Chronic Obstructive Pulmonary Disease (COPD) Stove Project
The Chronic Obstructive Pulmonary Disease (COPD) Stove Project in Quetzaltenango, Guatemala, is a collaboration between UC Berkeley, UCSF, and the Universidad del Valle de Guatemala. This will be a prospective cohort study of 200 individuals with COPD due to biomass smoke exposure identified with spirometry at a public hospital. Eligible women will be complete a baseline health and exposure questionnaire, after which they will be followed prospectively with spirometry and symptom questionnaires for 6 months. Additionally, 32 participants of the main study who cook primarily over an open fire will be recruited for a stove intervention sub-study. These participants will receive one of four types of improved cookstoves locally available in Guatemala (Dona Dora, Helps-Onil Stove, liquid propane gas [LPG] stove and LPG stove with a partial gas subsidy). Stove performance and acceptability will be assessed with personal and kitchen monitoring of PM and CO, stove use monitors (SUMs), and a stove acceptability questionnaire before and after the intervention. This group will be followed for 6 months post-intervention with periodic spirometry, symptom questionnaires, and blood samples to assess for serum markers of inflammation commonly associated with biomass smoke exposure. Overall, we believe that those with COPD may be a group that is particularly sensitive to on-going biomass smoke exposure, and a relevant target for stove interventions.

Guarnieri MJ, Diaz JV, Basu C, Diaz A, Pope D, et al. (2014) Effects of Woodsmoke Exposure on Airway Inflammation in Rural Guatemalan Women. PLoS ONE 9(3): e88455. doi:10.1371/journal.pone.0088455

NACER-Neurodevelopment and anthropometric growth of infants exposed to household air pollution in rural Guatemala: A pilot study for a future clean stove intervention trial
NACER was an 18-month longitudinal pilot study (NACER) conducted between January 2012 and December 2013 in rural Guatemala in collaboration with UCSF and Universidad del Valle de Guatemala. The aim of the study was to examine the impact of maternal and infant exposures to household air pollution on infant outcomes, including low birth weight, preterm birth and infant neurodevelopment. Personal CO and PM exposures were measured using real time monitors worn on vests by the pregnant women/mothers, or kept near the infant after birth. Airborne polycyclic aromatic hydrocarbons (8 vapor-phase PAHs measured using passive diffusion badges) were measured at 24-28 weeks of pregnancy and during the post-partum meeting. We measured urinary metabolites of PAHs/VOCs/8-OHdG and 8-isoprostane on women 3 months after the delivery of the infant. A 12 week randomized stove (“Doña Dora” chimney stove/behavior change intervention was conducted from January to April 2014.

Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE)
We carried out a study in the Western Highlands of Guatemala to better understand the relationship between acute respiratory infections in children and exposure to indoor air pollution. To do this, we chose several communities that are well suited for such a study and have installed an improved cookstove called a plancha in half of the participating households. We examined acute respiratory infections (ARI) in children 18 months of age over a 2 year period to see if there was a difference in the incidence of ARI in children who have the plancha compared to children who do not have the plancha. We measured levels of pollution in households that have the plancha and those without the plancha. After completing the study, all participating households received a plancha.

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Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter (CRECER)
Our primary goal is to follow the cohort of children who participated in the Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) – Guatemala, longitudinally for a 5-year period to elicit the chronic effects of inhaled PM during the critical time window of infant lung development on respiratory health.

This recently concluded intervention trial randomized 500 rural Guatemalan households to improved plancha stoves (intervention) or traditional open wood stoves (control) and measured as the main study outcome, the incidence of acute lower respiratory infections (ALRI) in children from birth to 18 months. In addition, extensive exposure assessment was performed and preliminary data suggests that the plancha stove has significantly decreased the levels of biomass smoke exposure inside the intervention homes. At the end of the trial, which concluded in December 2004, all control households were offered an improved plancha stove.

This randomized trial has created a unique opportunity to follow this cohort of children who had variable exposures to biomass smoke from birth to 18 months (critical time window for lung development) and observe the effects of these exposures on future respiratory health.

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Householdair pollution from biomass fuels in urban and rural areas in Paraguay
In collaboration with the Direccion General de Salud Ambiental (DIGESA), Ministry of Health, and PAHO-Paraguay, we conducted the first study characterizing the air quality of households using firewood or charcoal to cook as well as those withusing LPG or electricity. We monitored 24-hour PM2.5 and CO levels in the household kitchen area. Additionally, an outdoor PM2.5 sampling campaign was performed in each comunity. Indoor PM2.5 levels were high in households using firewood, followed by those using charcoal. Households cooking with LPG and electricity showed PM2.5 concentrations similar to levels found at outdoor. Ambient PM2.5 were frequently above 35 ug/m3 and was attributable to biomass used to cook, but also to combustion of residential and agricultural waste.

The project findings will contribute to advancing the DIGESA and PAHO-Paraguay strategic plans for air pollution. These include the development of national air quality guidelines, justification for programs supporting clean energy in households, and increasing national capacity for air quality monitoring. It is hoped this research will be useful to improve the life quality of families with economic needs in Paraguay.