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Faruque Parvez, Patrick Kinney, Habibul Ahsan, Tariqul Islam, R. Ahmed, A.R. Mollah. T. Dana Andrew Trevett

A collaborative research by

NACOM and World Health Organization (WHO), Bangladesh and

Mailman School of Public Health

Columbia University, New York, USA

Biomass use: importance from global, regional and local context  

•         About half of the world’s population depends on  biomass (e.g., wood, dung, agricultural waste, etc.) for cooking, home heating and small scale industrial use

•         Three-fourths or more people living in Sub-Saharan Africa, Western Pacific region and Southeast Asian countries use biomass

•         Overall, about 90% people in Bangladesh use biomass. However, the use is more than 97% in rural areas of Bangladesh

Health effects of biomass fuel use 

•         Biomass combustion produces a number of toxic and carcinogenic elements and particulate matter (PM), CO and Polycyclic Aromatic Hydrocarbons (PAH)

•         A number of epidemiological studies have reported higher incidences of Chronic Obstructive Pulmonary Disease (COPD) and Acute Respiratory Infections (ARI), low birth weight babies, cataract among women and children who are exposed to biomass combustion 

•         Recent reports suggest effects on hypertension among adults and anemia and stunning in early childhood

Magnitude of the health effects

•         It is estimated that indoor air pollution from biomass use cause 2.8 million deaths per year, including a million children due to lower acute respiratory infections

•         It is reported that about 150,000 women from Southeast Asia alone had died from COPD in 2000 attributed to biomass fuel use

•          A recent World Health Organization (WHO) showed that use of biomass fuel has been causing 50,000 premature deaths annually in Bangladesh

•         In total, biomass has been contributing for 3.6 percent of disease burden in Bangladesh

Highlights of Columbia University’s finding on biomass research in Bangladesh 

Fine particle (PM2.5) distribution in the study samples

PM2.5 conc.              % (n)                   Cumulative %        (ug/m3)          

Up to 65                       5  (4)                             5

>65-260                   35 (31)                            40

>260-520                 26 (23)                           66

>520-650                 18 (16)                        84

   >650                     16 (14)                      100

Fine particle conc. and self reported respiratory illness in the past year

Health professional consulted for your respiratory illness

Person consulted                    % (n)

   None                                                 7 (3)  

   Rural physician                    9 (4)

   Qualified physician             84(38)

Summary of the main findings

•         We find, on average, the study participants are exposed to PM2.5 about ten times higher than the U.S. and Bangladesh health based standard (645µg/m3).                                                                  

•         The study participants who experienced a respiratory illness in the past year (51%) were exposed to significantly higher levels of particulate matter than those who had not been exposed (903µg/m3 vs. 467µg/m3, p<0.05).

•         Individuals with predictive FEV1 <=75 were exposed to significantly higher levels of  PM2.5  than FEV1 >75 (912 µg/m3 vs. 518µg/m3, p<0.08).

•         Strong association between reduced lung function and number of years of cooking (p<0.05)

•         We also report strong associations between PM2.5 and urinary 1-hydroxy pyrene and 8-OHdG, two biomarkers for PAH and oxidative stress.

The trouble makers and possible solutions

Energy usage:
 
Actual usage: 14%
Smoke: 8%
Waste: ~78%

Some advantages and disadvantages of improved stove use

Advantages:

•         Produce little smoke compared to traditional stoves

•         Some evidences to reduce particulate matter and other pollutants

•         Highly cost-effective in terms of fuel usage and improving respiratory health status

•         Improved quality of life of women and children responsible for cooking food and collecting an storing of fuel

 Disadvantages:

•         Inconvenience/not user friendly: personal comfort, fuel type and maintenance

•         Not completely free (require little investment), require more space, some times a chimney and not easily movable from one place to the other

•         Failed to incorporate business community in promoting improved stoves in most of the countries

Objectives of the Study

•         The overall objective of the study is to develop cost effective solution to reduce health hazards associated with biomass fuel combustion in kitchen

Specific objectives of the project are:

•         To assess the linkages between biomass fuel use and respiratory illness among women and children in rural areas in Bangladesh

•         To assess and test the efficacy of improved stoves in reducing the respiratory illness

•         To assess the effect of hand washing on child health with regard to diarrhea and Acute Respiratory Infection (ARI).

•         To enhance the awareness of local people about the health hazards associated with biomass fuel use and about benefit of hand washing

Study site

Study plan /design

Study design/plan

•         Target group and sample size: 600 non-smoking women and their children under five years

            Intervention villages                                                                    Control villages

Major study parameters:

•          Exposure data- by collecting air  (for PM 2.5) and urine samples (for urinary 1-hydroxy pyrene and 8-OHdG, two biomarkers for PAH and oxidative stress).

•          Clinical information- on respiratory illness including ALRI

•          Lung function tests – by spirometry, blood oxygen saturation and blood pressure

Major Project  Activities 

•         Collect baseline and post intervention data on exposure, ALRI, lung functions, blood oxygen saturation, diarrhea, etc.  for comparison

•         Collect socio-economic and other qualitative data using structured questionnaires and conducting FGD

•         Conduct programs to increase awareness within study area

•         Provide improved stoves and hand washing soaps to study HH

•         Follow them for about a year

•         Weekly visits by village health workers to collect information on stove performance, respiratory illness, diarrhea and stove use

•         Recollect/repeat information and sample collection

Current work: update

•         Identified study and control villages and HHs

•         Developed and field tested questionnaires and other data collection tools and formats

•         Recruited and trained village health workers

•         Piloted data collection procedure

•         Identified potential study participants and collected preliminary information from them (n=260) including eligibility and interest in the study

•         Distributed improved stoves in few number of villages for initial assessment in village outside study area.