Abstract
Interventions to reduce household air pollution (HAP) are key to reducing associated morbidity and mortality in low- and middle- income countries (LMICs); especially among pregnant women and young children. This systematic review aims to determine the effectiveness of interventions aimed to reduce HAP exposure associated with domestic solid biomass fuel combustion, compared to usual cooking practices, for improving health outcomes in pregnant women and children under five in LMIC settings. A systematic review and meta-analysis was undertaken with searches undertaken in MEDLINE, EMBASE, CENTRAL, GIM, ClinicalTrials.gov, and Greenfile in August 2020. Inclusion criteria were experimental, non-experimental, or quasi-experimental studies investigating the impact of interventions to reduce HAP exposure and improve associated health outcomes among pregnant women or children under 5 years. Study selection, data extraction, and quality assessment using the Effective Public Health Practice Project tool were undertaken independently by two reviewers. Seventeen out of 7293 retrieved articles (seven pregnancy, nine child health outcome; 13 studies) met the inclusion criteria. These assessed improved cookstoves (ICS; n = 10 studies), ethanol stoves (n = 1 study), and Liquefied Petroleum Gas (LPG; n = 2 studies) stoves interventions. Meta-analysis showed no significant effect of ICS interventions compared to traditional cooking for risk of preterm birth (n = 2 studies), small for gestational age (n = 2 studies), and incidence of acute respiratory infections (n = 6 studies). Although an observed increase in mean birthweight was observed, this was not statistically significant (n = 4). However, ICS interventions reduced the incidence of childhood burns (n = 3; observations = 41 723; Rate Ratio: 0.66 [95% CI: 0.45-0.96]; I : 46.7%) and risk of low birth weight (LBW; n = 4; observations = 3456; Odds Ratio: 0.73 [95% CI: 0.61-0.87]; I : 21.1%). Although few studies reported health outcomes, the data indicate that ICS interventions were associated with reduced risk of childhood burns and LBW. The data highlight the need for the development and implementation of robust, well-reported and monitored, community-driven intervention trials with longer-term participant follow-up. [Abstract copyright: © 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.]
Original language | English |
---|---|
Article number | e12958 |
Journal | Indoor Air |
Volume | 32 |
Issue number | 1 |
DOIs | |
Publication status | Published - 6 Jan 2022 |
Bibliographical note
Funding Information:KEW holds a University of Birmingham Global Challenges Scholarship. The funders had no involvement in the conduct of the research and/or preparation of the article conduct. We are very grateful for Karen Biddle’s support in proofreading the manuscript.
Publisher Copyright:
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Keywords
- child health outcomes
- environmental health
- health improvement
- indoor air pollution
- intervention effectiveness
- pregnancy outcomes
- Cooking
- Premature Birth
- Humans
- Child, Preschool
- Biomass
- Air Pollution/analysis
- Pregnancy
- Air Pollution, Indoor/analysis
- Female
- Developing Countries
- Outcome Assessment, Health Care
- Child
- Infant, Newborn
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Environmental Engineering
- Building and Construction