In-door Air Pollution Impacting the Health of Women & Children in Developing Countries: Priority for Health Policymakers

In-door air pollution (IAP) caused by unprocessed wood fuels is impacting the health of the poor, where disproportionate numbers are residing in developing countries.[1] Approximately 90% of rural households in developing countries are relying on wood, dung and crop residues as their main energy source and the numbers are expected to increase.[2] Such energy sources are cheap and easily available locally. However, there are not very clean nor efficient. Besides the fuels, poor functioning stoves and housing conditions make them highly vulnerable. Although a massive shift to kerosene is expensive, promoting the use of charcoal with enhanced stove system will reduce the health impact.

IAP caused by unprocessed wood fuels is threatening the health of the poor in many ways. When they are burned, they leave behind high concentrations of invisible breathable particles of a variety of gases and chemical products. For example, study in rural part of Nigeria shows that the mean concentration of nitrogen dioxide, sulphur dioxide, carbon monoxide, and hydrogen sulphide always stay higher than the permissible limit.[3] The amount of these substances in a poorly ventilated home can exceed WHO’s standard of particle size by more than 20 times.[4]  Particles less than 2.5 micro can penetrate deeply into the lungs and cause multiple health issues.[5] In fact, there are substantial literatures indicating positive correlations between higher concentrations of total suspended particulates and higher rates of mortality.4,5,[6]

As a result, nearly 2 million deaths from various illnesses were reported and among these deaths, 44% were due to pneumonia, 54% from chronic obstructive pulmonary disease, and 2% from lung cancer, where women and children accounted the highest.[7] In rural part of many developing countries, women do most of the cooking, thus they are subjected to continued exposure. It is estimated that 59% of all the deaths attributed to IAP are among female.[8] Children are also considered the second victims. While cooking mothers often carry young children, thus children are exposed to those breathable particles for prolonged period. As a result, 56 % of all the deaths attributed to IAP are among children younger than 5 years old.7 Indeed, the health impact of women and children creates huge economic burdens to the community and in general to country.

To avert the deaths we need to promote alternative energy sources. Although a massive shift to kerosene is preferred, in rural setting it is a very expensive investment, thus is not a cost-effective strategy. However, many alternative mitigation strategies can be promoted to save lives.  The use of charcoal in the few pockets where unprocessed wood fuels are being used widely would be more affordable. Such a measure would have immediate health benefits and lower the mortality. Charcoal, when burned, releases reduced concentrations of harmful particles and more useful energy than unprocessed wood fuel.9 By supplementing with behavioral changes such as keeping children away from stoves and cooking areas, it is possible to achieve significant reduction in mortality. To compensate the wood harvested, the promotion of charcoal use should always be introduced with strong forest policies such as tree replanting to encourage sustainable forest and woodland. Furthermore, to offset part of the emissions due to carbon combustion, it is critical to adapt low-carbon and more productive charcoal production techniques. Sugar charcoal is considered to contain pure carbon than wood charcoal, for instance.[9]

Along with the promotion of charcoal, major changes in housing designs is also crucial to allow adequate ventilation. For example, allowing cooking areas to remove excess hot air and introduce clean air. Replacing the traditional cooking stoves with technologically enhanced stoves will also help to minimize the emission of pollutants. Over the years various types of technologically improved stoves have been tested in many parts of developing countries. The Clean Cook stove, which is tested in Ethiopia, showed reduction in the average particles concentration by half, for example.[10] Similarly cleaner cooking technologies are testing various improved stoves for their efficiency in villages in India, Bangladesh, and Haiti.[11],[12]

The health impact of IAP from unprocessed wood fuel is very huge and should be a priority for policymakers in developing countries. Recognizing this, in 2010, the formal U.S. Secretary State, Hillary Clinton, made a speech in which she underscored the huge impact of IAP in many developing world. There is no doubt that the above mitigation strategies will help reduce some of the health impacts.


[1] Duflo E, Greenstone M, Hanna R “Indoor air pollution, health and economic well-being” Published by Copernicus Publications on behalf of the Institute Veolia Environment. http://www.hks.harvard.edu/fs/rhanna/documents/sapiens-1-1-2008.pdf

[2] Bruce N, Perez-Padilla, and Albalak R (2000) “Indoor air pollution in developing countries: a major environmental and public health challenge” World Health Organization

[3] Oguntoke O, Opeolu BO, Babatunde N (2010) “ Indoor air population and health among rural dwellers in Odeda area South-Western Nigeria” Ethiopian Journal of Environmental studies and management. 3(2): 1-8.

[4] Yassi A, Kjellstrom T, de Kok T, Guidotti TL. Health and energy use. Basic Environmental Health. New York: Oxford University Press; 2001:315.

[5] United States Environmental Protection Agency. Revisions to the National Ambient Air Quality Standards for Particles Matter. Federal Register, July 18 1997, 62: 38651–38701.

[6] World Health Organization. Indoor Air pollution and Health: Fact sheet. No 29

[7] World Health Organization. Indoor air Pollution and health: Fact sheet accessed on 2/26/2014. http://www.who.int/mediacentre/factsheets/fs292/en/

[8] Skolnik R (2012) “Global health 101” 2nd Edition: American Public Health Association Press. Page 146-147.

[9] FAO Corporate Document Repository “Chapter 10-using charcoal efficiency retrieved on 3/2/2014.  http://www.fao.org/docrep/X5328E/x5328e0b.htm

[10] CEIHD/Gaia Association (2007) “ Indoor air pollution monitoring Summary report” Center for Entrepreneurship in international health and development, School of public health, University of California, Berkeley California.

[11] Abhishek Kar, Ibrahim H. Rehman, Jennifer Burney, S. Praveen Puppala, Ramasubramanyaiyer Suresh, Lokendra Singh, Vivek K. Singh, Tanveer Ahmed, Nithya Ramanathan, Veerabhadran Ramanathan. Real-Time Assessment of Black Carbon Pollution in Indian Households Due to Traditional and Improved Biomass Cookstoves. Environmental Science & Technology, 2012;

[12] A. M. Mobarak, P. Dwivedi, R. Bailis, L. Hildemann, G. Miller. Low demand for nontraditional cookstove technologies. Proceedings of the National Academy of Sciences, 2012; DOI: 10.1073/pnas.1115571109

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