Assessment of Effectiveness of ICS in Reducing Indoor Air Pollution and Improving Health in Nepal1

B. Tuladhara,*, I. Gurunga, B. Shresthaa, A. Singha, K. Karkia, A. Pillarisetti b, K. Bajracharyac
Environment and Public Health Organization (ENPHO), Kathmandu, Nepal b Full Bright Scholar c Alternative Energy Promotion Center/Energy Sector Assistance Programme (ESAP), Ministry of Environment, Science and Technology
Abstract A popular technology to reduce indoor air pollution (IAP) in rural homes of Nepal is the mud brick improved cook stoves (ICS) which is being promoted by the National Biomass Energy Support Programme of Energy Sector Assistance Programme (ESAP) / Alternative Energy Promotion Centre (AEPC), as well as other agencies and so far more than 230,000 ICS have been installed in the country. A research conducted by Environment and Public Health Organization (ENPHO) for the Biomass Energy Programme of AEPC/ESAP has found that the average concentration of PM2.5 and CO in houses that use traditional cook stoves is very high but the mud brick ICS was able to reduce the PM2.5 by 65.7% and CO by 62.3% after three months and 63.2% and 60.0% respectively after one year of installation of the ICS. The study, which was conducted in three districts (Dolakha, Ilam and Dang), followed the “Before-After” design; hence both pollution measurements and questionnaires survey were conducted twice for each of the 36 participating households: first before the installation of ICS or with traditional cook stoves (TCS) and the second after the installation of ICS. A cross-sectional study done at the same time in 72 households in Kavre district also had similar results. The average PM2.5 concentration in households with ICS was 66.4% less than the households with traditional stoves. Similarly the concentration of CO was 62.3 % less in households with ICS. The reduced pollution level also results in major health benefits. However as the pollution levels are still higher than WHO guideline values even after installation of ICS, there is a need for more improvement in areas such as ventilation and kitchen management. Keywords: indoor air pollution, ICS, PM2.5, CO, health

1. INTRODUCTION With more than 80 percent of the population depending on solid biomass fuel, such as wood, dung and agricultural residues, for cooking, indoor air pollution (IAP) is a major problem in Nepal. WHO estimates that 2.7 percent of Nepal’s national burden of disease is attributed to solid fuel use and this causes 7500 deaths per year (WHO, 2007). In order address this problem, different government and non-government organizations, as well as private companies and international agencies have initiated various programmes and introduced a variety of technologies to reduce IAP in Nepal. One of the most simple and popular technologies to reduce IAP in rural homes in Nepal has been the improved cook stoves (ICS). The mud brick ICS is being promoted by the Energy Sector Assistance Programme (ESAP) of the Alternative Energy Promotion Centre (AEPC), as well as other agencies. So far more than 230,000 such stoves have been installed in the country and AEPC/ESAP plans to install 500,000 stoves in its second phase (20072012). Realizing the need for effective monitoring and evaluation, AEPC/ESAP assigned Environment and Public Health Organization (ENPHO) to conduct an assessment of the effectiveness of ICS in reducing

indoor air pollution and improving the health. The study had two major activities: (i) measurement of 24-hr mean concentrations of two principal indoor air parameters – particulate matter of size less than 2.5 micron (PM2.5) and carbon monoxide (CO); and (ii) questionnaire survey and observation for both indoor air pollution and health impact assessment. 2. STUDY DESIGN The design for this study was developed by ENPHO together with AEPC/ESAP in consultation with experts from the Centre for Entrepreneurship in International Health Development (CEIHD), University of California, Berkeley in order to ensure that it was technically sound and comparable to other international studies of similar nature. It is based on the international best practices, a review of recent literature on study design for similar studies and optimum utilization of available resources in terms of time, funding and equipment The study followed the “Before-After” design; hence both pollution measurement and questionnaires survey were conducted three times for each household: first before the installation of ICS or with traditional cook stoves (TCS), second: three months after the installation of ICS – two pot-hole mud brick stove to see immediate impacts and the third: one year after installation of ICS to assess long term impacts.

Paper presented at International Conference on Renewable Energy Technology for Sustainable Development, Kathmandu, Nepal, 2009

3% and 60. representing high hills of Nepal.5) and carbon monoxide (CO) were selected as the key pollution parameters for this study as these parameters are generally regarded by experts.5 is presented in Table 1. the highest and lowest 24-hr average mean PM2.2% after three months and after one year for PM2.127 mg/m3 in before phase (kitchens with TCS) and 0. 3.7% and 63.5 Interim 70 35 150 75 Target 1 Interim 50 25 100 50 Target 2 Interim 30 15 75 37.5 microns (PM2. The data shows that the pollution levels in houses that use TCS are very high and the ICS that is promoted in Nepal is quite successful in reducing IAP. while the one year data was collected from 34 of the same households. and reflects the range of air pollution concentrations in different homes in comparison to the mean concentration in the same homes. The data for three months after installation of the ICS was collected from 36 of the same households. the sampling was done for 24 hours for both PM2. In both ‘Before’ and ‘After’ phases of IAP monitoring. Based on a conservative COV of 1.5 was measured using UCB particle monitors while CO concentration was measured using HOBO CO loggers.174 ppm with TCS and 8.762 mg/m3 after one year of switching to ICS. The concentration of PM2. WHO does not have specific guideline values for indoor air quality but the ambient air quality guidelines is also applicable to all non-occupational environments. After monitoring.5 and 62. The questionnaires were designed based on international guidelines and experiences of Nepalese environmental health experts. Parallel to this study.349 ppm with the ICS after three months and 8. Data for before installation of ICS was collected from 47 households in three different districts – Boch VDC in Dolakha.621 ppm after one year.728 mg/m3 the after three months and 0.Particulate matter less than 2.5 Target 3 Guideline 20 10 50 25 Value Source: WHO. 2005 • By district. According to Edwards et al (2007). which store the minute-by-minute data over the entire measurement period. including the World Health Organization and the University of California Berkeley. the sample size required to detect a statistically significant difference in the mean indoor air pollution levels before and after the installation of the ICS depends on the percent difference in those means and in the variability in the differences in those means (Before – After). KEY FINDINGS Some of the major findings of the study are as follows: • The average 24-hr mean PM2.0% after three months and after one year for CO. The required sample size for both the studies was determined based on statistical rules and sampling techniques designed by the CEIHD for the Household Energy and Health Project. For the questionnaire survey. However the fact that the pollution levels are still higher than WHO guideline values even after installation of ICS shows that there is a need for more improvement in areas such as ventilation and kitchen management. these data are then downloaded into a personal computer and analyzed. Average PM10 PM 2. The coefficient of variation (COV) is an indicator of the variability in measurements.5 and CO following standard protocols developed by CEIHD so that the data can be compared with WHO Guideline Values. as the two best indicators of IAP. two different sets of questionnaires one for IAP and the other for health impact assessment were administered in both phases of study. including indoors. Mabu VDC in Ilam representing mid-hills and Laxmipur VDC in Dang in the plains.5 and CO concentrations were measured in Dolakha and Ilam . The WHO guideline values for ambient air quality for PM10 and PM2. It is equal to the standard deviation (SD) divided by the mean. Both of these equipments contain data loggers. Both these equipment were purchased new from CEIHD and calibrated at the Indoor Air Pollution Laboratory of University of California Berkeley. The average 24-hr mean CO concentration was 22. the study was done in three different districts representing different ecological zones and cultural settings. The field studies were done between October 2007 and February 2009. it was decided that at least 31 households would be required to be sampled both before and after the installation of ICS.5 concentration was 2. The average percent change of the IAP concentration between the TCS and ICS were therefore 65. ENPHO also conducted a cross-section study in Kavre District in the mid hills in 36 households with ICS and 36 households without ICS using the same equipment in 2008.5 PM10 PM2. In order to get representative samples from households across Nepal.0 and a detectable difference of 50%. Table 1: WHO Air Quality Guidelines Annual 24 hr.

5 measurements both in TCS and ICS combined together (N=72. • The correlation between the concentration levels of 24-hr CO and PM2.349 1 yr.5 CO Mean PM2.337ppm with the ICS. a similar change was reported from 96.217 0.6 55.3 51.374 38.172ppm with ICS. such as ventilation and cooking habits are also very important in determining IAP levels.6 67.174 3 mo 1.429mg/m3 with the ICS and for CO these were 38. In Dolakha. Major health outcomes included upper respiratory infections such as cough. remarkable improvements in the health condition of both the women and young children were observed following the installation of ICS.854 0.818 8.557ppm with TCS and 17.337 0.889 8.6% to 16. In Ilam.4 63. This again shows that the while the potential for pollution reduction by the mud brick ICS is very high.660ppm with the TCS. While a few houses it was found that the level of PM2.728mg/m3 and 3.5 decreased by over 90 percent. in one house the PM2.127 22.368 3. According to the main cook.728 8.5 CO Mean Value (mg/m3) Before 3.429 17.5 CO Ilam PM2. and 0. the measured mean concentrations of PM2.5 in individual HH % reduction in CO in individual household 80 70 60 50 40 30 20 10 0 -10 Figure 1: Absolute differences of PM2. 1.762 8. However.841) was also found highly significant.889mg/m3 and 8.320 0.2% after installation.210 0.3 58.5 concentration actually increased. besides the stove design.2 60.2% to 46. whistling/wheezing of the chest.749 8.308 3.5 CO Dang PM2.653 26. as there was only a three month gap between the installation of the ICS • . the occurrence of these health outcomes were substantially reduced after ICS installation. The large difference in pollution levels in the two districts both before and after the installation of the ICS shows that other factors. ventilation and kitchen management.657 0.269 2.5 concentrations in each household (each bar represents a household) 100 75 50 25 0 -25 -50 Figure 2: Absolute differences of CO concentrations in each household (each bar represents a household) • The percent reduction in pollution level is also significantly different in the different households.7% after ICS installation in adults. phlegm. headaches and eye irritation.621 59. Pearson’s Correlations Coefficient = 0.5 were 3.0 Avg % reduction after 1 yr 100 90 % reduction in PM2. In children.660 2.respectively in both ‘before’ and ‘after’ measurements. Reported coughing events decreased from 55. there are several other factors which need to be considered.571 0.312 15.5 70. These include operation and maintenance of the stoves. Table 2: Pollution levels before and after installation of ICS Parame ter Dolkha PM2. influenza.5 and CO were respectively 0. the mean PM2.374mg/m3 with TCS and 1.

The cross sectional study done in 72 households found that the average PM2. there is a need for more awareness programmes for scaling up ICS throughout the country. Thus 69% of the households were reported occasional problem of smoke coming back into the kitchen. Similarly the concentration of CO was 62. fuel types and condition.N. In the field. XI(2). the Regional Renewable Energy Service Centers of AEPC/ESAP particularly Centre for Rural Technology (CRT).. 48 hour CO concentrations were reduced by 70% and 48-hour PM concentrations were reduced by 44% (Chengappa. Centre for Entrepreneurship in International Health and Development. R. CEIHD and Enterprise Works/VITA (2006). However. However. particularly in houses with poor ventilation. Bajpai.N. et. 2007. and Khalakdina. D. particularly for women and children. E-mail: • The findings of this study are similar to the findings of other similar studies in other countries including Two recent studies were performed following a similar 'before and after' study design and using identical equipment in regions of India. • the ICS also results in significant health benefits as well as other benefits such as reduced firewood consumption. Major among them included ventilation condition. and Smith. Design considerations for field studies of changes in indoor air pollution due to improved stoves.5 and CO by more than 60 percent. al. 4. The results of the cross-sectional study was very similar to the result from the before & after study. Impact of improved cookstoves on indoor air quality in the Bundelkhand region in India. XI(2). One year after installation of the stoves.R. pp: 19-32 Edwards. the actual health impacts of ICS may not be very clear. Two types of improved stoves were installed in this region – the Laxmi stove and the Bhagyalaxmi stove. • The concentration levels of IAP were found to be affected by a number of factors. (2007). 2007. Edwards.. AEPC/ESAP and ENPHO is currently conducting a follow up monitoring the same households one year after installation of the ICS. Edwards. In the Bundelkhand region of India.. K. Energy for Sustainable Development The Journal of the International Energy Initiative. Energy for Sustainable Development The Journal of the International Energy Initiative.The Journal of the International Energy Initiative XI (2). al. and their staff were very helpful. Outside of Pune. A. Pennise. and to some extent. K.5 concentrations for the Laxmi stove and a 49% reduction for the Bhagyalaxmi stove. This can be a major health hazard. This will provide more valuable information on operation and maintenance of the ICS and its performance over a long period.. ACKNOWLEDGEMENT The authors are grateful to the support provide by AEPC/ESAP for conducting this study and the technical support provided by CEIHD and Partnership for Clean Indoor Air (PCIA) in designing the study and procuring the necessary equipment. India. __________________ * Corresponding Author: enpho@mail. and reduced time for cooking. The study also shows that proper operation and maintenance of the ICS is essential for fully achieving its desired results and other aspects such as improved ventilation and kitchen management are also equally installation and use of the ICS. Shields. Indoor Air Pollution Monitoring in Ghana: Third Progress Report. and Smith. Center for Entrepreneurship in International Health and Development. pp: 33-44 Dutta. K. University of California Berkeley Chengappa. users’ behavior. low-cost and locally built mud brick ICS can reduce the pollution levels as indicated by concentration of PM2. CONCLUSIONS Overall. The findings of this study can be used as a tool for motivating people to install ICS.R. 2007). Impact of improved biomass cookstoves on indoor air quality near Pune.. Tel: +977-1-4468641. CO concentrations were similarly reduced by 39% in Laxmi and 38% in Bhagyalaxmi stoves (Dutta et.R. K.. Evaluation of Efficacy and Effectiveness of the EcoStove for Reducing Indoor Air Pollution Exposures among Nicaraguan Women. K. R. geographical and climatic condition. 2007). C. A. ARTI noted a 24% reduction in mean PM2. One year after the installation of these stoves. R. the study has also clearly shown that the simple. the Appropriate Rural Technology Insitute (ARTI) evaluated indoor air pollution levels in 110 homes between August 2004 and December 2005.5 concentration in households with ICS was 66.. Namsaling Community Development Center (NCDC) and Resource Management and Rural Empowerment Center (REMREC). cleaner kitchens. India. Development Alternatives (DA) evaluated improvements in IAQ after ICS installation in 60 households. pp: 71-81 . The study also indicates that REFERENCES CEIHD (2006). the study has found very high levels of indoor air pollution from burning of biomass fuels. Energy for Sustainable Development.4% less than the households with traditional stoves. improved health and reduced firewood consumption are the main benefits of the stoves. and Shields. R. Overall the ICS users are satisfied with their new stoves and feel that reduced smoke.3 % less in households with ICS. Hubbard.and second phase of the assessment. and Smith.

World Health Organization. Indoor Air Pollution: national burden of disease estimates. Situation Analysis of Indoor Air Pollution and Development of Guidelines for Indoor Air Quality Assessment and House building for Health. 1986. World Health Organization. World Health Report: Reducing risks. Vol. Geneva. 1986. No. WHO 2007. pp. Geneva. Switzerland.6. Geneva. Winrock International Nepal. Indoor Air Pollution and Household Energy Monitoring: Workshop Resources. WHO Press. WHO 2005.R. Indoor Smoke Exposures from Traditional and Improved Cookstoves Comparisons among Rural Nepali Women.NHRC 2004. Indoor Air Pollution and Health Impacts: Status Report for Nepal. Nepal Health Research Council. World Health Organization. WHO Press. Geneva. Switzerland. Nepal Reid H. Household Energy. World Health Organization. and Sherchan B. . Air Quality Guidelines Global Update. Mountain Research and Development.4. Smith K. Switzerland.F. WHO Press.. WHO 2005. Switzerland. Kathmandu. Winrock 2004. 293 -304 WHO 2002. promoting healthy lives.

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