On April 3, 2023, Megha Thakur succesfully defended her thesis entitled ‘low-smoke chulha and health consequences in Indian slums’.
The dissertation can be accessed here: https://cris.maastrichtuniversity.nl/en/publications/low-smoke-chulha-and-health-consequences-in-indian-slums
Household air pollution (HAP) is one of the leading environmental and public health concerns globally. Resulting from the inefficient combustion of solid fuels (i.e. wood, coal, charcoal, crop waste, dung), and kerosene, HAP disproportionately affects the poorest and marginalized populations, including women and children. Nearly 2.4 billion people (around a third of the global population) still depend on polluting fuels and technologies for cooking. Women and children bear the brunt of HAP because of the amount of time they spend indoors. Both long- and short-term exposure to HAP has impacts on health. Chronic exposure over the lifetime increases the risk for non-communicable diseases such as respiratory cancers, cardiovascular disease, stroke, and chronic obstructive pulmonary disease (COPD). Short exposure can already lead to acute health outcomes such as pneumonia and adverse
pregnancy outcomes such as stillbirth, preterm delivery, and low birth weight.
The main burden of HAP can be seen in low-resource settings. Use of solid fuels in India is not only common in the rural homes but also in the slum areas as well as in a majority of smaller cities and towns. However, most of the studies on HAP are conducted in rural areas with little evidence from urban areas. In 2018, 86.6 million people in urban India were still primarily dependent on polluting fuels and technologies for cooking. Slum residents face a disproportionate risk to HAP because of the dense population often residing in poorly ventilated houses. Although a direct switch to clean fuels remains the ideal solution, it is still a challenge. Having identified these challenges, WHO guidelines recommend more advanced combustion cookstoves (stoves that maximize combustion efficiency) offering some health benefits which should be prioritised in the transition to clean cooking solutions. Project Exhale aimed to reduce the levels of HAP and improve the respiratory health of women and children in urban slums by installing a locally manufactured improved cookstove (ICS).
The aims of Megha’s research were:
1) To conduct a systematic review and meta-analysis of the impact of ICS on women’s and child health in low- and middle-income countries;
2) To conduct a cross-sectional study among and health; and
3) To evaluate the effectiveness of an ICS on the health of women and children in slums in a trial.
Accelerating access to cleaner solutions is crucial to reduce the negative effects of solid fuel use. Encouraging adoption and sustained use has proven challenging and overcoming barriers is complex. We developed two practical implementation tools to optimse the implementation of cleaner cooking solutions. These were published in the Lancet Planetary Health.
You can access the publication here: https://www.thelancet.com/action/showPdf?pii=S2542-5196%2822%2900094-8
Abstract: 2∙6 billion people rely on solid fuels for cooking or heating. Accelerating access to cleaner solutions is crucial to reduce the negative effects of solid fuel use. Despite abundant evidence on how to implement these solutions, previous attempts have been disappointing. An overview of the evidence is missing and the translation of the evidence into practice is poor. We conducted an umbrella review using eight databases to: consolidate evidence on the factors that influence the implementation of improved solid fuel cookstoves and clean fuels in low-income and middleincome countries; weigh the level of confidence in existing evidence; and develop two practical implementation strategy tools. We identified 31 relevant reviews (13 systematic reviews and 18 narrative reviews) that covered over 479 primary studies. We found 15 implementation factors supported by the highest level of evidence. Regarding improved solid fuel cookstoves, these factors included: cost; knowledge and beliefs about the innovation; and compatibility. For clean fuels these factors included: cost; knowledge and beliefs about the innovation; and external policy and incentives. The factors were synthesised into the Cleaner Cookstove Implementation Tool and the Clean Fuel Implementation Tool. These tools can be used to optimise the implementation of cleaner cooking solutions, thereby improving health, environmental, climate, and gender equity outcomes.
Improved cookstoves have shown to be effective in reducing household air pollution and improving health in research settings, but implementation of the stoves on a large scale has been challenging.
Our publication in npj | primary care respiratory medicine presents several key points that might foster successful implementation, including community-focused approaches, the creation of public awareness, usage information, the assurance of maintenance, the involvement of women and an appropriate business model.
You can read the publication here: https://www.nature.com/articles/s41533-019-0148-4
Pending the much-needed transition to using cleaner fuels, can improved cookstoves help reduce morbidity and mortality due to household air pollution (HAP) from biomass combustion among women and children in low and middle income countries?
We conducted a systematic review and meta-analysis to answer this question! Read more in our Thorax publication: https://thorax.bmj.com/content/73/11/1026
Why read on?
This is the first meta-analysis assessing the health impact of improved cookstoves, providing valuable information for agenda setting to reduce the substantial global burden of morbidity and mortality from HAP.
What did we conclude?
Meta-analyses indicate that improved biomass cookstoves can decrease respiratory and ocular symptoms among women; no demonstrable impact on perinatal or child health was observed.
An independent company ‘Shiva Analyticals’ assessed the impact of the EXHALE cookstove on pollution.
They concluded that CO reduced by 64% and PM2.5 reduced by 89.4% when using the EXHALE stove compared to traditional stoves!
More information about the tests can be found in this document: EXHALE stove – CO & PM2.5
Professor Onno van Schayck, and Cristian, Preeti and Megha – the three PhD researchers working on Project Exhale – attended the International Primary Care Respiratory Group (IPCRG) South Asian Scientific Conference in Colombo, Sri Lanka at the beginning of August, 2017. Professor Onno van Schayck spoke on the “Global impact of air pollution and local solutions”, while Cristian and Preeti spoke about their community engagement work on Project Exhale and won an award for their presentation at the conference.
A health camp organized by Health in Slums, Bangalore Baptist Hospital and Pragathi Charitable Trust was held in Ashrayanagar in July, 2017. During the health camp, the local community was provided with a health check (with approximately 100-150 consultations) and free medicines as needed. One member of the community – a 65 year old woman – was also operated for a cataract at Bangalore Baptist Hospital through this activity. Esther Boudewijns (Maastricht University, the Netherlands), who spent almost five months in Bangalore supporting Dr. Megha Thakur with her work on Project Exhale, raised the funds necessary for the health camp.
We are pleased to announce that a new article entitled “COPD and asthma: the emergency is clear, now is the time for action” by Onno van Schayck and Esther Boudewijns has been published in The Lancet. You can access it here.
Onno van Schayck recently spoke to the Dutch news channel NOS about Project Exhale.
Click here to find out more!
Would you like to know what we recommend for research and opportunities in policy making to improve respiratory health in urban slums? Read our publication in the Lancet Respiratory Medicine: https://www.thelancet.com/action/showPdf?pii=S2213-2600%2816%2930245-4
More than half the world’s population lives in urban areas, and an estimated 863 million people currently live in urban slums. Although urbanisation is usually coupled with economic development, rural-to-urban migration can result in negative implications for respiratory health. Slum residents who live in informal settlements and who commonly have inadequate access to health services are at a particularly high risk of being aff ected by the dual burden of infectious and non-communicable respiratory diseases over the course of their lives.
The challenge for cities in low-income and middle-income countries is to mitigate emerging risk factors
and prioritise expanded access to preventive care for chronic diseases, while still managing infectious