Household Air Pollution Interventions to Improve Health in Low- and Middle-Income Countries: An Official American Thoracic Society Research Statement
Peggy S. Lai, Nicholas L. Lam, Bill Gallery, Alison Lee, Heather Adair‐Rohani, Donee Alexander, Kalpana Balakrishnan, Iwona Bisaga, Zoë Chafe, Thomas Clasen, Anaité Díaz-Artiga, Andrew P. Grieshop, K. Harrison, Stella M. Hartinger, Darby Jack, Seyram Kaali, Melis Lydston, Kevin Mortimer, Laura Nicolaou, Esther Obonyo, Gabriel Okello, Christopher O. Olopade, Ajay Pillarisetti, Alisha Noella Pinto, Joshua P. Rosenthal, Neil W. Schluger, Xiaoming Shi, Claudia Thompson, Lisa M. Thompson, John Volckens, Kendra N. Williams, John R. Balmes, William Checkley, Obianuju B. Ozoh
Abstract
Abstract Background An estimated 3 billion people, largely in low- and middle-income countries, rely on unclean fuels for cooking, heating, and lighting to meet household energy needs. The resulting exposure to household air pollution (HAP) is a leading cause of pneumonia, chronic lung disease, and other adverse health effects. In the last decade, randomized controlled trials of clean cooking interventions to reduce HAP have been conducted. We aim to provide guidance on how to interpret the findings of these trials and how they should inform policy makers and practitioners. Methods We assembled a multidisciplinary working group of international researchers, public health practitioners, and policymakers with expertise in household air pollution from within academia, the American Thoracic Society, funders, nongovernmental organizations, and global organizations, including the World Bank and the World Health Organization. We performed a literature search, convened four sessions via web conference, and developed consensus conclusions and recommendations via the Delphi method. Results The committee reached consensus on 14 conclusions and recommendations. Although some trials using cleaner-burning biomass stoves or cleaner-cooking fuels have reduced HAP exposure, the committee was divided (with 55% saying no and 45% saying yes) on whether the studied interventions improved measured health outcomes. Conclusions HAP is associated with adverse health effects in observational studies. However, it remains unclear which household energy interventions reduce exposure, improve health, can be scaled, and are sustainable. Researchers should engage with policy makers and practitioners working to scale cleaner energy solutions to understand and address their information needs.