Around the world there are different types of fuels that are used for cooking and heating. While people in the developed world are accustomed to electricity or gas for cooking and heating purposes, most of those in the developing world rely upon biomass fuels, such as wood, cow dung, and crop waste. On the basis of cleanliness, efficiency, cost, convenience, and decreasing health impacts, biomass fuels are at the bottom of the energy ladder (World Health Organization [WHO], 2016a). Globally, it is estimated that some three billion people depend on biomass fuels to meet everyday needs such as cooking and heating (Bensch & Peters, 2015; Desai, Mehta, & Smith, 2004; Dherani et al., 2008; Smith, 1987; Smith, Mehta, & Maeusezahl-Feuz, 2004). That number represents 41% of the world's current population. Combustion of biomass is the dominant source of indoor air pollution (IAP) (Torres-Duque, Maldonado, Perez-Padilla, Ezzati, & Viegi, 2008; Zhang & Smith, 2007). In high-mortality developing countries, IAP ranks fourth among preventable risk factors contributing to the global burden of disease (Smith, 1993; WHO, 2002).
Those people in households using traditional open-fire cookstoves are rarely aware of the health risk such stoves can bring into their lives. There are many respiratory and other related health issues linked to the exposure of combustion products on a daily basis. Women exposed to IAP from poorly functioning and unvented cookstoves have a significantly higher risk of asthmatic attacks, with an odds ratio of 1.26 (Agrawal, 2012), which increases if people in the household also smoke tobacco. Furthermore, exposure to this type of IAP is associated with "both chronic bronchitis and emphysema phenotypes of chronic obstructive pulmonary disease (COPD) as well as a distinct form of obstructive airway disease called bronchial 'anthracofibrosis'" (Assad, Balmes, Mehta, Cheema, & Sood, 2015).
There is a great need for interventions that would reduce the exposure to IAP, reduce the risk for incident COPD, and "attenuate the longitudinal decline in lung function" (Assad et al., 2015). Biomass cookstoves produce significant black carbon emissions, which have a strong association with systolic blood pressure (SBP) (Baumgartner et al., 2014). Studies have also shown that clean cookstove interventions have effectively decreased SBP levels. In one study in Nicaragua, a clean cookstove intervention showed that a 5.9 mmHg reduction in SBP level was observed among women [greater than or equal to] 40 years and a 4.6 mmHg reduction was observed among obese women, with a confidence interval of 95% (Clark et al., 2013).
The World Health Organization (WHO) has indicated that IAP can also be associated with other chronic illnesses such as tuberculosis, cataracts, and asthma (WHO, 2002). A causal pathway diagram by Haas explains the reasons for low birth weights and also reports how IAP can lead to several other diseases in a chain reaction (Fullerton, Bruce, & Gordon, 2008). Additionally, IAP contains particulate matter and carbon monoxide; increased exposure to particulate matter leads to increased maternal lung diseases, which in turn leads to reduced nutrient intake and reduced oxygen delivery to the placenta. Reduced nutrient intake by the mother and reduced oxygen supply to the placenta results in impaired fetal growth, which could cause preterm delivery or low birth weight. Increased exposure to carbon monoxide also results in reduced oxygen content in maternal and child blood, and results in preterm delivery or low birth weight (Fullerton et al., 2008).
Thus, through various diseases as a result of exposure to IAP, many lives are affected--not just through earlier mortality but also by many years of lost disability adjusted life years (DALYs) and sick days. A study done in 2010 showed that approximately 9.9 million DALYs were attributable globally to ambient [PM.sub.2.5] from household cooking with solid fuels (Chafe, 2014). A more recent study showed that 16.9 million DALYs are due to IAP from poor cooking methods in India alone (Rohra & Taneja, 2016). According to a 2014 report from WHO, globally 4.3 million deaths--equivalent to the entire population of Kentucky--were attributable to IAP in 2012, almost all of them in developing countries. Additionally, WHO reported that there were one million deaths in India in 2010 because of IAP (WHO, 2016b). Thus, WHO lists IAP as the "leading environmental cause of death in the world" and responsible for more deaths than malaria (Martin, Glass, Balbus, & Collins, 2011).
From the above listed data, it is clear that IAP is a serious health concern on a global scale, and especially in India. The purpose of this environmental assessment pilot study was to 1) understand the magnitude of IAP levels in dwellings in a community in India called Solaipalem and 2) demonstrate a basis for an intervention to help community members reduce the risk of respiratory illnesses associated with indoor cooking. We also wanted to design, manufacture, and complete preliminary tests on a new improved metal cookstove (NIMC) prototype that would be affordable and culturally acceptable in a real house setting.
A continuing goal of this project is to work towards eliminating cultural barriers to an improved cookstove by employing community members of Solaipalem to finalize and mass produce an effective and affordable clean cookstove aligned with their cultural needs. This approach not only has the potential to promote health but also to foster economic development by keeping the cookstove production jobs within the community. Ultimately, the overall purpose of this effort is to assist community members in reduc ing respiratory health risk through adoption of clean cookstoves. The study presented in this article only addresses the initial environmental assessment and pilot study of NIMC within this community in rural India.
Materials and Methods
Samples and Participants
We visited Solaipalem, a rural village in the southeastern state of India called Andhra Pradesh, in December 2015 for the initial environmental assessment and to determine if a more comprehensive...