Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries.

BACKGROUND: The World Health Organisation reported that 45% of global acute respiratory infection (ARI) deaths in children under five years are attributable to household air pollution, which has been recognised to be strongly associated with solid biomass fuel usage in domestic settings. The introduction of legislative restrictions for charcoal production or purchase can result in unintended consequences, such as reversion to more polluting biomass fuels such as wood; which may increase health and environmental harms. However, there remains a paucity of evidence concerning the relative health risks between wood and charcoal. This study compares the risk of respiratory symptoms, ARI, and severe ARI among children aged under five years living in wood and charcoal fuel households across 30 low- and middle-income countries. METHODS: Data from children (N = 475,089) residing in wood or charcoal cooking households were extracted from multiple population-based Demographic and Health Survey databases (DHS) (N = 30 countries). Outcome measures were obtained from a maternal report of respiratory symptoms (cough, shortness of breath and fever) occurring in the two weeks prior to the survey date, generating a composite measure of ARI (cough and shortness of breath) and severe ARI (cough, shortness of breath and fever). Multivariable logistic regression analyses were implemented, with adjustment at individual, household, regional and country level for relevant demographic, social, and health-related confounding factors. RESULTS: Increased odds ratios of fever (AOR: 1.07; 95% CI: 1.02-1.12) were observed among children living in wood cooking households compared to the use of charcoal. However, no association was observed with shortness of breath (AOR: 1.03; 95% CI: 0.96-1.10), cough (AOR: 0.99; 95% CI: 0.95-1.04), ARI (AOR: 1.03; 95% CI: 0.96-1.11) or severe ARI (AOR: 1.07; 95% CI: 0.99-1.17). Within rural areas, only shortness of breath was observed to be associated with wood cooking (AOR: 1.08; 95% CI: 1.01-1.15). However, an increased odds ratio of ARI was observed in Asian (AOR: 1.25; 95% CI: 1.04-1.51) and East African countries (AOR: 1.11; 95% CI: 1.01-1.22) only. CONCLUSION: Our population-based observational data indicates that in Asia and East Africa there is a greater risk of ARI among children aged under 5 years living in wood compared to charcoal cooking households. These findings have major implications for understanding the existing health impacts of wood-based biomass fuel usage and may be of relevance to settings where charcoal fuel restrictions are under consideration.

Investigating Cooking Activity Patterns and Perceptions of Air Quality Interventions among Women in Urban Rwanda.

Household air pollution (HAP) from biomass cooking with traditional stoves is a major cause of morbidity and mortality in low-and-middle-income countries (LMICs) worldwide. Air quality interventions such as improved cookstoves (ICS) may mitigate HAP-related impacts; however, poor understanding of contextual socio-cultural factors such as local cooking practices have limited their widespread adoption. Policymakers and stakeholders require an understanding of local cooking practices to inform effective HAP interventions which meet end-user needs. A semi-structured questionnaire was administered to 36 women residing in biomass-cooking fuel households in Kigali, Rwanda to identify cooking activity patterns, awareness of HAP-related health risks and ICS intervention preferences. Overall, 94% of respondents exclusively used charcoal cooking fuel and 53% cooked one meal each day (range = 1-3 meals). Women were significantly more likely to cook outdoors compared to indoors (64% vs. 36%; p < 0.05). Over half of respondents (53%) were unaware of HAP-related health risks and 64% had no prior awareness of ICS. Participants expressed preferences for stove mobility (89%) and facility for multiple pans (53%) within an ICS intervention. Our findings highlight the need for HAP interventions to be flexible to suit a range of cooking patterns and preferred features for end-users in this context.

Effectiveness of interventions to reduce household air pollution from solid biomass fuels and improve maternal and child health outcomes in low- and middle-income countries: a systematic review protocol.

BACKGROUND: A variety of public health interventions have been undertaken in low- and middle-income countries (LMICs) to prevent morbidity and mortality associated with household air pollution (HAP) due to cooking, heating and lighting with solid biomass fuels. Pregnant women and children under five are particularly vulnerable to the effects of HAP, due to biological susceptibility and typically higher exposure levels. However, the relative health benefits of interventions to reduce HAP exposure among these groups remain unclear. This systematic review aims to assess, among pregnant women, infants and children (under 5 years) in LMIC settings, the effectiveness of interventions which aim to reduce household air pollutant emissions due to household solid biomass fuel combustion, compared to usual cooking practices, in terms of health outcomes associated with HAP exposure. METHODS: This protocol follows standard systematic review processes and abides by the PRISMA-P reporting guidelines. Searches will be undertaken in MEDLINE, EMBASE, CENTRAL, WHO International Clinical Trials Registry Platform (ICTRP), The Global Index Medicus (GIM), ClinicalTrials.gov and Greenfile, combining terms for pregnant women and children with interventions or policy approaches to reduce HAP from biomass fuels or HAP terms and LMIC countries. Included studies will be those reporting (i) pregnant women and children under 5 years; (ii) fuel transition, structural, educational or policy interventions; and (iii) health events associated with HAP exposure which occur among pregnant women or among children within the perinatal period, infancy and up to 5 years of age. A narrative synthesis will be undertaken for each population-intervention-outcome triad stratified by study design. Clinical and methodological homogeneity within each triad will be used to determine the feasibility for undertaking meta-analyses to give a summary estimate of the effect for each outcome. DISCUSSION: This systematic review will identify the effectiveness of existing HAP intervention measures in LMIC contexts, with discussion on the context of implementation and adoption, and summarise current literature of relevance to maternal and child health. This assessment reflects the need for HAP interventions which achieve measurable health benefits, which would need to be supported by policies that are socially and economically acceptable in LMIC settings worldwide. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020164998.

Impact of volatile fatty acids to alkalinity ratio and volatile solids on biogas production under thermophilic conditions.

The study assessed the impact of volatile fatty acids (VFA) to total alkalinity (TA) ratio (VFA/TA), and percentage volatile solids (VS) reduction of batch and semi-continuous anaerobic co-digestion of palm nut paste waste (PNPW) and anaerobic-digested rumen waste (ADRW) on digester stability and biogas production under the environmental condition of 50 ± 1°C and hydraulic retention time of 21 days for the batch studies and 14 days for semi-continuous co-digestion. The co-digestion ratios were based on percentage digester volume corresponding to 90%:10%, 75%:25% and 50%:50%. During batch and semi-continuous anaerobic co-digestion, VFA/TA of 0.32-1.0 and VS reduction of 53-67% were observed as the stable range at which biogas production was maximum. In terms of semi-continuous anaerobic digestion (AD), except for the 50%:50% ratio where biogas production progressed steadily from the first to fourteenth days, biogas production initially dropped from 180.1 to 171.3 mL between the first and third days of the 90%:10% reaching a maximum of 184 mL on the fourteenth day. Biogas production declined from 198.8 to 187.5 mL on the second day and then increased to 198.8 ± 0.5 mL in the case of the 75%:25% with a significant difference between the treatment ratios at p < 0.05. Therefore, the study can confirm that the 50%:50% ratio (PNPW:ADRW) is a suitable option for managing crude fat-based waste under thermophilic AD due to its potential for rapid start-up and complete biodegradation of active biomass within a 21-day period. This presupposes that residual methane as greenhouse gas will be void in the effluent if disposed of.

Biomass cooking carbon monoxide levels in commercial canteens in Kigali, Rwanda.

Carbon monoxide (CO) is harmful to human health, yet there is limited evidence concerning emissions associated with biomass fuel cooking in occupational settings. Real-time 48-hour monitoring of CO concentrations at breathing height, was undertaken in staff and student kitchen and serving areas of two commercial canteens. We characterized two diurnal CO peaks coinciding with cooking activities. Peak CO concentrations of 255.5 ppm and 1-hour average of 76.3 ppm (IQR: 57.8-109.0 ppm) were observed in the student kitchen; the staff kitchen levels were 208.5 ppm, and 76.3 ppm (IQR: 52.5-114.0 ppm), respectively. High magnitude CO concentrations (8-hour average: 40.7 ppm SD: 40.0 ppm) which exceed World Health Organisation (WHO) Indoor Air Quality standards were observed. Further investigation of personal exposure and health impacts among kitchen staff is required, to inform interventions in this setting.

Investigating the Association between Wood and Charcoal Domestic Cooking, Respiratory Symptoms and Acute Respiratory Infections among Children Aged Under 5 Years in Uganda: A Cross-Sectional Analysis of the 2016 Demographic and Health Survey.

Background: Household air pollution associated with biomass (wood, dung, charcoal, and crop residue) burning for cooking is estimated to contribute to approximately 4 million deaths each year worldwide, with the greatest burden seen in low and middle-income countries. We investigated the relationship between solid fuel type and respiratory symptoms in Uganda, where 96% of households use biomass as the primary domestic fuel. Materials and Methods: Cross-sectional study of 15,405 pre-school aged children living in charcoal or wood-burning households in Uganda, using data from the 2016 Demographic and Health Survey. Multivariable logistic regression analysis was used to identify the associations between occurrence of a cough, shortness of breath, fever, acute respiratory infection (ARI) and severe ARI with cooking fuel type (wood, charcoal); with additional sub-analyses by contextual status (urban, rural). Results: After adjustment for household and individual level confounding factors, wood fuel use was associated with increased risk of shortness of breath (AOR: 1.33 [1.10-1.60]), fever (AOR: 1.26 [1.08-1.48]), cough (AOR: 1.15 [1.00-1.33]), ARI (AOR: 1.36 [1.11-1.66] and severe ARI (AOR: 1.41 [1.09-1.85]), compared to charcoal fuel. In urban areas, Shortness of breath (AOR: 1.84 [1.20-2.83]), ARI (AOR: 1.77 [1.10-2.79]) and in rural areas ARI (AOR: 1.23 [1.03-1.47]) and risk of fever (AOR: 1.23 [1.03-1.47]) were associated with wood fuel usage. Conclusions: Risk of respiratory symptoms was higher among children living in wood compared to charcoal fuel-burning households, with policy implications for mitigation of associated harmful health impacts.

Benchmarking performance of solid waste management and recycling systems in East Africa: Comparing Kigali Rwanda with other major cities.

This paper aims to benchmark performance of combined solid waste management (SWM) and recycling systems in major cities of East Africa. The Wasteaware indicators are used to present a detailed systems analysis for Kigali in Rwanda, including a mass flow diagram; comparative data are taken from the Wasteaware database for Dar es Salaam, Tanzania, Kampala, Uganda, Nairobi, Kenya, and also for neighboring Maputo, Mozambique. The stand-out result is the relatively high collection coverage achieved, in Maputo with extensive international technical assistance, and in Kigali using its own local resources. In both cases, governance factors are key. Kigali uses a public-private partnership, with exclusive franchises in 35 sectors being tendered every three years; households pay an affordable fee depending on their ability to pay (the service is free to the poorest category); and 95% fee collection rates are achieved, partly through co-collection with charges for local security patrols, which is a service people value highly given the recent history of the country. Another key priority to improve SWM across East Africa is to eliminate open dumping - only Kampala currently has an engineered disposal site. Recycling rates also need to be increased - only Nairobi currently has a good baseline to build on (30%). Common weaknesses include a lack of segregation at source, of institutional capacity, and of available and reliable waste data.

Environmental impact assessment in higher education institutions in East Africa: the case of Rwanda.

Due to the pressure on limited resources produced by a growing population and due to a decade of war, Rwanda is facing a major problem in environmental protection. Because of such problems, it seems only reasonable that environment-related courses should play an important role in the curricula of institutions of higher learning. The main aim of this research is to present a comprehensive picture of Environmental Impact Assessment (EIA) integration in graduate and undergraduate programs in Rwandese higher education institutions and to make recommendations for its improvement. During this study, two surveys were conducted: the first survey targeted Environmental Impact Assessment lecturers and the second survey was for Environmental Impact Assessment practitioners (including EIA certified experts and competent authorities). The study found that Environmental Impact Assessment is not well established in these institutions and it is not taught in some programs; civil engineering, for example, has no Environmental Impact Assessment courses. Recommendations to improve EIA education are proposed, such as requiring that a common core course in Environmental Impact Assessment be made available in Rwandese higher learning institutions.