to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI).ResultsBreast cancer risk was increased among women reporting ever burning synthetic logs (whichmay also contain wood) in their homes (OR = 1.42, 95%CI 1.11, 1.84), but not for everburning wood alone (OR = 0.93, 95%CI 0.77, 1.12). For synthetic log use, longer duration >7years, older age at exposure (>20 years; OR = 1.65, 95%CI 1.02, 2.67) and 2 or more variantsin GSTM1, T1, A1 or P1 (OR = 1.71, 95%CI 1.09, 2.69) were associated with increased risk.

Conclusions – Burning wood or synthetic logs are both indoor PAH exposure sources; however, positive associations were only observed for burning synthetic logs, which was stronger for longer exposures, adult exposures, and those with multiple GST variant genotypes. Therefore, our results should be interpreted with care and require replication.


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