Establishing a Demographic, Development and Environmental Geospatial Surveillance Platform in India: Planning and Implementation.

BACKGROUND: Inadequate administrative health data, suboptimal public health infrastructure, rapid and unplanned urbanization, environmental degradation, and poor penetration of information technology make the tracking of health and well-being of populations and their social determinants in the developing countries challenging. Technology-integrated comprehensive surveillance platforms have the potential to overcome these gaps. OBJECTIVE: This paper provides methodological insights into establishing a geographic information system (GIS)-integrated, comprehensive surveillance platform in rural North India, a resource-constrained setting. METHODS: The International Clinical Epidemiology Network Trust International established a comprehensive SOMAARTH Demographic, Development, and Environmental Surveillance Site (DDESS) in rural Palwal, a district in Haryana, North India. The surveillance platform evolved by adopting four major steps: (1) site preparation, (2) data construction, (3) data quality assurance, and (4) data update and maintenance system. Arc GIS 10.3 and QGIS 2.14 software were employed for geospatial data construction. Surveillance data architecture was built upon the geospatial land parcel datasets. Dedicated software (SOMAARTH-1) was developed for handling high volume of longitudinal datasets. The built infrastructure data pertaining to land use, water bodies, roads, railways, community trails, landmarks, water, sanitation and food environment, weather and air quality, and demographic characteristics were constructed in a relational manner. RESULTS: The comprehensive surveillance platform encompassed a population of 0.2 million individuals residing in 51 villages over a land mass of 251.7 sq km having 32,662 households and 19,260 nonresidential features (cattle shed, shops, health, education, banking, religious institutions, etc). All land parcels were assigned georeferenced location identification numbers to enable space and time monitoring. Subdivision of villages into sectors helped identify socially homogenous community clusters (418/676, 61.8%, sectors). Water and hygiene parameters of the whole area were mapped on the GIS platform and quantified. Risk of physical exposure to harmful environment (poor water and sanitation indicators) was significantly associated with the caste of individual household (P=.001), and the path was mediated through the socioeconomic status and density of waste spots (liquid and solid) of the sector in which these households were located. Ground-truthing for ascertaining the land parcel level accuracies, community involvement in mapping exercise, and identification of small habitations not recorded in the administrative data were key learnings. CONCLUSIONS: The SOMAARTH DDESS experience allowed us to document and explore dynamic relationships, associations, and pathways across multiple levels of the system (ie, individual, household, neighborhood, and village) through a geospatial interface. This could be used for characterization and monitoring of a wide range of proximal and distal determinants of health.

Household Air Pollution Exposures of Pregnant Women Receiving Advanced Combustion Cookstoves in India: Implications for Intervention.

BACKGROUND: Household air pollution (HAP) resulting from the use of solid cooking fuels is a leading contributor to the burden of disease in India. Advanced combustion cookstoves that reduce emissions from biomass fuels have been considered potential interventions to reduce this burden. Relatively little effort has been directed, however, to assessing the concentration and exposure changes associated with the introduction of such devices in households. OBJECTIVES: The aim of this study was to describe HAP exposure patterns in pregnant women receiving a forced-draft advanced combustion cookstove (Philips model HD 4012) in the SOMAARTH Demographic Development & Environmental Surveillance Site (DDESS) Palwal District, Haryana, India. The monitoring was performed as part of a feasibility study to inform a potential large-scale HAP intervention (Newborn Stove trial) directed at pregnant women and newborns. METHODS: This was a paired comparison exercise study with measurements of 24-hour personal exposures and kitchen area concentrations of carbon monoxide (CO) and particulate matter less than 2.5 µm in aerodynamic diameter (PM2.5), before and after the cookstove intervention. Women (N = 65) were recruited from 4 villages of SOMAARTH DDESS. Measurements were performed between December 2011 and March 2013. Ambient measurements of PM2.5 were also performed throughout the study period. FINDINGS: Measurements showed modest improvements in 24-hour average concentrations and exposures for PM2.5 and CO (ranging from 16% to 57%) with the use of the new stoves. Only those for CO showed statistically significant reductions. CONCLUSION: Results from the present study did not support the widespread use of this type of stove in this population as a means to reliably provide health-relevant reductions in HAP exposures for pregnant women compared with open biomass cookstoves. The feasibility assessment identified multiple factors related to user requirements and scale of adoption within communities that affect the field efficacy of advanced combustion cookstoves as well as their potential performance in HAP intervention studies.

Patterns of stove usage after introduction of an advanced cookstove: the long-term application of household sensors.

Household air pollution generated from solid fuel use for cooking is one of the leading risk factors for ill-health globally. Deployment of advanced cookstoves to reduce emissions has been a major focus of intervention efforts. However, household usage of these stoves and resulting changes in usage of traditional polluting stoves is not well characterized. In Palwal District, Haryana, India, we carried out an intervention utilizing the Philips HD4012 fan-assisted stove, one of the cleanest biomass stoves available. We placed small, unobtrusive data-logging iButton thermometers on both the traditional and Philips stoves to collect continuous data on use patterns in 200 homes over 60 weeks. Intervention stove usage declined steadily over time and stabilized after approximately 200 days; use of the traditional stove remained relatively constant. We additionally evaluated how well short-duration usage measures predicted long-term use. Measuring usage over time of both traditional and intervention stoves provides better understanding of cooking behaviors and can lead to more precise quantification of potential exposure reductions and consequent health benefits attributable to interventions.

Cooking practices, air quality, and the acceptability of advanced cookstoves in Haryana, India: an exploratory study to inform large-scale interventions.

BACKGROUND: In India, approximately 66% of households rely on dung or woody biomass as fuels for cooking. These fuels are burned under inefficient conditions, leading to household air pollution (HAP) and exposure to smoke containing toxic substances. Large-scale intervention efforts need to be informed by careful piloting to address multiple methodological and sociocultural issues. This exploratory study provides preliminary data for such an exercise from Palwal District, Haryana, India. METHODS: Traditional cooking practices were assessed through semi-structured interviews in participating households. Philips and Oorja, two brands of commercially available advanced cookstoves with small blowers to improve combustion, were deployed in these households. Concentrations of particulate matter (PM) with a diameter <2.5 µm (PM2.5) and carbon monoxide (CO) related to traditional stove use were measured using real-time and integrated personal, microenvironmental samplers for optimizing protocols to evaluate exposure reduction. Qualitative data on acceptability of advanced stoves and objective measures of stove usage were also collected. RESULTS: Twenty-eight of the thirty-two participating households had outdoor primary cooking spaces. Twenty households had liquefied petroleum gas (LPG) but preferred traditional stoves as the cost of LPG was higher and because meals cooked on traditional stoves were perceived to taste better. Kitchen area concentrations and kitchen personal concentrations assessed during cooking events were very high, with respective mean PM2.5 concentrations of 468 and 718 µg/m3. Twenty-four hour outdoor concentrations averaged 400 µg/m3. Twenty-four hour personal CO concentrations ranged between 0.82 and 5.27 ppm. The Philips stove was used more often and for more hours than the Oorja. CONCLUSIONS: The high PM and CO concentrations reinforce the need for interventions that reduce HAP exposure in the aforementioned community. Of the two stoves tested, participants expressed satisfaction with the Philips brand as it met the local criteria for usability. Further understanding of how the introduction of an advanced stove influences patterns of household energy use is needed. The preliminary data provided here would be useful for designing feasibility and/or pilot studies aimed at intervention efforts locally and nationally.