Household air pollution following replacement of traditional open fire with an improved rocket type cookstove.

Cooking with biomass fuel is an important source of household air pollution (HAP) in developing countries, and a leading risk factor for ill-health. Although various designs of "improved cookstoves" (ICS) have been promoted as HAP interventions in these settings, few of them have undergone in-field evaluation, partly due to the challenge of conducting field measurements in remote settings. In this study we assessed the change in carbon monoxide (CO) exposure following the replacement of the traditional three-stone stove with a popular ICS in 49 homes in Western Kenya. We also assessed the suitability of using kitchen CO as a proxy for kitchen PM. Reduction in 48h mean kitchen CO was 3.1ppm (95% CI: -8.1, 1.8) and in personal CO was 0.9ppm (95% CI: -4.3, 2.6) following stove replacements. Overall, 48-h kitchen and personal CO exposures were lower after stove replacement (28% and 12%, respectively) but with wide confidence intervals that also suggested possible increases in exposure. There were statistically significant reductions in peak kitchen and personal CO concentrations represented by the 8-h 95th percentile: reductions of 26.1ppm (95% CI: -44.6, -7.6) and 8.0ppm (95% CI: -12.2, -3.8), respectively. This is equivalent to 53% reduction in kitchen CO and 39% reduction in personal CO. We found good correlation between kitchen CO and PM concentrations overall (r=0.73, n=33 over averaging periods approximating 1day), which varied by time of day and exposure setting. These variations limit the applicability of CO as a proxy measure for PM concentrations. A combination of interventions, including better designed stoves, improved ventilation and cleaner fuels, may be needed to reduce HAP to levels that are likely to improve health.