1. July 22, 2013
Luke P. Naeher, Associate Professor
Environmental Health Science, College of Public Health
University of Georgia
October 2, 2013
Indoor air pollution in developing countries:
Challenges and opportunities in Chile and Peru
Luke P. Naeher, Profesor Asociado
Ciencias de la Salud Ambiental de la Facultad de Salud Pública de la
Universidad de Georgia
02 de octubre 2013
Contaminación intradomiciliaria en países en desarrollo:
desafíos y oportunidades en Chile y Perú

2. Outline of Presentation
1. Household Air Pollution (HAP) in the
developing world – Introduction and
Background
2. Our current HAP project in Ayacucho, Peru
3. Future directions of/opportunities for HAP
research in Chile and Peru

3. Outline of Presentation
1. Household Air Pollution (HAP)
in the developing world –
Introduction and Background
2. Our current HAP project in Ayacucho, Peru
3. Future directions of/opportunities for HAP research in Chile and
Peru

6. Globally, approximately 3 billion people rely on solid fuels as
their main source of domestic energy
6Picture source: WHO Household Energy Database (2010)

7. Household Air Pollution
 Biomass smoke
contains 1000s of
chemicals in the form
of incomplete
combustion products
(Naeher et al. 2007; Smith and Mehta 2003; Smith
1987)
7
Picture source: http://burningissues.org/images/smokehouse1top-a.jpg

8. 8
DISTRIBUTION OF DISEASE BURDEN:
DEVELOPING COUNTRIES
Picture source: WHO 2002
4th leading risk
factor of disease
burden

10. Health Effects
 Biomass smoke exposure is
associated with:
 Acute lower respiratory infections (ALRI),
chronic obstructive pulmonary disease (WHO 2011;
Bruce et al. 2005; Orozco-Levi et al. 2006; Regalado et al. 2006).
 Increasing evidence:
 low birth weight, asthma, acute upper
respiratory infections, tuberculosis and
cataracts (McCracken et al. 2011; Naeher et al. 2007; Smith and Mehta 2003).
 Emerging evidence:
 Oxidative stress and inflammation, adverse
respiratory health, cardiovascular disease
(Banerjee et al. 2011; Adetona et al. 2011; Romieu et al. 2009; Clark et al. 2012; McCracken et
al. 2011). 10

11. Sensitive subpopulations
 Women and children in developing nations
 Spend more time at home and in the kitchen1
 Children < 5 years of age
 56% of all indoor air pollution-attributable deaths2
1. Smith, K. R. "Deadly Household Pollution: A Call to Action," Indoor Air 16 (2006): 2.
2. Rehfuess, E., Mehta, S., and Prüss-Üstün, A. "Assessing Household Solid Fuel Use: Multiple Implications for the Millennium Development Goals," Environmental Health Perspectives
114 (2006): 373-378.

12. Global Alliance for Clean Cookstoves
 Launched in September 2010 with the goal of installing
100 million improved stoves by the year 2020

13. Peru’s National Stove Program
 In Peru almost 93% of the rural
population rely on biomass
fuels for cooking and heating
(INEI, 2007).
 In 2009, the Peruvian
government launched a
“500,000 improved cookstoves
national campaign for a
smokeless Peru”
(http://www.ityf.org.pe/en/).
13
http://energy.gov/articles/department-energy-planning-cookstoves-research-relea
: Improved cookstove in village of Santa Cruz de Lanchi, installed through
Peru’s national cookstove program. | Photo credit: Ranyee Chiang, DOE

14. 14
WHO 24hr air
quality guideline of
25 µg/m3

15. Outline of Presentation
1. Household Air Pollution (HAP) in the developing world –
Introduction and Background
2. Our current HAP project in
Ayacucho, Peru
3. Future directions of/opportunities for HAP research in Chile and
Peru

16. Briefly, I will discuss one of our recent household
air pollution studies from Peru, and then I will
discuss our current project in Ayacucho, Peru
 Santiago de Chuco – HAP exposure
assessment following the installation of an
improved stove with chimney
 Ayacucho – HAP in homes where wood is
used to fuel cooking stoves, and low birth
weight in a group of over 100 pregnant
women

17. Peru
La Libertad Region
Santiago de Chuco Province
Santiago de Chuco
0 5 10 20 km

18. Before
After
Stove 2
48
48

19.  Kitchen PM2.5
 DUSTTRAK™ Aerosol Monitor (realtime)
 SKC AirChek® 2000 Pump with Cyclone
(gravimetric)
 Personal PM2.5
 SKC AirChek® XR5000 Pump with Cyclone
 CO
 Drӓger Pac III
Air Sampling

20. Results
 After three weeks of using the new stoves,
reductions in indoor air pollution were seen across
the board in all study communities, with:
 Larger reduction in Kitchen vs. Personal
 Consistent with other studies

22. Home 14 – Stove 1

23. Home 14 – Stove 1

24. Home 14 – Stove 1

25. Relationship between household air pollution
related exposure and birth weight in
Ayacucho, Peru

26. Subject Recruitment
 Subjects were recruited by Peruvian researchers and
students through local clinics (goal: 100+ subjects)
 Subjects recruited after home visit
 Subjects had to be in third trimester of pregnancy and cook
with wood exclusively

30. Exposure Assessment
 Done by Peruvian graduate students
who were lab and field trained for two
weeks
 Kitchen and personal CO and PM2.5
measurements
 CO measurement – Draeger PAC III
single gas monitor (electrochemical
sensor)
 PM2.5 measurement – RTI Inc. MicroPEM
v 3.2 (laser photometer)

31. Exposure Assessment
 Reasons for instrument choice
 Real time capabilities + gravimetry for MicroPEM
 Portability
 Wearing compliance measure (on-board MicroPEM)
 Capability to run for 48 hours
 Simple to learn (learned within two weeks in the lab and field by
Peruvian research graduate students)
 Instrument operated very well within first two months
 Collection of measurements were mostly complete
 Performance degraded over the last month of sampling
 Many measurements were incomplete

32. Exposure Assessment
 Kitchen:
Samplers were
set up in kitchen
beside cooking
stoves at
breathing height
 Personal:
Subjects wore
both samplers in
vests in breathing
zone

35. Other Study Information/Data
 Pre- and post-exposure measurement
questionnaire
 Demographics
 Health related information
 Wearing compliance issues
 Field notes
 house characteristics
 Clinics:
 birth weight
 birth related information

36. Strengths
 Both kitchen and personal exposure
measurements with measure of wearing
compliance
 Both real time and gravimetry measurements for
PM2.5
 Relatively homogeneous population
 Relatively wide range of exposure with same
fuel type

37. Limitations
 Incomplete exposure measurements for
some subjects
 Exposure measurement was conducted once
and only in the third trimester
 Sample size

38. Outline of Presentation
1. Household Air Pollution (HAP) in the developing world –
Introduction and Background
2. Our current HAP project in Ayacucho, Peru
3. Future directions
of/opportunities for HAP
research in Chile and Peru

39. Heart Disease and Combustion Particle Doses
Solid Fuel
Zone
From “Mind the Gap,”
Smith/Peel, 2010 and Pope
et al., 2009

40. 0
5
10
15
20
25
30
35
0 200 400 600 800 1000
Annual mean PM2.5 - ug/m3
HeartDiseaseImpact
From “Mind the Gap,”
Smith/Peel, 2010 and Pope
et al., 2009

41. Smith et al. 2011
Physician-diagnosed severe pneumonia
Plancha
(Chimney)
stove
Open fire

43.  Kenya
 the jiko stove
http://hopebuilding.pbworks.com/w/page/19222589/Kenyan-stove-manufacturer-provides-energy-efficient-cooking,-encourages-tree-planting

44. India
Chulah

45. Opportunities for future household air
pollution research in Chile and Peru
 Investigate the implementation of super low emissions
stoves (example: gas stoves), and study:

46. Grant currently in review at NIH/Fogarty:
TRANSFERRING ECAPACITY TO CHILE
 We propose to build eCapacity in Chile by developing technological capacity
that will improve the sophistication of environmental health research there.
 This effort will build on our current Fogarty planning grant “Planning for a Global
Environmental Health Hub in Chile” (1R24TW009545-01), a decade-long collaboration with
University of Chile researchers funded by the Fogarty International Training in Environmental
and Occupational Health (ITREOH) program (D43TW005746), and our current support from
Fogarty through the Human Health Impacts of Climate Change program (1R21TW009032).
 By e-Capacity we refer to transferring expertise from the US to Chile
regarding information and communication technology (ICT) techniques and
software, in particular pertaining to the areas of:
 exposure measurement,
 epidemiology, and
 geospatial technology tools for addressing health impacts.
 We propose to teach courses and participate in collaborative research in
Chile in four key areas:
 1) Climate Change Research,
 2) Geospatial Analysis,
 3) Household Air Pollution Measurement, and
 4) New Epidemiologic Methods.