There is little demonstrated evidence of health benefits from access to ‘improved’ stoves and clean fuels

Around three billion of the world’s poorest people have to burn firewood, animal dung, crop waste and coal to cook food and heat homes, using traditional stoves and open fires. The health-damaging smoke that results is estimated to cause some four million premature deaths each year, principally of women and children.

Although many governments, multinational companies and nongovernment organisations were promoting access to improved stoves and clean fuels, “there is little demonstrated evidence of health benefits from most of these programmes or technologies,” according to a report published this week in the journal PLoS Medicine.

The report by William Martin II, an associate director at the National Institutes of Health in the U.S., and others arose from an international meeting of experts to address gaps in the current evidence on the health effects of household air pollution and unsafe stoves.

As momentum to improve stoves and household air quality was growing rapidly, evaluation of the impact of such interventions on health was both urgent and essential, their report noted.

“Programmes to introduce clean cook-stoves cannot simply assume that these so-called improved stoves will be accepted by the household or that they will benefit health.”

Foregoing a thorough evaluation during the initial stages of implementation and scale-up, particularly of the stove’s acceptability and performance in everyday use, carried the risk that such programmes would not improve health.

A recent trial carried out in Guatemala had suggested that stoves must at least halve smoke exposure to substantially improve health. “If this finding is replicated in future studies, the daunting task ahead is to facilitate access to cleaner-burning stoves and fuels that are affordable, acceptable to families, and scalable to hundreds of millions of households.”

Not only must the improved stove or fuel intervention achieve a large and sustainable reduction in household air pollution, but families should be willing to more or less exclusively use the new stove or fuel.

In order to produce the desired health benefits, programmes that sought to curb such air pollution required evidence-based technology and delivery mechanisms as well as robust, well-resourced, transparent and timely evaluation, it added.

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