title: Household Air Pollution Exposures of Pregnant Women Receiving Advanced Combustion Cookstoves in India: Implications for Intervention.
abstract: BACKGROUND
  Household air pollution (HAP) resulting from the use of solid cooking fuels is a leading contributor to the burden of disease in India. Advanced combustion cookstoves that reduce emissions from biomass fuels have been considered potential interventions to reduce this burden. Relatively little effort has been directed, however, to assessing the concentration and exposure changes associated with the introduction of such devices in households.
  
  
  OBJECTIVE
  The aim of this study was to describe HAP exposure patterns in pregnant women receiving a forced-draft advanced combustion cookstove (Philips model HD 4012) in the SOMAARTH Demographic Development & Environmental Surveillance Site (DDESS) Palwal District, Haryana, India. The monitoring was performed as part of a feasibility study to inform a potential large-scale HAP intervention (Newborn Stove trial) directed at pregnant women and newborns.
  
  
  METHODS
  This was a paired comparison exercise study with measurements of 24-hour personal exposures and kitchen area concentrations of carbon monoxide (CO) and particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5), before and after the cookstove intervention. Women (N = 65) were recruited from 4 villages of SOMAARTH DDESS. Measurements were performed between December 2011 and March 2013. Ambient measurements of PM2.5 were also performed throughout the study period.
  
  
  RESULTS
  Measurements showed modest improvements in 24-hour average concentrations and exposures for PM2.5 and CO (ranging from 16% to 57%) with the use of the new stoves. Only those for CO showed statistically significant reductions.
  
  
  CONCLUSIONS
  Results from the present study did not support the widespread use of this type of stove in this population as a means to reliably provide health-relevant reductions in HAP exposures for pregnant women compared with open biomass cookstoves. The feasibility assessment identified multiple factors related to user requirements and scale of adoption within communities that affect the field efficacy of advanced combustion cookstoves as well as their potential performance in HAP intervention studies.
authors.affiliation: Department of Environmental Health Engineering, Sri Ramachandra University, Porur, Chennai, India. Electronic address: kalpanasrmc@ehe.org.in.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Balakrishnan
authors.affiliation: Department of Environmental Health Engineering, Sri Ramachandra University, Porur, Chennai, India.
authors.forename: Sankar
authors.initials: S
authors.lastname: Sambandam
authors.affiliation: Department of Environmental Health Engineering, Sri Ramachandra University, Porur, Chennai, India.
authors.forename: Santu
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Environmental Health Engineering, Sri Ramachandra University, Porur, Chennai, India.
authors.forename: Krishnendu
authors.initials: K
authors.lastname: Mukhopadhyay
authors.affiliation: The INCLEN Trust International, Okhla Industrial Area, Phase-I, New Delhi, India.
authors.forename: Mayur
authors.initials: M
authors.lastname: Vaswani
authors.affiliation: The INCLEN Trust International, Okhla Industrial Area, Phase-I, New Delhi, India.
authors.forename: Narendra K
authors.initials: NK
authors.lastname: Arora
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Darby
authors.initials: D
authors.lastname: Jack
authors.affiliation: Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Pillariseti
authors.affiliation: Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Bates
authors.affiliation: Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA.
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Smith
mesh_terms: D000397:Air Pollution; D016902:Air Pollution, Indoor / Q000517:prevention & control*; D018533:Biomass; D002248:Carbon Monoxide / Q000032:analysis*; D016022:Case-Control Studies; D003296:Cooking / Q000295:instrumentation*; D004781:Environmental Exposure / Q000517:prevention & control*; D004784:Environmental Monitoring; D005191:Family Characteristics; D005260:Female; D006794:Household Articles; D006801:Humans; D007194:India; D052638:Particulate Matter / Q000032:analysis*; D011247:Pregnancy
chemical_list: D052638:Particulate Matter; D002248:Carbon Monoxide
keywords: Haryana; Newborn Stove Trial; PM(2.5); Philips gasifier stove; biomass fuel; carbon monoxide; indoor air pollution