Environmental Health Sciences

Intervening to Improve Birth Weight and Infant Respiratory Health in Rural Ghana

Emissions from cook-stoves using solid fuels dominate total population exposures to noxious combustion pollutants. Exposure to high levels of smoke from cooking fires is a daily reality for over 3 billion people who rely on solid fuels for household energy.  The 2004 update to the WHO’s comparative risk assessment estimates that smoke from cooking causes 2 million premature deaths per year. Household air pollution represents one of the major global environmental risk factors for reduced life expectancy, due in large part to increased risk of death from acute lower respiratory infection in childhood.  A number of substances in biomass smoke harm humans, including suspended particles, carbon monoxide, nitrous oxides, formaldehyde and polycyclic organic matter.

Reducing childhood morbidity related to biomass  smoke exposures is a priority public health goal. The proposed research is highly significant because no studies to date have used a randomized control trial (RCT) design to examine the effects of prenatal cooksmoke exposures on birth outcomes.  Additionally, no birth outcome study to date has measured exposure to specific biomass pollutants during pregnancy, preventing quantitative analysis of exposure- response. Equally importantly, no RCTs have previously examined the relationship between cooksmoke exposures and childhood pneumonia in Africa. We will test whether commercially available, low cost high efficiency cookstoves will improve infant health outcomes. If our study confirms that exposures during pregnancy are associated with lower birth weights, and that prenatal and postnatal exposures are associated with elevated acute lower respiratory infection risk, then interventions that target this window of susceptibility may yield disproportionately great health benefits in Ghana and many locations world-wide. Exposure-response information also will be valuable in assessing health co-benefits of climate mitigation efforts directed at reducing biomass cooking emissions in Africa, an area of growing interest.

This study is the first randomized cook stove intervention study in Africa.   The Mailman School's primary investigators include Drs. Patrick Kinney, Darby Jack, and Robin Whyatt, professors of Environmental Health Sciences. Columbia University is working in collaboration with Seth Owusu-Agyei, PhD and Kwaku Poku Asante, MPH, MD at the Kintampo Health Research Center in Ghana.  More information about the clinical trial can be found at the NIH Clinical Trials website.