Household and personal air pollution exposure measurements from 120 communities in eight countries: results from the PURE-AIR study

Summary

Background

Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM _2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM _2·5 and black carbon in rural communities with a wide range of cooking environments.

Methods

As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM _2·5 measurements were collected. Light absorbance (10 ⁻⁵m ⁻¹) of the PM _2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period.

Findings

Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM _2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m ³ [95% CI 43–48]), electricity (53 μg/m ³ [47–60]), coal (68 μg/m ³ [61–77]), charcoal (92 μg/m ³ [58–146]), agricultural or crop waste (106 μg/m ³ [91–125]), wood (109 μg/m ³ [102–118]), animal dung (224 μg/m ³ [197–254]), and shrubs or grass (276 μg/m ³ [223–342]). Among households cooking primarily with wood, average PM _2·5 concentrations varied ten-fold (range: 40–380 μg/m ³). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM _2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM _2·5 personal exposures between women (67 μg/m ³ [95% CI 62–72]) and men (62 [58–67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM _2·5 (0·79 [95% 0·71–0·88] for men and 0·82 [0·74–0·91] for women) and black carbon (0·64 [0·45–0·92] for men and 0·68 [0·46–1·02] for women).

Interpretation

Using clean primary fuels substantially lowers kitchen PM _2·5 concentrations. Importantly, average kitchen and personal PM _2·5 measurements for all primary fuel types exceeded WHO’s Interim Target-1 (35 μg/m ³ annual average), highlighting the need for comprehensive pollution mitigation strategies.