Can a Stove Save Children's Lives?

According to the World Health Organization, millions of children around the world face increased vulnerability to pneumonia because of exposure to smoke from traditional cooking methods; as a result, close to a million of them die each year. Three billion people—half the world’s population—eats food prepared using indoor stoves that burn wood, charcoal, coal, even dung. Combustion of these biomass fuels may also be behind other health problems, from low birth-weights to cancer.

Can replacing traditional stoves with cleaner alternatives save children’s lives? For the moment, the answer to this question is unknown, although many, including researchers at the Mailman School’s Department of Environmental Health Sciences are working hard to find out. With funding from the National Institute of Environmental Health Science, the Mailman team is bringing low-emission cookstoves to rural Ghana. The five-year, randomized controlled study, the first of its kind in Africa, will look at the effect of the stoves on children’s health, measuring the impact beginning in the prenatal period.

The team will follow about 1,000 pregnant women in 30 villages. All will be equipped with personal air monitors to measure pollutants as they cook, some on new stoves and some using the traditional method. After the children are born, the researchers will evaluate their weight and respiratory health. “During pregnancy, the fetus is very vulnerable to environmental exposures that can impact their health for years to come,” explains Pat Kinney, ScD, who is leading the effort together with Darby Jack, PhD, and Robin Whyatt, DrPH, from Columbia and Seth Owusu-Agyei and Kwakupoku Asante from the Kintampo Health Research Centre in Ghana.

While the potential upside is huge, scientists face a number of challenges, not least of which is finding the right stove. Newer designs use engineering tricks like fans powered by thermoelectric generatorsto improve efficiency, but so far none of these new technologies are available at scale. This spring, Harvard and MIT researchers reported that cookstoves they were testing in India were plagued with breakdowns. Many families stopped using them, and no health improvements were seen. The Mailman team is taking a cautious approach by vetting stoves to make sure that they both reduce air pollution exposure and hold up over time.

Another crucial consideration is local customs. Working with the Kintampo Health Research Center in Ghana, the researchers field-tested a number of stoves. “We’ve spent a lot of time observing how people cook and trying to figure out and test what kind of stoves were appropriate for the local community,” says Dr. Jack. “In West Africa they cook a lot of dense, starchy foods that require vigorous stirring,” he explains. “Anything not stable to enough to support this kind of cooking was rejected.”

As the researchers evaluate whether the stoves can improve children’s health, they will also look for the intermediary step between smoke exposure and pneumonia—namely, the specific pathogen or pathogens responsible. Helping them do this is a diagnostic technology developed by the School’s Center for Infection and Immunity called MassTag PCR. Using pathogens’ genetic material collected from sick patients with a nasal swab, researchers hope to identify which kinds of microbes can be thwarted by reducing indoor pollution. Evidence from a multicenter study in Guatemala pointed to a decrease in bacterial infections after a cookstove intervention; the new technique will provide much more specificity.

“We’ll have a much brighter light to shine on the issue thanks to our collaboration with the CII team,” says Dr. Jack.

Funding for this piece of the study is provided by the Global Alliance for Clean Cookstoves, a public-private partnership launched by the Clinton Global Initiative and led by the United Nations Foundation. More than 400 partners, including three-dozen countries, U.N. agencies, corporations, and the actress Julia Roberts have lined up behind their ambitious goal of  “100 by 20,” or 100 million safe cook stoves by 2020.

Beyond improving children’s health, the Alliance argues that low-emission cookstoves could be a boon for the environment and women. By burning less wood, they preserve trees and curb the release of carbon dioxide, a greenhouse gas. And when women spend less time searching for fuel, they are better able to go to school or take a job.

While investors and manufacturers speed ahead, the basic health benefits of the stove remain to be seen. Is advocacy outstripping what’s possible given current cookstove technology? A sobering implication of the Guatemala study is that cookstoves need to be cleaner than previously thought. “There is a lot of excitement around cook stoves,” says Dr. Jack. “The public health possibilities here are fantastic. The pivotal question at this stage, though, is how clean is clean enough, and what household energy systems will get us there.”