20% Of All Indian Child Mortality in Ages 1-4 Due To IAP: Study

A BMC Public Health Research Paper by Diego G Bassani, Prabhat Jha, Neeraj Dhingra and Rajesh Kumar on "Child mortality from solid-fuel use in India: a nationally-representative case-control study" says that Child mortality risks from all causes due to solid fuel exposure were lower than previous estimates, but as exposure was common, solid fuel caused 6% of all deaths at ages 0-4, 20% of deaths at ages 1-4 or 128000 child deaths in India in 2004. Solid fuel use has declined only modestly in the last decade. According to the authors, aside from reducing exposure, complementary strategies such as immunization and treatment could also reduce child mortality from acute respiratory infections.

The paper finds that solid fuel use was very common (87% in households with child deaths and 77% in households with living children).

The paper notes that more girls than boys died from exposure to solid fuels. Solid fuel use was also associated with non-fatal pneumonia (boys: PR 1.54 95%CI 1.01-2.35; girls: PR 1.94 95%CI 1.13-3.33). After adjustment for demographic factors and living conditions, solid-fuel use significantly increase child deaths at ages 1-4 (prevalence ratio (PR) boys: 1.30, 95%CI 1.08-1.56; girls: 1.33, 95%CI 1.12-1.58).

The researchers find that with the exception of the colder regions of India, girl deaths at ages 1-4 years had higher prevalence of solid-fuel use when compared to living girls of the same age than did boys. The frequency of self-reported pneumonia was not different between boys and girls but they observed higher solid-fuel use among girls with self-reported pneumonia. Time spent indoors and proximity to pollution source influence the level of exposure and data also suggest that girls spend more time indoors than boys. Other factors such as gender preference, believe the researchers, may also influence treatment access and we believe that differential access to health services may explain the higher mortality among girls. Indeed, hospital based studies have shown that boys are more likely than girls to be admitted for acute respiratory infections.

Such findings are sometimes interpreted as if boys had a higher susceptibility to respiratory infections than girls, but the higher hospital admission rates for boys may be a consequence of the gender differences in access to health care, according to the study. Treating child respiratory symptoms from solid fuel smoke may prevent child deaths while not affecting the incidence of respiratory symptoms, and indeed boys and girls had equal incidence of self-reported pneumonia but girls had higher mortality.

Other factors may explain the gender differences in survival after the onset of pneumonia and further studies are needed to clarify the role of severity of respiratory diseases and other biological factors (i.e. ability to overcome disease/survive), says the paper. The study says it is less subject to gender-based selection bias because it collects information directly in the household.

The researchers compared household solid fuel use in 1998 between 6790 child deaths, from all causes, in the previous year and 609601 living children from 1.1 million nationally-representative homes in India. Analysis were stratified by child’s gender, age (neonatal, post-neonatal, 1-4 years) and colder versus warmer states. They also examined the association of solid fuel to non-fatal pneumonias.

Most households in developing countries, including in India, use solid fuels (coal/coke/lignite, firewood, dung, and crop residue) for cooking and heating. Such fuels increase child mortality, chiefly from acute respiratory infection. There are, however, few direct estimates of the impact of solid fuel on child mortality in India.

Read the Full Paper here:

Child mortality from solid-fuel use in India: a nationally-representative case-control study

BMC Public Health 2010

by Diego G Bassani, Prabhat Jha, Neeraj Dhingra, Rajesh Kumar

The Quest For Scalable Solutions To Energy Poverty

Simon Bishop, Head of Policy & Communications, Shell Foundation in an interview with EarthSky talks about energy poverty and the innovative solutions required to overcome the lack of access to basic energy that half of the world's population faces today. Simon talks about Shell Foundation applying business thinking to energy challenges that affect the developing world by listening to ‘voice of the customer’.

LISTEN TO THE INTERVIEW

According to Simon, given the huge scale of the challenges of providing solutions to rural energy or indoor air pollution, it is not just about "coming up with solutions that help one particular village, in one particular country in Africa. We want to try and come up with solutions that can be replicated many, many times over around the world. Scalability is the number one priority, I would say, for the foundation. Without scale, we are not going to make a significant dent on these issues that affect half the world’s population."

The Interview with EarthSky:

Simon Bishop: There are between two and three billion people in the world who don’t have access to basic energy services, such as electricity or efficient, clean fuels for cooking their food. That’s the kind of thing that we try and tackle.

Simon Bishop of the Shell Foundation is talking about energy poverty – a lack of access to basic energy needs.

Simon Bishop: So, for example, take that issue that half the world’s population is cooking on open fires and traditional stoves. There are stoves out there – ‘clean cook stoves’ – that dramatically reduce both fuel use and emissions. The great thing about them is that they are potential self-financing solutions to this health, poverty, energy, climate change issue. People can pay the roughly $20 price tag for the stoves through the fuel savings they make over the first six months. So it’s a self-financing solution.

Bishop said his team looks for solutions that can scale up, or be replicated all over the world. He spoke of Husk Power Systems in India.

Simon Bishop: This organization takes rice husks, which are waste material, and it turns them into electricity. Imagine if you’re living in Bihar, one of the poorest states in India, which doesn’t have a government-run large-scale electricity grid. Many, many villages are therefore dark. They literally don’t have electricity. You can take a byproduct that they have locally and turn that into electricity and then supply it on local grids. It’s just a huge step forward for those local populations.

Simon Bishop spoke more about the work of the Shell Foundation.

Simon Bishop: The Shell Foundation was an independent charity that was set up by Shell, the company, in 2000. We focus on global poverty and environmental challenges with a link to energy and globalization.

He gave an example of cooking stoves as an opportunity to positively change the way the world uses energy.

Simon Bishop: Every single day, half the world’s population, three billion people, cook their food on open fires and traditional stoves, burning things like wood and dung, pretty much anything they can get their hands on. So the challenge is, how can we help those people cook more effectively? Why do we want to do that? One, is there’s a climate change angle to it. Half the world’s population burning things is not helpful. But there’s also a significant health angle. The smoke that they inhale kills around 1.5 million people every year. So when you talk about energy challenges and big events going on, we feel that one of the most important areas that requires focus is access to energy for those two or three billion people who don’t have access, and that’s what we focus on.

Bishop emphasized that for solutions to work, they must come in part from people for whom they’re intended.

Simon Bishop: You clearly need some technological knowledge, but absolutely you also need that solution to be what we term ‘voice of the customer’ driven. This is sort of an area that the Foundation focuses on, applying business thinking to energy challenges that affect the developing world, and listening to customers coming up with customer-driven solutions, rather than perhaps what has happened in the past, maybe with some governments and NGOS, where there’s been a sort of like ‘patrician’ approach to things, where solutions have been developed in countries such as Britain or America and then sort of ‘dumped’ on the developing world, as this is good for you. We want to avoid that. We want to listen to the market. We want to listen to the people on the ground, and then deliver solutions that they like and that they’re going to use, and ultimately they’re going to pay for.

Scalability, said Bishop, is integral to the success of energy solutions for the future.

Simon Bishop: Trying to find scalable solutions to these tricky challenges is difficult. You have to be willing to put in significant resources, possibly millions of dollars. And you have to be innovative. Let’s get back to the size of the problem. Half the world’s population lack access to basic energy, or they cook their food on open fires and traditional stoves, with the smoke leading to all kinds of negative health impacts. So if you’re looking or solutions to these problems, these solutions have to go to scale. They have to impact huge numbers of lives. We’re not really in favor of coming up with solutions that help one particular village, in one particular country in Africa. We want to try and come up with solutions that can be replicated many, many times over around the world. Scalability is the number one priority, I would say, for the foundation. Without scale, we are not going to make a significant dent on these issues that affect half the world’s population.

Read here the interview and comments

Global Efforts On Indoor Air Pollution

The world of cook stoves is changing as companies are stepping forward to market models that are efficient and durable while micro-finance and other initiatives are likely to make them affordable as well, says an article in the Newsweek. 

According to the magazine, "When it comes to fighting global warming, much of the world’s attention has focused on ways to eliminate coal-fired power plants, promote electric vehicles, and build wind farms. But what if there were something far simpler and more low-tech that would have the same benefit as taking more than half the cars in the United States off the road? Well, it turns out there is—which is why everyone from the US Congress to the United Nations and the philanthropic wing of Shell Oil is suddenly talking about cookstoves."

Newsweek points out that converting most of the world’s poor to more efficient stoves would do as much to prevent global warming as taking 134 million cars off the streets which is why building better stoves—and finding a way to persuade the poor to use them—has become a priority.

The energy bill passed by the U.S. Senate in May calls for the government to help distribute stoves. A similar bill passed by the U.S. House of Representatives in 2009 even mandated that 20 million homes be provided with better stoves within five years.

However, the article points out the challenges which have existed in tackling the issue and what possibly makes the efforts to deal with indoor air pollution different this time is the creation of enterprises around marketing of improved cook stoves.

Says Newsweek, "The history of cookstoves, however, is one of a succession of well-intentioned failures. India paid tens of millions of dollars to supply stoves to rural villages between 1984 and 2004. But the government stoves were of poor quality and, because they were given away, there was no natural after-market for servicing them. As a result, within a few years the vast majority were no longer in use.

Many, though, think this time will be different. A handful of private companies have decided there is money to be made in stoves, and they are marketing models that are efficient, durable, and priced between $25 and $100. That’s still too costly for many of the world’s poorest. Experts say the price has to drop below $12 for guaranteed widespread adoption. But some are hoping that the growing ranks of microfinance banks will be persuaded to lend money to villagers to bridge this gap, or that Western companies might be persuaded to finance distribution in exchange for carbon-trading credits. The U.N. Foundation also plans to launch a Global Alliance for Clean Cookstoves in September. But it remains unclear whether enough of the world’s poor can be persuaded to change the way they cook in time to keep the entire planet from roasting."

Read here the Newsweek story

Finding IAP Solutions Through Enterprise and Improved Stoves

Shell Foundation's Breathing Space Campaign aims to address the problem of indoor air pollution through market mechanisms and private sector involvement rather than subsidies, says Anuradha Bhavnani, Shell Foundation's Regional Director for India, in The Hindu's Survey of the Environment 2010.

In the annual compendium on Environment published by The Hindu, Senior Assistant Editor N Gopal Raj writes that the concern about the impact of indoor air pollution is now finding an answer in improved cook stove technologies that increases thermal efficiency and lowers emissions.

The report quotes the forthcoming paper by Dr Venkataraman and others in Energy for Sustainable Development as pointing out that the "unmet challenge of delivering clean cooking energy for the poor continues to loom large. Given the projected dominance of solid biomass as the cooking energy source for a majoriuty of Indians, there remains the need for ensuring the availability of stove technologies that can deliver truly superior performance, both in terms of thermal efficiency and emissions as well as effective delivery mechanisms."

Full article can be read at The Hindu's Survey of the Environment 2010. Click here to order a copy.