Health Impact of Locally-Produced, Improved Ceramic Cookstoves on Children in rural Western Kenya Open Access

Foote, Eric (2012)

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Pneumonia is the leading cause of death of children under 5 years old. Indoor air pollution (IAP)
is a major risk factor for pneumonia. Unprocessed biomass fuels, commonly used in households
in developing countries, generate high levels of IAP. Improved cookstoves reduce IAP in
comparison to traditional indoor open fires. In rural Kenya, a non-governmental organization sold
~2,500 inexpensive (US$3) ceramic cookstoves (jikos) from 2008-2010. In one study, jikos
reduced smoke in the home, cook times, fuel use, and airborne particles ≤2.5 μm in diameter by
13%. We conducted a longitudinal observational study on the health impact of jikos on children
under 3 years old in 20 villages. We enrolled 200 households with children <24 months old and
fieldworkers conducted 25 biweekly household visits. The child's caretaker reported their
primary stove use in the past week. Fieldworkers observed children for signs of pneumonia
following WHO IMCI guidelines. Reported stove use during 3,951 biweekly home visits over a
year, included 3-stone firepit (81.8%), jiko (15.7%), both (2.3%), and other (0.2%).In 99.9% of
visits, respondents reported burning unprocessed biomass fuel. A lower percentage of children in
jiko-using households had cough (1.5% vs. 2.9%, rate ratio [RR], 0.5, 95%CI: 0.3, 1.2),
pneumonia (1.0% vs. 1.7%, RR 0.7, 95%CI: 0.3, 1.8) and severe pneumonia (0.3% vs. 0.5%, RR
0.8, 95%CI 0.2, 3.1). Cell phone ownership, a proxy for socioeconomic status among
respondents, was associated with jiko use (p<0.01). Cell phone ownership was also independently
associated (p<0.03) with a lower rate of severe pneumonia and cough and there was a trend
towards association of a decreased rate of pneumonia (p=0.053). Although jiko use was not
associated with a significant reduction in the rate of respiratory illness when compared to 3-stone
firepit use, analysis was limited by insufficient statistical power. Since the data suggested a
beneficial effect of jiko use, further research on the health impact of, and equity of access to,
improved cookstoves is warranted. Interventions to prevent pneumonia should utilize an
integrated approach including reducing IAP, as well as addressing risk factors such as low
birthweight, crowding, and immunization and nutritional status.

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Tables and Figures...24

Table 1: Baseline Demographic Characteristics of Caretakers and Enrolled Children;
Household Assets; and Water Handling, Sanitation, and Hygiene Practices, Among Users
of Upesi Jiko Stoves and 3-Stone Firepits, Nyando District, Kenya Who Completed
>75% of Biweekly Visits...24
Table 2: Percentage of Children with Respiratory Illness Observed during Home Visits,
by Stove Type, April 2010-April 2011, Nyando District, Kenya...25
Table 3: Percentage of Children with Respiratory Illness Observed during Home Visits,
Among Regular Jiko and 3-Stone Firepit Users, April 2010-April 2011, Nyando District,
Table 4: Association Between Ownership of Household Assets and Respiratory Illness in
Children, April 2010-April 2011, Nyando, District Kenya...27

Figure 1: Upesi Jiko...28

Figure 2: Percentage of Households Reporting Jiko Use April 2010-April 2011, Nyando
District Kenya...29

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