Cardiovascular and Respiratory Effects of a Cookstove Intervention in Two Rural Communities in Western Kenya

摘要

Background: Household air pollution (HAP) from incomplete combustion of solid fuels is associated with substantial cardiopulmonary mortality, particularly in developing countries. We examined the impact of a cookstove replacement intervention on indoor fine particulate matter (PM2.5), carbon monoxide (CO) concentrations, and markers of cardiovascular and respiratory health. Methods: We enrolled 99 women (mean age: 34.4 years, SD: 7.4) from two Kenyan rural communities in a cookstove intervention study. We measured 24-hour HAP concentrations, resting blood pressure (BP) with an automated sphygmomanometer, and performed spirometry and pulse oximetry before and 1 and 6 months after stove intervention. We used robust mixed effects linear regression models to estimate post-intervention (versus pre-intervention) changes in HAP and health outcomes, adjusting for age, education, and study site. Results: Pre-intervention median (IQR) CO and PM2.5 levels were 19.0 (9.0-40.8) ppm and 64.0 (36.0-127.0) μg/m3, respectively. All participants reported using wood as their primary cooking fuel, with 93% having no access to a gas cook stove and 88% having no access to electricity. Cookstove intervention was associated with 12.5 (95% CI: 8.8,16.3) ppm lower mean CO, 23.6 (4.6, 42.7) μg/m3 lower mean PM2.5, 3.9 (1.3, 6.5) mmHg lower systolic BP mmHg, 1.2% (0.8%, 1.6%) higher perfusion index, and 5.5 (3.1, 7.9) bpm lower resting pulse rate at 6 months post-intervention versus baseline. Non-significant improvements in diastolic BP, exhaled CO, carboxyhemoglobin, and peak expiratory flow were also observed. Site-specific estimates varied slightly but trended in the same direction. Conclusion: Among healthy women in two rural Kenyan communities exposed to high levels of HAP, cookstove intervention was associated with lower levels of HAP and improvements in some markers of cardiovascular health after 6 months.