Unventilated Indoor Coal-Fired Stoves in Guizhou Province, China: Reduction of Arsenic Exposure through Behavior Changes Resulting from Mitigation and Health Education in Populations with Arsenicosis

We report the results of a coordinated mitigation effort aimed at reducing arsenic (As) exposure in three counties of Guizhou province, China. Mitigation occurred in 2005 and encompassed 21 villages with 47,000 inhabitants, who were exposed to high levels of As in their diet through consumption of As-contaminated chili peppers and corn dried over unventilated stoves that burned coal containing high levels of As. The coal was mined by villagers from local pits. Inhalation of air that contained high levels of As contributed to approximately 25% of the daily As intake of 6-9 mg. Before mitigation, a baseline survey of 45,364 residents in 2004 identified more than 2,800 individuals with arsenicosis. The survey also found that many residents were aware of the health effects of As in general but lacked in-depth understanding of the link between coal use and arsenicosis. Consequently, an overwhelming majority (> 95%) continued to use high-As coal. This survey provided the basis for a health education campaign that promoted lifestyle changes coupled with the shutting down of local coal pits and the installation of 10,000 new stoves with chimneys for ventilation. The cost of the mitigation was about 4 million Yuan RMB (US$500,000) and was financed mostly by the government. A postmitigation response survey in 2005 found that > 85% of the residents now associate the use of coal with arsenicosis; > 90% correctly learned to operate the new ventilated stoves; and > 90% dry corn and chili peppers outdoors in the sun. Urinary As concentrations in the region decreased from 0.198 +/- 0.300 mg/L (n = 144) in 2004 to 0.049 +/- 0.009 mg/L (n = 50) in 2005 in individuals with arsenicosis (p < 0.01), which is consistent with the behavior changes.