Adverse birth outcomes associated with household air pollution from unclean cooking fuels in low- and middle-income countries: A systematic review.

Approximately 3.8 billion people in low- and middle-income countries use unclean fuels as a source of primary cooking fuel as well as for heating. For pregnant women, the toxic chemicals produced by combustion of unclean fuels not only affect women's health directly, but particulate matter and carbon monoxide are absorbed in maternal blood and cross the placental barrier impairing fetal tissue growth. PRISMA 2009 guidelines were used for this systematic review. The inclusion criteria were quantitative, peer reviewed journal articles published within a date range of May 1, 2013-June 12, 2021 examining birth outcomes related to household air pollution from type of cooking fuel in low- and middle-income countries. The quality of available evidence was evaluated using the Office of Health Assessment and Translation (OHAT) risk of bias rating tool. Of the 553 studies screened, 23 satisfied the inclusion criteria. Of the studies that met the inclusion criteria, 14 were cross-sectional, 5 cohort, 1 case-control and 3 randomized control trials conducted across 15 different countries. A range of birth outcomes are reported across studies including birthweight (19), small for gestational age (6), spontaneous abortion (3), preterm birth (6), stillbirth (7) and neonatal mortality (6). The reviewed studies presented evidence for an increased risk of low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), stillbirth, neonatal mortality and reduction in birthweight with solid fuel and kerosene use compared to cleaner fuels like gas and LPG. Systematically reviewing the evidence and risk of bias ratings illuminated several gaps in the current literature related to exposure assessment, outcome measurement and adequacy of adjustment for confounding.

Women's experiences with mixed use of wood and gas cookstoves and fuels in rural Lambayeque, Peru / Experiencias de mujeres en el uso mixto de combustibles para cocinar en una zona rural de Lambayeque, Perú

Introduction: Despite program efforts to encourage use of clean cookstoves and fuels to mitigate climate change, many communities continue to use wood-fueled open fires. Objectives: Describe experiences of participants with mixed use of cooking and fuel technologies (e.g. open fires and chimney stoves using wood and liquefied petroleum gas (LPG) stoves) in rural Lambayeque, Peru in 2018. Material and methods: Fifteen participants were interviewed using a qualitative exploratory research design. Data was collected through semi-structured interviews and analyzed using thematic content analysis. Results: Four categories emerged: decisions about acquiring cooking fuels are primarily based on cost; plastic trash is used to light wood-burning stoves; decisions to use gas over wood are based on quick food cooking time; and benefits and health problems are recognized, but mixed use of fuels persist. Conclusion:Use of both traditional wood cookstoves and plastic trash to ignite fires were used frequently because both are free or cheap. The environmental impact of cutting down trees isn't considered important, but interviewees did notice detriments to their wellbeing. Although gas stoves are used and benefits were mentioned, use of traditional stoves persists. We recommend that policy makers in Peru begin to address barriers to full adoption of new clean cooking technologies and consider governmental subsidies to meet families' spending priorities.

Introducción: A pesar de los esfuerzos del programa para alentar el uso de estufas y combustibles limpios para mitigar el cambio climático, muchas comunidades continúan utilizando fuegos abiertos a leña. Objetivo: Describa las experiencias de los participantes con el uso mixto de la cocina y las tecnologías de combustible (por ejemplo, fuegos abiertos y estufas de chimenea que usan estufas de leña y gas licuado de petróleo (GLP)) en la zona rural de Lambayeque, Perú, en 2018. Material y métodos: Quince participantes fueron entrevistados utilizando un diseño de investigación exploratoria cualitativa. Los datos se recopilaron a través de entrevistas semiestructuradas y se analizaron mediante análisis de contenido temático. Resultados: Surgieron cuatro categorías: las decisiones sobre la adquisición de combustibles para cocinar se basan principalmente en el costo; la basura plástica se usa para encender estufas de leña; las decisiones de usar gas sobre la madera se basan en el tiempo de cocción de comida rápida; y se reconocen los beneficios y los problemas de salud, pero persiste el uso mixto de combustibles. Conclusión: El uso de estufas de leña tradicionales y basura plástica para encender incendios se usaba con frecuencia porque ambos son gratuitos o baratos. El impacto ambiental de la tala de árboles no se considera importante, pero los entrevistados notaron daños en su bienestar. Aunque se usan estufas de gas y se mencionaron los beneficios, el uso de estufas tradicionales persiste. Recomendamos que los encargados de formular políticas en Perú comiencen a abordar las barreras para la adopción total de nuevas tecnologías de cocina limpia y consideren los subsidios