Health impacts of household energy use:  indicators of exposure to air pollution and other risks

Perspectives The information gained from national surveys is essential for monitoring performance towards health goals and targets and informing allocation of resources for health priorities. Recent evidence of the negative impact of household air pollution on health suggests that it is time to upgrade national surveys to inform decision-making on improved fuels and cookstoves. More than 40% of the world's population rely on solid fuels such as wood, crop residues or dung for their cooking and heating needs. 1 Household air pollution, caused by cooking indoors with solid fuels, is the third leading risk factor for morbidity and mortality globally. In 2010, 3.5 million deaths and 4.3% of global disability adjusted life years were attributable to household air pollution. 2,3 Pollutants from inefficient combustion of solid fuels, especially black carbon particles, also contribute to global climate change. Consistent and correct use of improved cookstoves and cleaner fuels have the potential to improve health, reduce deforestation, mitigate climate change and improve livelihoods. 4 Cleaner fuels such as liquefied petroleum gas or ethanol may be required to reduce exposures for critical health gains, but improved solid fuel stoves currently remain the only widely available and affordable option in many regions of the world. 4 Although studies have shown that near exclusive use of an improved stove may be necessary to achieve measurable health benefits, evidence on the health and other benefits associated with improved stoves is growing. The Demographic and Health Survey (DHS) and the Multiple Indicator Cluster Survey (MICS) are two nationally-representative household surveys that have been widely used to collect data on health risks and outcomes since 1984 and 1995, respectively. 7 To date, surveys of this type have been conducted nearly 600 times in roughly 190 countries, typically every three to five years among 5000 to 30 000 households. These surveys collect information using a standard model questionnaire approach to produce data that are comparable within and across countries over time. 7 The sample is representative at national and regional levels and for urban and rural residence. Sampling is based on a stratified two-stage cluster design. 8 The topics included in national surveys have evolved over time based on the data needed by host countries. 7 Among approximately 400 questions in MICS and 850 in DHS, only three questions in both, plus two additional questions in MICS, are used to assess household air pollution. These five questions ask about …