Exposure to household air pollution from the use of traditional energy sources is a top-ten risk factor for morbidity and mortality worldwide. Emissions from traditional energy sources in the home create unhealthy levels of household air pollution and the issue is pervasive. Approximately 3 billion people rely on fuels like wood, charcoal, and kerosene to support needs such as cooking, heating, and lighting. Approximately 80% of the population in Rwanda uses such fuels, making exposure to household air pollution the 3rd leading contributor to the burden of disease in this country. Exposure to household air pollution is also a problem in the developed world. Nearly 30 million Americans burn solid fuels as their primary source of heating energy. Nearly 50 years of research on ?cleaner? household energy technologies has demonstrated only modest global impact, due to a combination of economic, cultural, and technologic barriers that prevent access to and usage of clean energy. A further limitation is that nearly all household energy interventions, to date, have focused on replacing only a single energy source (i.e., replacing just cooking, or just lighting) with a more modern technology. We propose to address these issues by conducting a randomized controlled trial that (1) focuses on total household energy (2) in a country that evinces readiness for alternative forms of energy, (3) by forming a public- private partnership to promote technological solutions that are consumer-focused and market sustainable, (4) by investigating outcome measures that are clinically actionable and strongly linked to morbidity/mortality, and (5) by developing project outputs that can inform policymakers with cost-benefit information. We hypothesize that a whole-house energy intervention (replacing all primitive forms of energy within the home with cleaner, modern forms) will produce meaningful reductions in household air pollution and health benefits in rural Rwandan homes. The randomized controlled trial will substitute traditional forms of household energy (biomass for cooking and kerosene for lighting) with solar power and liquefied petroleum gas stoves in rural Rwanda. Participants will be followed for 3 years with repeated measurements of household air pollution exposure (24-hour fine particulate matter and black carbon), energy usage, and health. Primary health endpoints will include blood pressure in adult women and men and lung-function growth in children; secondary health endpoints include blood pressure in children and lung-function change in adults. The long-term goals of this research are to increase the clinical knowledge-base on the health effects on household air pollution, to demonstrate that a whole-house energy intervention will produce meaningful household air pollution reductions and health benefits in rural Rwandan homes, to elucidate the relationship between fuel subsidy levels and household air pollution exposure, and to demonstrate that scalable solutions to the household air pollution disease burden are achievable via public-private-governmental partnerships.
Exposure to household air pollution from primitive energy sources (such as charcoal and wood-burning stoves and kerosene lamps) is a top-ten risk factor for morbidity and mortality worldwide. This research will investigate whether a whole-house energy intervention can produce meaningful health benefits for women, men, and children in rural Rwandan homes. Outputs from this work will increase the clinical knowledge-base on the health effects on household air pollution and will generate policy-relevant information on scalable solutions to achieving cleaner, healthier forms of household energy.