Health impacts of a randomized biomass cookstove intervention in northern Ghana.

BACKGROUND: Household air pollution (HAP) from cooking with solid fuels has adverse health effects. REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) was a randomized cookstove intervention study that aimed to determine the effects of two types of "improved" biomass cookstoves on health using self-reported health symptoms and biomarkers of systemic inflammation from dried blood spots for female adult cooks and children, and anthropometric growth measures for children only. METHODS: Two hundred rural households were randomized into four different cookstove groups. Surveys and health measurements were conducted at four time points over a two-year period. Chi-square tests were conducted to determine differences in self-reported health outcomes. Linear mixed models were used to assess the effect of the stoves on inflammation biomarkers in adults and children, and to assess the z-score deviance for the anthropometric data for children. RESULTS: We find some evidence that two biomarkers of oxidative stress and inflammation, serum amyloid A and C-reactive protein, decreased among adult primary cooks in the intervention groups relative to the control group. We do not find detectable impacts for any of the anthropometry variables or self-reported health. CONCLUSIONS: Overall, we conclude that the REACCTING intervention did not substantially improve the health outcomes examined here, likely due to continued use of traditional stoves, lack of evidence of particulate matter emissions reductions from "improved" stoves, and mixed results for HAP exposure reductions. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov (National Institutes of Health); Trial Registration Number: NCT04633135 ; Date of Registration: 11 November 2020 - Retrospectively registered. URL: https://clinicaltrials.gov/ct2/show/NCT04633135?term=NCT04633135&draw=2&rank=1.

Updated Emission Factors from Diffuse Combustion Sources in Sub-Saharan Africa and Their Effect on Regional Emission Estimates.

Diffuse emission sources outside of kitchen areas are poorly understood, and measurements of their emission factors (EFs) are sparse for regions of sub-Saharan Africa. Thirty-one in-field emission measurements were taken in northern Ghana from combustion sources common to rural regions worldwide. Sources sampled included commercial cooking, trash burning, kerosene lanterns, and diesel generators. EFs were calculated for carbon monoxide (CO), carbon dioxide (CO2), as well as carbonaceous particulate matter, specifically elemental carbon (EC) and organic carbon (OC). EC and OC emissions were measured from kerosene lighting events (EFEC = 25.1 g/kg-fuel SD = 25.7, EFOC = 9.5 g/kg-fuel SD = 10.0). OC emissions from trash burning events were large and highly variable (EFOC = 38.9 g/kg-fuel SD = 30.5). Combining our results with other recent in-field emission factors for rural Ghana, we explored updated emission estimates for Ghana using a region specific emissions inventory. Large differences are calculated for all updated source emissions, showing a 96% increase in OC and 78% decrease in EC compared to prior estimates for Ghana's emissions. Differences for carbon monoxide were small when averaged across all updated source types (-1%), though the household wood use and trash burning categories individually show large differences.

Prices, peers, and perceptions (P3): study protocol for improved biomass cookstove project in northern Ghana.

BACKGROUND: Despite their potential health and social benefits, adoption and use of improved cookstoves has been low throughout much of the world. Explanations for low adoption rates of these technologies include prices that are not affordable for the target populations, limited opportunities for households to learn about cookstoves through peers, and perceptions that these technologies are not appropriate for local cooking needs. The P3 project employs a novel experimental design to explore each of these factors and their interactive effects on cookstove demand, adoption, use and exposure outcomes. METHODS: The P3 study is being conducted in the Kassena-Nankana Districts of Northern Ghana. Leveraging an earlier improved cookstove study that was conducted in this area, the central design of the P3 biomass stove experiment involves offering stoves at randomly varying prices to peers and non-peers of households that had previously received stoves for free. Using household surveys, electronic stove use monitors, and low-cost, portable monitoring equipment, we measure how prices and peers' experience affect perceptions of stove quality, the decision to purchase a stove, use of improved and traditional stoves over time, and personal exposure to air pollutants from the stoves. DISCUSSION: The challenges that public health and development communities have faced in spreading adoption of potentially welfare-enhancing technologies, like improved cookstoves, have highlighted the need for interdisciplinary, multisectoral approaches. The design of the P3 project draws on economic theory, public health practice, engineering, and environmental sciences, to more fully grasp the drivers and barriers to expanding access to and uptake of cleaner stoves. Our partnership between academic institutions, in the US and Ghana, and a local environmental non-governmental organization creates unique opportunities to disseminate and scale up lessons learned. TRIAL REGISTRATION: ClinicalTrials.gov NCT03617952 7/31/18 (Retrospectively Registered).

Liquified Petroleum Gas (LPG) Supply and Demand for Cooking in Northern Ghana.

Like many other countries, Ghana relies on biomass (mainly wood and charcoal) for most of its cooking needs. A national action plan aims to expand liquefied petroleum gas (LPG) access to 50% of the country's population by 2020. While the country's southern urban areas have made progress toward this goal, LPG use for cooking remains low in the north. The aim of this cross-sectional study was to characterize the current state of the LPG market in this area and examine opportunities and barriers to scale up LPG adoption. We interviewed 16 LPG suppliers (stove, cylinder, and fuel vendors) as well as 592 households in the Kassena-Nankana Districts (KND) of Ghana. We find large rural-urban differences in LPG uptake: less than 10% of rural households own LPG stoves compared with over half of urban households. Awareness of LPG is high across the region, but accessibility of fuel supply is highly limited, with just one refilling station located in the KND. Affordability is perceived as the main barrier to LPG adoption, and acceptability is also limited by widespread concerns about the safety of cooking with LPG. Transitioning to a cylinder recirculation model, and providing more targeted subsidies and credit options, should be explored to expand access to cleaner cooking in this region.

Exposures to and origins of carbonaceous PM2.5 in a cookstove intervention in Northern Ghana.

REACCTING (Research on Emissions Air Quality, Climate, and Cooking Technologies in Northern Ghana) was a 200-home cookstove intervention study from 2013 to 2015. Study households were divided into four groups: a control group, a group given two locally made rocket stoves, a group given two Philips forced draft stoves, and a group given a locally made rocket stove and a Philips stove. In a subset of study households, 48-hour PM2.5 exposure samples were collected for adults and children, as well as in the primary cooking area. Further, weekly ambient background PM2.5 samples were collected for the first nine months of the study. All PM2.5 samples were analyzed for elemental and organic carbon (EC/OC), and a subset was also analyzed for organics. Mixed effects modeling was applied to quantify differences in PM exposures between the groups and to assess relationships between exposures and cooking area measurements. Results showed that personal OC exposure for the intervention groups was 56.6% lower than the control group (p≤0.01). Both intervention groups given Philips stoves had significantly lower EC exposure than the control group (60.6% reduction, p≤0.02). Only weak relationships were found between personal and cooking area EC or OC. Source apportionment modeling was performed on both the personal/microenvironment and the ambient organics PM2.5 data sets to assess the sources of the observed PM. We identified six PM sources. The identified source factors were similar among the data sets, as well as with previous work in Navrongo. Two sources, one characterized by the presence of methoxyphenols, and one by the presence of polyaromatic hydrocarbons and EC, were associated with biomass burning, and accounted for a median of 9.2% of OC and 15.3% of EC personal exposure. Here, we demonstrate the utility of using the cooking-related source apportionment factors within a mixed effects model for more precise estimation of exposures due to cooking, rather than other combustion sources unrelated to the intervention.

Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana (REACCTING): study rationale and protocol.

BACKGROUND: Cooking over open fires using solid fuels is both common practice throughout much of the world and widely recognized to contribute to human health, environmental, and social problems. The public health burden of household air pollution includes an estimated four million premature deaths each year. To be effective and generate useful insight into potential solutions, cookstove intervention studies must select cooking technologies that are appropriate for local socioeconomic conditions and cooking culture, and include interdisciplinary measurement strategies along a continuum of outcomes. METHODS/DESIGN: REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) is an ongoing interdisciplinary randomized cookstove intervention study in the Kassena-Nankana District of Northern Ghana. The study tests two types of biomass burning stoves that have the potential to meet local cooking needs and represent different "rungs" in the cookstove technology ladder: a locally-made low-tech rocket stove and the imported, highly efficient Philips gasifier stove. Intervention households were randomized into four different groups, three of which received different combinations of two improved stoves, while the fourth group serves as a control for the duration of the study. Diverse measurements assess different points along the causal chain linking the intervention to final outcomes of interest. We assess stove use and cooking behavior, cooking emissions, household air pollution and personal exposure, health burden, and local to regional air quality. Integrated analysis and modeling will tackle a range of interdisciplinary science questions, including examining ambient exposures among the regional population, assessing how those exposures might change with different technologies and behaviors, and estimating the comparative impact of local behavior and technological changes versus regional climate variability and change on local air quality and health outcomes. DISCUSSION: REACCTING is well-poised to generate useful data on the impact of a cookstove intervention on a wide range of outcomes. By comparing different technologies side by side and employing an interdisciplinary approach to study this issue from multiple perspectives, this study may help to inform future efforts to improve health and quality of life for populations currently relying on open fires for their cooking needs.