The health benefits of interventions to reduce indoor air pollution from solid fuel use: a cost-effectiveness analysis

The air pollution-related health benefits of interventions to reduce indoor air pollution from cooking and heating with solid fuels are evaluated in South and South-east Asia, Africa, and the Americas using generalized cost-effectiveness methodology. Three scenarios are assessed: 1) providing access to cleaner fuels, (2) providing access to improved stoves, and (3) providing part of the population with access to cleaner fuels and part of the population with improved stoves. All intervention scenarios are compared with the current situation, i.e., the ‘‘business as usual’’ scenario where current exposures to indoor air pollution from solid fuel use would be sustained. Two major health outcomes associated with indoor air pollution are addressed, namely acute lower respiratory infections (ALRI) in young children under five years of age and chronic obstructive pulmonary disease in adults over twenty. While providing access to cleaner fuels has a larger health impact on the population than improved stoves, there are considerable health benefits associated with improved stove use. Improved stoves are also much more cost-effective than cleaner fuels. Of the cleaner fuels, kerosene, or paraffin, is more cost-effective than liquified petroleum gas (LPG), since kerosene is cheaper than LPG. Concerns about kerosene use, including poisoning, explosions, and possible carcinogenic effects, should be carefully considered before recommending its widespread use over LPG, however. This analysis offers further support for the argument that, from a public health point of view, there should be a continued emphasis on the promotion of improved stoves, as well as other locally appropriate means to reduce exposures within solid fuel-using households, until everyone can be given access to cleaner fuels.