Impact of improved cookstoves on women's and child health in low and middle income countries: a systematic review and meta-analysis

Megha Thakur, Paulien A. W. Nuyts, Esther A. Boudewijns, Javier Flores Kim, Timor Faber, Giridhara R. Babu, Onno C. P. van Schayck*, Jasper V. Been

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

46 Citations (Web of Science)

Abstract

Objectives Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs).

Design Systematic review and meta-analysis of (quasi-)experimental studies identified from 13 electronic databases (last update: 6 April 2018), reference and citation searches and via expert consultation.

Setting LMICs

Participants Women and children

Interventions Improved biomass cookstoves

Main outcome measures Low birth weight (LBW), preterm birth, perinatal mortality, paediatric acute respiratory infections (ARIs) and COPD among women.

Results We identified 53 eligible studies, including 24 that met prespecified design criteria. Improved cookstoves had no demonstrable impact on paediatric lower ARIs (three studies; 11560 children; incidence rate ratio (IRR)=1.02 (95% CI 0.84 to 1.24)), severe pneumonia (two studies; 11061 children; IRR=0.88 (95% CI 0.39 to 2.01)), LBW (one study; 174 babies; OR=0.74 (95% CI 0.33 to 1.66)) or miscarriages, stillbirths and infant mortality (one study; 1176 babies; risk ratio (RR) change=15% (95% CI -13 to 43)). No (quasi-)experimental studies assessed preterm birth or COPD. In observational studies, improved cookstoves were associated with a significant reduction in COPD among women: two studies, 9757 participants; RR=0.74 (95% CI 0.61 to 0.90). Reductions in cough (four studies, 1779 participants; RR=0.72 (95% CI 0.60 to 0.87)), phlegm (four studies, 1779 participants; RR=0.65 (95% CI 0.52 to 0.80)), wheezing/breathing difficulty (four studies; 1779 participants; RR=0.41 (95% CI 0.29 to 0.59)) and conjunctivitis (three studies, 892 participants; RR=0.58 (95% CI 0.43 to 0.78)) were observed among women.

Conclusion Improved cookstoves provide respiratory and ocular symptom reduction and may reduce COPD risk among women, but had no demonstrable child health impact.

Registration PROSPERO: CRD42016033075

Original languageEnglish
Pages (from-to)1026-1040
Number of pages15
JournalThorax
Volume73
Issue number11
DOIs
Publication statusPublished - Nov 2018

Keywords

  • COPD epidemiology
  • paediatric lung disaese
  • pneumonia
  • clinical epidemiology
  • HOUSEHOLD AIR-POLLUTION
  • RANDOMIZED-CONTROLLED-TRIAL
  • COMPARATIVE RISK-ASSESSMENT
  • CHIMNEY STOVE INTERVENTION
  • IMPROVED COOKING STOVES
  • RESPIRATORY HEALTH
  • CARBON-MONOXIDE
  • WOOD SMOKE
  • PARTICULATE MATTER
  • PERSONAL EXPOSURES

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