BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF PUBLIC HEALTH

Assessment the effect of indoor air quality on mothers and child

health in Merawi town North West Ethiopia 2018.

By: Berhanemeskel Hunegnaw

Bahir Dar, 2018

Acronyms and abbreviations
WHO ……………………………………………….World Health Organization
HAP……………………………………………….House holed Air Pollution
LPG…………………………………………….Liquefied Petroleum Gas
PM……………………………………………..Particulate matter
DALYs………………………..Disability Adjusted Life Years
ALRIs …………………………………………Acute Lower Respiratory Infections
COPD……………………………………….Chronic Obstructive Pulmonary Disease (COPD)
CB………………………………………………. Chronic Bronchitis
PAH……………………………..Poll Aromatic Hydrocarbon
ARI……………………………………………….Acute respiratory infections
CO……………………………………………….Carbon Monoxide
P.P.M…………………………………………….Parts Per Million
LMIC…………………………………………..Low and Middle Income Countries
ICS……………………………………………..Improve Cock Stove
SPM……………………………………………Suspended Particulate Matter
Introduction
Background
Indoor air pollution can be traced to prehistoric times when humans first moved to cold climates and it
became necessary to construct shelters and use fire inside them for cooking, warmth and light. Fire led to
exposure to high levels of pollution, as evidenced by the soot found in prehistoric caves ( 1 )

Globally, almost 3 billion people rely on bio-mass (wood, charcoal, crop residues, and dung) and coal as
their primary source of domestic energy (1,2). Biomass accounts for more than one-half of domestic
energy in many developing countries and for as much as 95% in some lower income ones (1,3)
Approximately half the world’s population and up to 90% of rural households in developing countries
still rely on unprocessed biomass fuels in the form of wood, dung and crop residues ( 2 )

According to the latest World Health Organization (WHO 2016) report, 8 million people die every year
globally because of air pollution among these, 4.3 million die because of air pollution from house-hold
sources and 3.7 million die because of ambient air pollution These are typically burnt indoors in open
fires or poorly functioning stoves. As a result there are high levels of air pollution, to which women,
especially those responsible for cooking, and their young children, are most heavily exposed. WHO
estimates exposure to air pollution from cooking with solid fuels is associated with over 4 million
premature deaths worldwide every year including more than half a million children under the age of 5
years. These are typically burnt indoors in open fires or poorly functioning stoves. About 700 million
Africans, rely on biomass fuels for cooking (e.g. animal dung, crop residues, wood, and
charcoal).Although a billion people in sub-Saharan Africa are projected to gain access to electricity by
2040, 530 million will remain dependent on biomass fuels as a result there are high levels of air pollution,
to which women, especially those responsible for cooking, and their young children, are most heavily
exposed. In developing countries, however, even where cleaner and more sophisticated fuels are
available, house-holds often continue to use simple biomass fuels (3).

Biomass and coal smoke contain a large number of pollutants and known health hazards, including
particulate matter, carbon monoxide, nitrogen dioxide, sulfur oxides (mainly from coal), formaldehyde,
and poly-cyclic organic matter, including carcinogens such as benzoin[ a ] pyrene ( 5 ).
Statement of the problem
Nearly half of the world's population relies on solid fuels for house-hold heating and cooking these
resulting high levels of house holed air pollution (HAP) .(Bonjour et al., 2013).

Another 0.6 billion people use coal. Solid biomass fuels are typically wood, charcoal, dried animal dung
and agricultural residues such as straw and sticks, which have low combustion efficiency. Incomplete
combustion leads to discharge of smoke formed by fine particulate matter, which fills the kitchen or
living area. Other fuel types that are higher on the ‘energy ladder’ are kerosene, liquefied petroleum gas
(LPG) and electricity. Often households cannot afford these alternative fuels; instead, they opt to collect
wood, agricultural residue and animal dung as household fuels. In biomass burning households,PM10
(inhalable material <10m m in aerodynamic diameter) or PM2.5 often exceed guideline levels of mean 24h
concentration and severely more so during cooking .Exposure to solid fuel may have contributed to 1.6
million cases of premature mortality and>38.5 million disability-adjusted life-years (DALYs) in
2000,leading to 4% of the global health burden. Population growth and the rising price of alternative fuel
such as kerosene and LPG increase the use of biomass fuels in developing countries. The daily smoke
exposure household members’ face poses a severe yet largely preventable health risk. About 2 million
children under 5 die from pneumonia. Exposure to indoor air pollution doubles the risk of pneumonia and
other acute lower respiratory infections (ALRIs), contributing to > 800 000 deaths in children under 5.In
adults, chronic obstructive pulmonary disease (COPD) and chronic bronchitis (CB) are becoming major
causes of chronic morbidity and mortality in developing countries. Many studies have shown that
combustion-related air pollution is associated with reduced fetal growth. In humans, associations between
PAHs or PAH-DNA damage and fetal growth reduction have been reported in a number of studies. In
New York City, high PAH exposure during pregnancy was associated with decreased birth weight and
head circumference among black infants. A study in Poland also showed that pre-natal PAH exposure was
a risk factor for reduced fetal growth. In the Czech Republic, ambient PAHs significantly increased the
risk of intrauterine growth retardation. White newborns in Poland who had higher leukocyte PAH-DNA
adduct levels in umbilical cord blood (a measure of PAH exposure) had significantly reduced birth
weight, length, and head circumference .(Alexander Millman,et al. Air Pollution Threatens the Health of
Children in China PEDIATRICS Volume 122, Number 3, September 2008)

Acute respiratory infections (ARI) are a leading cause of childhood illness and death worldwide,
accounting for an estimated 6.5% of the entire global burden of disease. Biomass fuels are at the low end
of the energy ladder in terms of combustion efficiency and cleanliness. Smoke from biomass combustion
produces a large number of health damaging air pollutants including respirable particulate matter, carbon
monoxide (CO), nitrogen oxides, formaldehyde, benzene, 1,3 butadiene, polycyclic aromatic
hydrocarbons (such as benzo[a]pyrene), and many other toxic organic compounds. In developing
countries, where large proportions of households rely on biomass fuels for cooking and space heating,
concentrations of these air pollutants tend to be highest indoors. The fuels are typically burned in simple,
inefficient, and mostly unvented household cook stoves, which, combined with poor ventilation, generate
large volumes of smoke indoors. Moreover, cook stoves are typically used for several hours each day at
times when people are present indoors, resulting in much higher exposure to air pollutants than from
outdoor sources. In such settings, daily average and peak exposures to air pollutants often far exceed safe
levels recommended by the World Health Organization. A comparison of typical levels of carbon
monoxide (CO), particulate matter 10µ m (PM10), and 2.5 µ m (PM2.5) in developing-country homes
using biomass fuels with the US Environmental Protection Agency’s standards for 24-hour average
concluded that indoor concentrations of these pollutants in biomass-fuel-using developing-country homes
usually exceed the guideline levels several-fold. Exposure levels are usually much higher among women
who tend to do most of the cooking and among young children who stay indoors and who are often
carried on their mother’s back or lap while cooking. Zimbabwe found that women and young children
spend an average of 5 hours per day in the kitchen area, where air pollution levels from biomass fuel
combustion for cooking tend to be very high. The measured levels of CO in the kitchen were in the range
of 300–1000 p.p.m. (Vinod Mishra 2003 ,Indoor air pollution from biomass combustion and acute
respiratory illness in preschool age children in Zimbabwe International Journal of Epidemiology
2003;32:847–853

Significance of exposure to indoor air pollution and the increased risk of acute respiratory infections in
childhood, low birth weight, chronic obstructive pulmonary disease and lung cancer ( 3, 4).

The health effects have been somewhat neglected by the research community, donors and policy makers.
Biomass fuel is any material derived from plants or animals which is deliberately burnt by humans. Wood
is the most common example, but the use of animal dung and crop residues is also widespread (5).

China, South Africa and some other countries also use coal extensively for domestic needs. Many of the
substances in biomass smoke can damage human health. The most important are particles, carbon
monoxide, nitrous oxides, sulphur oxides (principally from coal), formaldehyde, and polycyclic organic
matter, including carcinogens such as benzo [ a ] pyrene ( 5).

Particles with diameters below 10 microns (PM 10), and particularly those less than 2.5 microns in
diameter (PM 2.5), can penetrate deeply into the lungs and appear to have the greatest potential for
damaging health (8 ).
Combustion is very incomplete in most of these stoves, resulting in substantial emissions which, in the
presence of poor ventilation, produce very high levels of indoor pollution (9). Indoor concentrations of
particles usually exceed guideline levels by a large margin: 24-hour mean PM 10 levels are typically in the
range 300–3000m g/m3 and may reach 30 000m g/m3 or more during periods of cooking ( 6, 7, 9 ). The
United States Environmental Protection Agency’s standards for 24-hour average PM10 and PM 2.5

concentrations are 150 mg/m3 and 65 m g/m3 respectively (8).

The mean 24-hour levels of carbon monoxide in homes using biomass fuels in developing countries are in
the range 2–50 ppm; during cooking, values of 10–500 ppm have been reported. The United States
Environmental Protection Agency’s 8-hour average carbon monoxide standard is 9ppm or 10 mg/m3 (8 ).

Recognizing the extent of this problem, and in addition to efforts within countries, a number of
international initiatives have recently been launched to accelerate access to cleaner household energy,
including UN3 Sustainable energy for all (UN, 2014) and the UN Foundation Global Alliance for Clean
Cooks stoves (UNF, 2014). Whatever approach is taken by these various initiatives, planning must take
into account the fact that the 2.8 billion people relying on solid fuels are also the world's poorest people,
and furthermore that experience has shown that securing adoption and lasting use of clean and efficient
stoves and fuels can be very challenging, for reasons that involve a wide range of factors ( Rehfuess et al.,
2014).

Household air pollution (HAP) from the combustion of solid and other polluting fuels is responsible for a
very substantial public health burden, impacting primarily on homes in low and middle-income countries
(LMIC). In the 2010 Global Burden of Disease study (GBD-2010), cooking with solid fuels (wood, dung,
crop wastes, charcoal and coal), was estimated to cause 3.5 (un certainty interval: 2.7, 4.5) million
premature deaths in 2010, with a further 0.5 million outdoor air pollution deaths being attributed to
emissions from household cooking (Lim et al., 2012; Smith et al., 2014)

HAP was responsible for the largest global environmental burden among the risk factors studied. New W
HO estimates for 2012 using similar methods but updated solid fuel use and mortality data, report 4.3
million premature deaths (WHO, 2014)

Among 174 mothers and newborns for whom birth weight was measured within 24 house of the plancha
chimney stove (not per randomization) was associated with an adjusted 89 g (NS) increase in birth
weight, and a 26% reduction (NS) in risk of LBW.( RESPIRE study, Guatemala,RCT Smith et al. (2011)
According to some estimates, approximately half of the world population is reliant on biomass fuels
(wood, agriculture residues, and charcoal) for cooking and heating as the primary source of domestic
energy, and nearly 2 billion kilo-grams of biomass are burned every day in developing countries.

The use of wood and other forms of biomass as a cooking fuel is common in developing countries such
as India. In rural areas of India, biomass is used as the primary household cooking fuel and almost 90% of
the energy used is accounted for by biomass (wood, 56%; crop residues, 16%; dung, 21%). Wood smoke
contains hundreds of chemical compounds. Some of the components pre-sent in wood smoke that are a
health concern include particles, polycyclic aromatic hydrocarbons and carbon mono oxide. Exposure of
air pollutants levels are usually much higher among women who tend to do most of the cooking 9 and
among young children who stay indoors and who are often carried on their mother’s back or lap while
cooking. A recent baseline survey conducted in two districts of Zimbabwe showed that women and young
children spend an average of 5 hours per day in the kitchen area, where air pollution levels from biomass
fuel combustion for cooking are often very high. The measured levels of CO in the kitchen were in the
range of 300-1,000 ppm.1

(Bruce N, Perez-Padilla R, Albalak R. Indoor air pollution in developing countries: a majo r

environmental and public health challenge. Bull WHO 2000; 78: 1080-92.)
Litterateur review
We conducted a cross over study in 2012 in two Kenyan villages; up to six different ICS were installed in
45 households during six two week periods. Forty-eight hour kitchen measurements of fine particulate
matter (PM 2.5) and carbon monoxide (CO) were collected for the TCS and ICS. Concurrent personal CO
measurements were conducted on the mother and one child in each household. We performed descriptive
analysis and com-pared paired measurements between baseline (TCS only) and each ICS. Results:The
geometric mean of 48-hour baseline PM 2. 5 and CO concentrations in the kitchen was 586μg/m3(95%
CI: 460, 747) and 4.9 ppm (95% CI: 4.3, 5.5), respectively. For each ICS, the geometric mean kitchen air
pollutant concentration was lower than the TCS: median reductions were 38.8% (95% CI: 29.5, 45.2) for
PM2.5 and 27.1% (95% CI: 17.4, 40.3) for CO, with statistically significant relationships for four ICS.
We also observed a reduction in personal exposures to CO with ICS use .( Fuyuen Yip ,etal . Assessment
of traditional and improved stove use on household airpollution and personal exposures in rural western
Kenya Environment International 99 (2017) 185–191)

A total of 2717 studies were identified. Fifty-one studies were selected for data extraction and 25 studies
were suitable for meta-analysis. The overall pooled ORs indicate significant associations with acute
respiratory infection in children (OR 3.53, 95% CI 1.94 to 6.43), chronic bronchitis in women (OR 2.52,
95% CI 1.88 to 3.38) and chronic obstructive pulmonary disease in women (OR 2.40, 95% CI 1.47 to
3.93).

We enrolled 10 750 children from 8626 households across 150 clusters between Dec 9, 2013, and Feb 28,
2016. 10 543 children from 8470 households contributed 15 991 child-years of follow-up data to the
intention-to-treat analysis. The IMCI pneumonia incidence rate in the intervention group was 15·76 (95%
CI 14·89–16·63) per 100 child-years and in the control group 15·58 (95% CI 14·72–16·45) per 100 child-
years, with an intervention versus control incidence rate ratio (IRR) of 1·01 (95% CI 0·91–1·13; p=0·80).
Cooking-related serious adverse events (burns) were seen in 19 children; nine in the intervention and ten
(one death) in the control group (IRR 0·91 [95% CI 0·37–2·23]; p=0·83).( Kevin Mortimer,etal ,A
cleaner burning biomass-fuelled cookstove intervention to prevent pneumonia in children under 5
years old in rural Malawi (the Cooking and Pneumonia Study): a cluster randomised controlled
trial Vol 389 January 14, 2017)

Houses in developing countries and rural communities WHO 2016

Most developing countries, on the other hand, use stones, bricks, concrete, and cement to build their
houses. Although the use of air conditioning is on the rise in warmer developing countries, most houses
rely on natural ventilation through open windows and shutters. Overcrowding and increased
industrialization have led to housing within close vicinity of industries and heavy traffic dense roads. The
poor socioeconomic strata of society in these countries continue to live in ill-ventilated and ill-lit
houses made of bamboo, wood, crop residues, tin sheets, and sometimes cloth. Biomass for cooking,
heating, and lighting is used widely in these parts of the world. Paints and whitewash are commonly used
in these houses. Insect infestations remain a major problem in developing and rural houses, and
repellents are widely used. The use of fragrances through air fresheners, frankincense, scented candles,
and potpourri is a rising trend. Increasing demands for improved housing have led to a growth spurt of
housing complexes with a faster turnover time period. This in turn has affected the quality of the
finished housing, leading to poor quality of the construction material, faulty electrical and
plumbing work, and an overall poor quality of housing

Sources of household air pollution 2016

Apart from the use of solid cooking fuels, there are more than 60 risk factors associated with the
increased burden of household air pollution. These are Cooking-related household air pollution,
Temperature control-related household air pollution, Smoking, Insecticides and pest control, Building
material, Perfumes, deodorants, and cleaning agents and others like ppm.

Effects of household air pollution WHO 2016

Of the 4.3 million people who die every year because of house-hold air pollution, 60% die
because of cardiovascular diseases and 40% die because of pulmonary diseases Short-term effects of
exposure to household air pollutants confer an increased risk for deaths because of cardiovascular as
well as respiratory causes. A 10 µg/m3 increase in indoor PM10 has been shown to increase
cardiovascular mortality by 0.36% and respiratory mortality by 0.42%. Similarly, a 10 µg/m3
increase in indoor PM 2.5 has been shown to increase cardiovascular mortality by 0.63% and
respiratory mortality by 0.75%. In the long term, every 10 µg/m3 increase of household PM10
increases the risk of mortality by 23% to 67% .

This study undertaken in India was aimed at identifying the effects of the indoor air pollutants SO2 ,NO2
and total suspended particulate matter (SPM) generated from fuel used for cooking on respiratory allergy
in children in Delhi. A total of 3,456 children were examined (59.2% male and 40.8% female). Among
these, 31.2% of the children’s families were using biomass fuels for cooking and 68.8% were using
liquefied petroleum gas. Levels of indoor SO 2 , NO2 and SPM, measured using a Handy Air Sampler
(Low Volume Sampler), were 4.60 ± 5.66 μ g/m3 , 30.70 ± 23.95 μ g/m3 and 705 ± 441.6 μ g/m3,
respectively. The mean level of indoor SO2 was significantly higher (p = 0.016) for families using
biomass fuels (coal, wood, cow dung cakes and kerosene) for cooking as compared to families using LP
gas. The mean level of indoor NO2 for families using biomass fuels for cooking was significantly higher
in I.T.O. (p = 0.003) and Janakpuri ( p = 0.007), while indoor SPM was significantly higher in Ashok
Vihar (p = 0.039) and I.T.O. ( p = 0.001), when compared to families using LP gas. Diagnoses of
asthma, rhinitis and upper respiratory tract infection (URTI) were made in 7.7%, 26.1% and 22.1% of
children, respectively. Respiratory allergies in children, which included asthma, rhinitis and URTI, could
be associated with both types of fuels (liquefied petroleum gas [LPG] and biomass) used for cooking in
the different study areas. This study suggests that biomass fuels increased the concentrations of indoor air
pollutants that cause asthma, rhinitis and URTI in children. LP gas smoke was also associated with
respiratory allergy.( Raj Kumar,etal.. Impact of Domestic Air Pollution from Cooking Fuel on Respiratory
Allergies in Children in India ASIAN PACIFIC JOURNAL OF ALLERGY AND IMMUNOLOGY
(2008) 26: 213-222)

Several studies have examined the effects of coal stoves on indoor air pollutant levels. Qing and
colleagues measured indoor and outdoor inhalable particulate (IP), SO2, and CO in children’s homes and
schools in four large cities in China.12 The estimated concentrations for IP, SO2, and CO were 247
μg/m3, 185 μg/m3, and 4.17 mg/m3, respec-tively, for children living in households using gas stoves, but
were 708 μg/m3, 436 μg/m3, and 6.55 mg/m3, respectively, for children living in house-holds using coal
stoves. Luo13 investigated 64 households to determine if any association exists be-tween indoor air
pollution and stove fuels in south-eastern China. Indeed, there were significantly higher SO2 levels in
households using coal stoves than those using natural gas. Smith KR. Indoor air pollution in developing
countries: rec-ommendations for research. Indoor Air 2002; 12: 1-7.
Conceptual frame work
Rational of study
Indoor air pollution is a serious environmental health problem in developing countries that has received
relatively little attention in comparison to other issues. The most significant source of indoor air pollution
is cooking smoke from low grade fuels burnt using inefficient stoves. Indoor air pollution is strongly
poverty related, as it is the poor who predominantly rely on lower-grade fuels and have least access to
clean technologies for cooking and heating. Furthermore, poor women and children are generally most
exposed to indoor smoke, as women cook and simultaneously care for young children, and thus are also
likely to be most at risk from the associated health effects. There is now strong evidence to support a link
between indoor air pollution and health, particularly respiratory disease, including acute respiratory
infections, chronic obstructive lung disease and lung cancer. Increasing evidence also suggests links with
cataracts, tuberculosis, asthma and possibly low birth weight, perinatal mortality and heart disease. There
is some consensus that respirable particulates, especially those measuring less than 2.5 µg in diameter
(PM2.5) have the greatest health impact, as they penetrate furthest into the lungs. However, few studies
have explored the health impacts of other pollutants. Interventions to alleviate indoor air pollution in
developing countries have tended to overtly focus on improved cooking stoves, despite the potential of
other interventions such as smoke hoods, cleaner fuels or modified kitchen or house design to increase
ventilation. There is a general lack of information on the effectiveness of these types of intervention in
reducing indoor smoke, and studies published to date are both difficult to compare and have produced
conflicting findings. There is much discussion around the most effective intervention(s) to reduce
pollution levels, and the debate at present is inconclusive. The promotional experience of improved
technologies to reduce indoor air pollution in developing countries has been mixed, and has focused on
the design and dissemination of improved stoves. Both large national-scale programmers and smaller
independent initiatives have been implemented, each with instances of success and failure. Many
initiatives have been designed according to the priorities of the implementers, or assumed priorities of
intended beneficiaries, with little participation from users. As with other development projects, many
initiatives have failed through failing to meet users’ needs, which include both practical and socio-cultural
factors. Many sources believe that a commercial focus is the optimal way to promote stoves, with
government and international agencies playing a supporting role. Very little work has been done to
establish the necessary reductions in pollution levels for the health impacts to be significantly reduced.
Although this is a priority for future research, the evidence supporting the health links suggests that the
way forward is to work towards any attainable reduction, on the assumption that this will pose a reduced
health risk.
Around half of the population in developing countries, and 90% of the rural population, rely on coal and
biomass (wood, dung, crop residues) for domestic energy, often using simple stoves that produce
incomplete combustion. In developing countries, the primary source of indoor air pollution is often the
combustion of dirty fuels used for cooking and/or heating, which has been found to be responsible for
many indoor pollutants, including carbon monoxide, particulate matter, sulphur dioxide, nitrogen dioxide,
and various organic compounds. Bruce et al (2000) estimate that IAP from biomass and coal smoke is
responsible for approximately 2 million annual deaths, representing around 4% of the global disease
burden, with acute respiratory infections (ARIs) being the greatest cause of mortality in children under
five.

The WHO 2000 estimates that the global burden of disease from exposure to particulate air pollution is
experienced indoors in developing countries, contributing to approximately 50% of disease among rural
and 25% among urban dwellers respectively.

IAP is a problem that is strongly poverty related , as it is the poor who both rely on lower-grade fuels and
have least access to clean technologies for cooking and heating (Bruce et al, 2000).

Many studies emphasis that poor women and children are at greatest risk from the health effects of IAP
(Boy et al, 2000) . In poor households in the South, women typically do most of the cooking and spend
most time indoors, thus they are subject to high levels of pollution both from being close to the fire, and
spending longer periods of exposure in the indoor environment.

Young children (especially infants under five years) are also greatly exposed as they are placed close to
where the mother is working – in some countries strapped to the mother’s back as she cooks - so are also
exposed to long periods in the polluted environment. Infants and young children are also physiologically
more susceptible to the health impacts (Boy et al , 2000; Bruce etal , 2000).

Children’s lungs are only fully developed in their late teens and t heir breathing is faster, thus they absorb
pollutants more readily than adults and retain them in their systems for longer (Banerjee, 2000). The
elderly and expectant women are also more susceptible (WHO, 2000).

Susceptibility is exacerbated by malnutrition, poor living standards, overcrowding and exposure to

disease through poor sanitation, as well as a low standard of medical care (WHO, 2000). Estimates from
developing countries where simple biomass stoves are used for cooking suggest that exposure is between
3 and 7 hours daily. Exposure can be longer in climates where these stoves are also used for space
heating. Few data have been collected on the concentration of individual pollutants within households.
The concentrations of many pollutants have not been recorded in the domestic setting. There are no
standards for indoor exposure to biomass smoke (Smith et al, 2000).

The United States Environmental Protection Agency (USEPA, 1997) standards for ambient air pollution
allow a 24-hour mean for PM10 ≤ 150 µ g/m3 . This mean should be exceeded no more than once in
100 days. The 24-hour means recorded within houses in developing countries range from 300 to 3,000 µ
g/m3 . Maximum levels of 30,000 µ g/m3 have been reported during cooking.

The USEPA (1997) standards for ambient air pollution allow an 8-hour mean for CO = 9ppm. The mean
recorded levels reported from studies in houses in developing countries range from 2 to 50 ppm, with
levels during cooking varying from 10 to 500 ppm. The USEPA (1997) standards for ambient ai r
pollution allow a 24-hour mean for SO2 of 365 µ g/m3. Using the conversion factor of 0.25 (Dockery &
Pope, 1994) the reported PM10 levels equate to 24-hour means for SO2 of 75 – 750 µ g/m3. The
conversion factor is based on studies of ambient air quality. Its applicability to indoor air quality is not
known. A study from Tamil Nadu (Balakrisna, 2000) found that the WHO guidelines for short-term
exposure to CO, NO2 and SO2 were exceeded in 40%, 63% and 67% of households respectively. WHO
guidelines recommend that SO2 should not exceed a 24 –hour mean of 150 µ g/m3. This figure resulted
from the application of a safety factor of 2 to the lowest 24-hour mean at which an exacerbation of
symptoms was consistently found in sensitised patients (WHO, 2000). The WHO guidelines for NO 2
recommend that means should not exceed 200 µ g/m3 over 1 hour or 40 µ g/m3 over a year. At a level of
double these, there is consistent evidence of reduced lung function in asthmatics. WHO guidelines for
CO2 recommend that mean exposure should not exceed 30,000 µ g/m3 over 1hour or 10,000 µ g/m3
over 8 hours. These standards are set so that carboxy hemoglobin levels will not exceed 2.5% in order to
protect middle aged and elderly, nonsmoking, coronary heart disease patients and the foet uses carried by
non-smoking pregnant mothers. No WHO guidelines have been set for suspended particles. The WHO
finds that, although increasing exposure to PM10 and PM2.5 are associated with increasing risk of
adverse health effects, the available evidence does not allow a clear judgment to be made of a level below
which no adverse effects would be expected. The potential health risks which have been identified
include:

• ARIs

• Chronic obstructive lung disease

• Cancer (of the lung, mouth, nasopharynx or larynx)

• Asthma

• TB

• Cataract

• Low birth weight

• Infant mortality

• Heart disease
Objective

 Assessment of traditional and improved stove use on indoor air Pollution and personal
exposures
 Assessment of indoor air quality
 Assessment of the relationship between indoor air pollution and mother’s cataract problem
 Assessment the relationship between indoor air pollution on pregnancy outcome (birth
weight)

Assessment the effect of indoor air quality on

mothers and child health in Merawi town North
West Ethiopia 2018

1. Determine the level of stove use among households in Merawi town(quantitative Cross-
sectional study design)
2. Determine the quality of indoor air quality among households in Merawi
town(quantitative Cross-sectional study design supported with qualitative study design)
3. Does either improved or traditional stove use have an association with cataract?
(Longitudinal follow up study design. Here exposed groups are those who do not use
either improved or traditional or both types of stoves while controls are those who use
either improved or traditional or both types of stoves )
4. Does either improved or traditional stove use have a relationship with birth outcome
specifically birth weight? (Longitudinal follow up study design. Here exposed groups are
those who do not use either improved or traditional or both types of stoves while controls
are those who use either improved or traditional or both types of stoves )
Methods
Work plan and budget
Reference

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