Respiratory risks from household air pollution in low and middle income countries.

A third of the world's population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5-4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.

Gordon SB ，Bruce NG ，Grigg J ，Hibberd PL ，Kurmi OP ，Lam KB ，Mortimer K ，Asante KP ，Balakrishnan K ，Balmes J ，Bar-Zeev N ，Bates MN ，Breysse PN ，Buist S ，Chen Z ，Havens D ，Jack D ，Jindal S ，Kan H ，Mehta S ，Moschovis P ，Naeher L ，Patel A ，Perez-Padilla R ，Pope D ，Rylance J ，Semple S ，Martin WJ 2nd ... -  《-》

Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18: a geospatial modelling study.

More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000-257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Bill & Melinda Gates Foundation.

Local Burden of Disease Household Air Pollution Collaborators 《Lancet Global Health》

Household air pollution from domestic combustion of solid fuels and health.

Inefficient cooking and heating with solid fuels in poorly ventilated homes are a major source of exposure to indoor air pollution in developing countries. Household air pollution from cooking and heating with solid fuels also is an important contributor to outdoor air pollution. The combustion of organically derived solid fuel is qualitatively similar to the burning of tobacco in terms of emissions of particulate matter and gases, and the mechanisms by which solid fuel smoke causes adverse health effects in human subjects are likely similar. The public health effect of domestic cooking and heating with solid fuels is great. The World Health Organization estimates that there are 3.8 million deaths globally per year attributable to household air pollution. This estimate is based on the strength of the evidence, primarily meta-analyses of epidemiologic studies of acceptable scientific quality, although for cardiovascular disease, the evidence is more inferential. The greatest burden of household air pollution-related premature deaths is in children with pneumonia exposed to biomass smoke. The greatest estimated burden in adults is cardiovascular disease, but chronic obstructive pulmonary disease and lung cancer are important causes of disability and premature death in women, who are the primary cooks and tend not to smoke tobacco in developing countries. Research gaps and opportunities for interventions to reduce effects of solid fuel smoke on public health are identified.

Balmes JR 《-》

Indoor air pollution in developing countries.

Chen BH ，Hong CJ ，Pandey MR ，Smith KR ... -  《-》

Indoor air pollution and the lung in low- and medium-income countries.

Kurmi OP ，Lam KB ，Ayres JG 《-》