Oct 2, 2013 geo hub workshop_air_luke naeher_final for u chile

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  • Potential solutions User behavior (eg fuel drying, use of stove pot lids) Living conditions (eg increased kitchen ventilation: window or ventilation holes) Fuel type (eg liquefied petroluem gas, low smoke fuels) Cookstoves (eg improved stoves with chimneys, flues) There are no internationally accepted design for biomass burning stoves.
  • Women and children are known to bear a vastly disproportionate burden of indoor air pollution in the developing world, as they spend much more time in the kitchen, and this proved true in our experience in Peru as well. Young children were most often carried like this on the mother’s back, effectively exposing the kids to whatever mom was exposed to
  • PM2.5 has been identified as the best single indicator of the health effects of combustion of biomass such as wood (Naeher et al. 2007; Perez-Padilla, Schilmann, and Riojas-Rodriguez 2010). 8hrHonduras: 1002.3 ug/3 (open fire) Clark et al 2010 24hr Guatemala: 520 ug/m3 (open fires) Naeher et al 2000: 24hr 24hrIndia: 468 and 718 ug/m3 (open fires) Mukhopadhyay et al 2012 24hrGhana: 650 ug/m3 (open fires) Pennise et al 2009 48hrMexico: 469 ug/m3 (open fires) Cynthia et al 2008 48hrPeru: 207.3 ug/m3 (open fires) Fitzgerald et al 2012 The high PM concentrations reinforce the need for interventions that reduce HAP exposures
  • And again, with stove 2 in chaguin/cachulla. These all actually look the exact same, because the industry subcontracted the job of their construction out to one man. This ensured that everyone received the same level of stove quality, but it also slowed the process of stove building down a bit, which set us back in our timing. In the end, we were forced to return to the states with only the pre-intervention sampling done in this region, and then train and send back a different group from UGA to finish what we started there, using the same field technicians as before.
  • As I mentioned before, we measured PM2.5 and CO, on the personal level and as a stationary sampling site in the kitchen near the stove. In a random subsample of the homes (since we did not have enough equipment to do every home), we captured real-time measures of PM2.5 using the Dusttrak aerosol monitor [click], which is a data-logging, light-scattering laser photometer that gives real-time aerosol mass readings. To obtain gravimetric measures, we used the SKC AirChek 2000 pump, which pulled air in at a constant rate of 1.5 liters per minute, with a BGI Triplex cyclone designed to capture PM2.5 on small, preweighed microfilters within the cyclone. Show video thing. For personal PM2.5 we used a very similar pump and cyclone setup, but the pump was a newer model with an internal lithium battery that could last 48 hours without being changed out. Finally, to measure CO in both settings, we used the Draeger Pac III, a gas measuring device with a specific CO sensor. Now, the equipment in the kitchen was placed in a box we like this, which we had constructed from local materials by a carpenter from town, with a piece of PCV tubing reaching up to approximate breathing height. The equipment sat in the box, and the sampling ends were attached to the tubing. The women all wore a vest like the one you see here, which was basically a converted firefighter radio harness, and the equipment sat in the vest with the sampling ends attached at breathing height or as near as possible. They wore these vests for the entirety of 2 days, only taking them off to bathe or to sleep, and during sleep it was set next to their beds on a chair or table.
  • Blah blah reading blah….statistically significan WHICH WE defined as… Even though the purpose of our study was not a comparison of stove models, we did find that they performed equally according to 2-way ANOVA testing, with the exception of the personal CO reductions in Chaguin
  • This is realtime CO and PM measures with the traditional stove, CO measured in ppm and PM measured in mg/m3. notice again the peaks around mealtimes
  • This is from the same home after the installation of a new stove. The scale was kept the same to show the gravity of the change. Peaks still line up with mealtimes, but were drastically reduced.
  • And now both of them together, to see the whole picture.
  • Visit, consent and recruitment typically took place on the same day. This was inefficient and a limitation which would be mentioned later, but was largely a factor of funding and schedule being affected by IRB.
  • Degradation was mostly a function of the instrument, but also some personnel performance
  • The limitations are largely a size of funding.
  • Oct 2, 2013 geo hub workshop_air_luke naeher_final for u chile

    1. 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. 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. 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
    4. 4. Globally, approximately 3 billion people rely on solid fuels as their main source of domestic energy 6Picture source: WHO Household Energy Database (2010)
    5. 5. 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
    6. 6. 8 DISTRIBUTION OF DISEASE BURDEN: DEVELOPING COUNTRIES Picture source: WHO 2002 4th leading risk factor of disease burden
    7. 7. 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
    8. 8. 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.
    9. 9. Global Alliance for Clean Cookstoves  Launched in September 2010 with the goal of installing 100 million improved stoves by the year 2020
    10. 10. 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
    11. 11. 14 WHO 24hr air quality guideline of 25 µg/m3
    12. 12. 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
    13. 13. 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
    14. 14. Peru La Libertad Region Santiago de Chuco Province Santiago de Chuco 0 5 10 20 km
    15. 15. Before After Stove 2 48 48
    16. 16.  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
    17. 17. 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
    18. 18. Home 14 – Stove 1
    19. 19. Home 14 – Stove 1
    20. 20. Home 14 – Stove 1
    21. 21. Relationship between household air pollution related exposure and birth weight in Ayacucho, Peru
    22. 22. 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
    23. 23. 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)
    24. 24. 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
    25. 25. 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
    26. 26. 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
    27. 27. 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
    28. 28. Limitations  Incomplete exposure measurements for some subjects  Exposure measurement was conducted once and only in the third trimester  Sample size
    29. 29. 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
    30. 30. Heart Disease and Combustion Particle Doses Solid Fuel Zone From “Mind the Gap,” Smith/Peel, 2010 and Pope et al., 2009
    31. 31. 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
    32. 32. Smith et al. 2011 Physician-diagnosed severe pneumonia Plancha (Chimney) stove Open fire
    33. 33.  Kenya  the jiko stove http://hopebuilding.pbworks.com/w/page/19222589/Kenyan-stove-manufacturer-provides-energy-efficient-cooking,-encourages-tree-planting
    34. 34. India Chulah
    35. 35. Opportunities for future household air pollution research in Chile and Peru  Investigate the implementation of super low emissions stoves (example: gas stoves), and study:
    36. 36. 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.

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