1. A pilot subsidized cook stove program for sub- Saharan Africa Darby Jack Patrick Kinney Eleanne van Vliet Mailman School of Public Health March 12, 2009

2. The problem

3. Source: Disease Control Priorities Project (dcp2.org)

4. From Kirk Smith Source: Kirk Smith

5. The project

6. Solutions Switch to a cleaner fuel Remove emissions from the home using a chimney Switch to an improved stove (increased combustion efficiency)

7. QuickTime ｪ and a decompressor are needed to see this picture. Kintampo Health Research Centre

8. EnterpriseWorks Gyapa Improved Woodstove

9. What we did We set out to answer two questions: How much do stoves reduce exposure? What factors lead people to permanently adopt stoves? What strategies might improve adoption?

10. Personal Monitoring (24-hr) Filter-based and real- time collection of PM 2.5

11. Personal Monitoring in the Field

13. Adoption: Focus groups and surveys Ongoing activity –One round of stove distribution occurred last summer; second round will occur this summer, drawing on what we’ve learned Generally, positive response –High percentage of households using stoves on follow-up visits –Continue to use 3-stone fires, however –Some foods are harder to cook

14. What’s next

15. The big questions How clean is clean enough? –Are there thresholds in the dose response relationship? What interventions will get you there? –How much do stoves reduce exposure (by stove type, mode of diffusion, etc) Does it matter when in the lifecycle exposure occurs?

16. Large-scale randomized trial Joint with Pat Kinney (air pollution epidemiologist), Robin Whyatt (toxicologist), and Seth Owusu (epidemiologist) Hypothesis 1: maternal exposure during pregnancy is associated with low birth weight Hypothesis 2: maternal exposure during pregnancy is associated with increased risk of Acute Lower Respiratory Infection (ALRI) Status: currently preparing revised proposal for NIH grant; first round was well-received, but ultimately unsuccessful.