Department of Public Health and Policy, University of Liverpool, UK.
Department of Public Health and Policy, University of Liverpool, UK.
Environ Int. 2017 Apr;101:7-18. doi: 10.1016/j.envint.2017.01.012. Epub 2017 Jan 28.
2.8 billion people cook with solid fuels, resulting in almost 3 million premature deaths from household air pollution (HAP). To date, no systematic assessment of impacts on HAP of 'improved' stove and clean fuel interventions has been conducted.
This systematic review synthesizes evidence for changes in kitchen and personal PM and carbon monoxide (CO) following introduction of 'improved' solid fuel stoves and cleaner fuels in low- and middle-income countries (LMIC).
Searches of published and unpublished literature were conducted through databases and specialist websites. Eligible studies reported mean (24 or 48h) small particulate matter (majority PM) and/or CO. Eligible interventions were solid fuel stoves (with/without chimneys, advanced combustion), clean fuels (liquefied petroleum gas, biogas, ethanol, electricity, solar) and mixed. Data extraction and quality appraisal were undertaken using standardized forms, and publication bias assessed. Baseline and post-intervention values and percentage changes were tabulated and weighted averages calculated. Meta-analyses of absolute changes in PM and CO were conducted.
Most of the 42 included studies (112 estimates) addressed solid fuel stoves. Large reductions in pooled kitchen PM (ranging from 41% (29-50%) for advanced combustion stoves to 83% (64-94%) for ethanol stoves), and CO (ranging from 39% (11-55%) for solid fuel stoves without chimneys to 82% (75-95%) for ethanol stoves. Reductions in personal exposure of 55% (19-87%) and 52% (-7-69%) for PM and CO respectively, were observed for solid fuel stoves with chimneys. For the majority of interventions, post-intervention kitchen PM levels remained well above WHO air quality guideline (AQG) limit values, although most met the AQG limit value for CO. Subgroup and sensitivity analyses did not substantially alter findings; publication bias was evident for chimney stove interventions but this was restricted to before-and-after studies.
In everyday use in LMIC, neither 'improved' solid fuel stoves nor clean fuels (probably due to neighbourhood contamination) achieve PM concentrations close to 24-hour AQG limit values. Household energy policy should prioritise community-wide use of clean fuels.
全球有 28 亿人使用固体燃料做饭，由此导致近 300 万人因室内空气污染（HAP）而过早死亡。迄今为止，尚无针对“改良”炉灶和清洁燃料干预措施对 HAP 影响的系统评估。
本系统评价综合了在中低收入国家（LMIC）引入“改良”固体燃料炉灶和清洁燃料后厨房和个人 PM 和一氧化碳（CO）变化的证据。
通过数据库和专业网站进行已发表和未发表文献的搜索。符合条件的研究报告了 24 小时或 48 小时的小颗粒物（主要为 PM）和/或 CO 的平均值。符合条件的干预措施为固体燃料炉灶（带/不带烟囱、先进燃烧）、清洁燃料（液化石油气、沼气、乙醇、电、太阳能）和混合燃料。使用标准化表格进行数据提取和质量评估，并评估发表偏倚。列出并计算了基线和干预后值以及百分比变化，对 PM 和 CO 的绝对变化进行了荟萃分析。
42 项纳入研究（112 项评估）大多涉及固体燃料炉灶。厨房 PM 的降幅较大（范围从先进燃烧炉灶的 41%（29-50%）到乙醇炉灶的 83%（64-94%）），CO 的降幅较大（范围从无烟囱的固体燃料炉灶的 39%（11-55%）到乙醇炉灶的 82%（75-95%）。对于带烟囱的固体燃料炉灶，观察到个人暴露的 PM 和 CO 分别降低 55%（19-87%）和 52%（-7-69%）。对于大多数干预措施，尽管大多数干预措施符合 CO 的 AQG 限值，但在干预后，厨房 PM 水平仍远高于世卫组织空气质量指南（AQG）限值。亚组和敏感性分析并未实质性改变研究结果；烟囱炉灶干预措施存在发表偏倚，但仅限于前后对照研究。
在 LMIC 的日常使用中，无论是“改良”的固体燃料炉灶还是清洁燃料（可能由于邻里污染），都无法达到接近 24 小时 AQG 限值的 PM 浓度。家庭能源政策应优先考虑在整个社区使用清洁燃料。
