space.template.Air+pollution

= Indoor Air Pollution in the Developing World = toc

**Overview**
Reliance on biomass such as wood, coal and animal waste as a source of fuel has led to deteriorating indoor air quality for communities around the world. Women and children are disproportionally affected by indoor air pollution due to their cooking and household activities (WHO, 2007). The use of traditional three-stone stoves and inefficient biomass stoves leads to smoke exposure that causes a range of health problems such as acute respiratory infections, asthma, eye infections and more. In addition, the burning of biomass is detrimental to the environment (Rowse, 2011). Although cleaner fuel sources such as kerosene, gas and electricity have been introduced to communities in the developing world, poverty is still the main driver for use of biomass as a fuel source. Indoor air pollution is a concern especially for the poor in developing countries and more so for those in cold climates where they use indoor fires to keep warm (WHO, 2007).

Acute respiratory infections
Acute respiratory infections kill more children under the age 5 than any other health related problem, including water-related illnesses (WHO, 2007). Children are exposed to smoke by spending time close to the fire assisting their mothers or when they are tied to their backs while she is cooking (Ezzati, 2001a). The children breathe in smoke containing particulate matter with concentrations of up to 3000 µg/m3 per 24 hours. The Environmental Protection Agency (EPA) recommends a maximum exposure rate of particulate matter at 150 µg/m3 per 24 hours. Studies have shown that children exposed to these high levels of PM suffer lower and upper respiratory infections and ear infections that may lead to deafness (WHO, 2007).

Chronic pulmonary disease
Continued exposure to wood smoke has shown to cause decrease in lung function. This is due to growth of lung fibroids and bronchiectasis that become a source of permanent bronchii damage. Most patients, mainly women, with these issues go to hospitals and clinics complaining of shortness of breath and restricted airflow (WHO, 2007).

Asthma
Several reports have found that continuous exposure to formaldehyde, sulfur dioxide and nitrogen dioxide that are produced when biomass is combusted lead to asthma (WHO, 2007).

Infant mortality and Low birth weight
Women exposed to carbon monoxide from burning biomass have shown to give birth to low weight children and probability of stillbirth increase (Ritz & Yu, 1999).

Eye infections
The most common eye infection from use of animal waste as a fuel is cataracts. When particulate matter from the smoke lands in the eye it damages the lens thus causing cataracts (WHO, 2007).

**Medical Anthropology Research**
Medical anthropology research on the effect of indoor air pollution is lacking. Most of the work done on indoor air pollution has focused on observational data and indirectly measure exposure rates. Furthermore, most studies on this subject do not adjust for socio-economic statuses of the communities under study (WHO, 2007). Therefore, medical anthropologists can contribute by evaluating communities’ view on their sources of fuel and the impact to their health (Dybas, 2013). Medical anthropologists who have studied this topic recommend behavioral changes to improve the situation. Some of the recommendations made include; (Agoramoorthy& Hsu, 2008) reducing the distance between children and the fire, (Aklaku et al., 2006) having a minimum of two open ventilation spaces such as doors and windows and, (Booth et al., 2010) decreasing cooking and biomass burning time (Barnes, 2004). In theory, educating community members on how to reduce indoor air pollution and improve their health is vital. Behavioral change and the community’s relationship to the environment are crucial to implement this. However, promoting behavior changes that are feasible and cost effective is easier said than done (Cave & Curtis, 1999). Even with careful adoption and promotion of behavioral changes, they may not work long term. The best method to measure behavioral change, researchers needs to observe and assess the change with time (Cave & Curtis, 1999). However, the community might only behavior in the recommended way while the researcher is there because they think that that is what the researcher wants to see (Barnes, 2004). Therefore, introducing improved technologies and educating community members how to implement the technology is not enough to reduce indoor air pollution. Behavioral changes that are cost effective are also important. Even when communities are willing to change a behavior that will improve their health, they are not usually financial able to make the change. Outside sources such as governments, not for profit organizations and others are needed to implement a technology that will lead to positive behavioral change. A comprehensive assessment of the technology is necessary to ensure that the environmental, social, and economical aspects of the community benefit.

**Applied Work**
Burning of biomass such as animal waste leads to exposure to particulate matter and carbon monoxide at levels that have been shown to cause serious (Rowse, 2011). Therefore, there has been a movement by international agencies such as WHO to advocate for the treatment of waste to produce energy in the developing world. Other reasons for this push include 1.) capture of greenhouse gases (GHG), 2.) women’s disproportionally exposure to risk 3.) a need to curb deforestation for fuel needs, and 4.) production of inexpensive fertilizer (Rowse, 2011). Anaerobic digesters and improved cook stoves are some of the technologies that can be used to mitigate these issues. For example in Haiti, where deforestation and indoor air pollution are serious issues, the United States Senate Committee on Foreign Relations is trying to finance Waste to Energy projects in Haiti; however political instability, corruption, lack of accountability by the public sector and poor infrastructure make financing Waste to Energy projects difficult. Currently, United Nations Environment Programme (UNEP), Norwegian Church Aid (NCA) and The National Renewable Energy Laboratory (NREL) are working on the implementation of biogas systems in the country but the process has been slow due to the reasons mentioned before (Booth et al., 2010). The scenario in Haiti is similar to the situation in other developing countries. Corruption, lack of education and political unrest make financing of these projects difficult by the private sectors. Organizations like the United Nations and World Bank may be the only parties willing to contribute to promoting Waste to Energy projects (ESMAP, 2007). However, there are communities in countries such as Peru, Ghana, India and China (Agoramoorthy& Hsu, 2008; Aklaku et al., 2006; Edwards et al., 2002; Ferrer et al., 2009) where implementation of these technologies has been successful. Nevertheless, medical anthropologists still need to work with scientists to ensure that the social, physical and health needs are met when implementing these systems.

**Online Resources**
Cooking up clean air in Africa: []

**Further Reading**
Gupta BN & Mathur N (1997) A study of the household environmental risk factors pertaining to respiratory disease. //Energy Environ Rev//; 13:61-67.

Air and climate change research: []

**References**
Agoramoorthy, G., and Hsu M. (2008). "Biogas Plants Ease Ecological Stress in India’s Remote Villages." //Human Ecology,//36(3), 435-441.

Aklaku, E. D., Jones, K., and Obiri-Danso, K. (2006). "Integrated biological treatment and biogas production in a small-scale slaughterhouse in rural Ghana." //Water// //Environment Research,// 78(12), 2335-2339.

Barnes, B.R., Mathee, A., Krieger, L., Shafritz, L., Favin,M., Sherburne, L. (2004).Testing selected behaviors to reduce indoor air pollution exposure in young children. //Health Education Research//, 19; 543–550

Booth, S., Funk Kip, and Haase Scott. (2010). "Haiti Waste-to-Energy Opportunity Analysis." National Renewable Energy Laboratory, Golden, Colorado.

Cave, B. and Curtis, C. (1999). The Effectiveness of Promotional Techniques in Environmental Health. WELL Study Task 165. Loughborough University, Loughborough.

Dybas, C. (2013). Cooking Up Clean Air in Africa. National Science Foundation. Retrieved on March 24, 2013 from http://www.nsf.gov/discoveries/disc_summ.jsp?cntn_id=126403&org=NSF&preview=false

Edwards, R., Smith, K., Zhang, J., Ma, Y. (2002). "Implications of changes in household stoves and fuel use in China."//Energy Policy,// 32 395-411.

ESMAP. (2007). "Haiti: Strategy to Alleviate the Pressure ofFuel Demand on National Woodfuel Resources." The International Bank for Reconstruction and Development/THE WORLD BANK, Washington DC.

Ezzati M, Kammen D (2001a). Quantifying the effects of exposure to indoor air pollution from biomass combustion on acute respiratory infections in developing countries. //Environmental Health Perspectives// 109:481-488.

Ferrer, I., Gamiz, M., Almeida, M., and Ruiz, A. (2009). "Pilot project of biogas production from pig manure and urine mixture at ambient temperature in Ventanilla (Lima, Peru)." //Waste Manage.,// 29(1), 168-173.

Ritz B & Yu F (1999) The effect of ambient carbon monoxide on low birth weight among children born in southern California between 1989 and 1993. Environmental Health Perspectives; 107: 17-25

Rowse, L. E. (2011). "Design of Small Scale Anaerobic Digesters for Application in Rural Developing Countries." //Master’s Report. University of South Florida. //

World Health Organization. (2007). "Indoor Air pollution: National Burden of Disease Estimates. Retrived on July 5th, 2012 from @http://www.who.int/indoorair/publications/indoor_air_national_burden_estimate_revised. pdf