1.1. The Global Poorest Communities and Access to Clean Energy
1.2. Current Approaches Available to the Global Poorest to Reduce HAP in the Short to Medium Term
1.3. The World Health Organisation Guidelines on Household Fuel Combustion
2. Materials and Methods
3.1. Analysis of the Clean Cookstove Catalog
3.2. Systematic Reviews Measuring PM2.5 Reduction and Health Outcomes from the Use of Improved Cookstoves, Published since the Publication of the WHO IAQ Guidelines
- Stove developers should be cognizant of the need to develop stoves that will be affordable to the poorest communities. Research funding focusing on producing affordable stoves that reduce HAP would improve the current availability of stoves to the poorest communities globally.
- ICS with HAP benefits should be promoted where possible. Where no stove is available which reduces HAP, the promotion of stoves that increase efficiency and reduce fuel use could be considered an intermediate step, although it must be recognized that they offer no direct health benefits to the user.
- Clear guidance is required to enable the identification of the most appropriate cookstove to promote to a community. This guidance should take into account the type and characteristics of the stove, stove sustainability, safety, emissions performance, efficiency, in-field performance, affordability, availability in different settings, and also the ability of the stove to meet community cooking needs. Further, it is important for field studies to outline the stove brand, model, and price to aid in knowledge translation and stove recommendations. A detailed scoping review is required to bring all of this information together in a format that is accessible for the clean cooking sector. A toolkit that supports community and programme leads in making local decisions by taking into account affordability, accessibility, acceptability, and sustainability issues alongside relevant national and legal policy would enable a more systematic approach to be taken to the introduction of HAP-reducing measures.
- Currently, of the 343 biomass ICS listed in the Clean Cookstove Catalog and available on the market, 185 (almost 60%) do not show evidence of any testing at all, either via the IWA tiers or by individual testing centres. Undergoing IWA tier rating testing and performance testing in the field should be a requirement for any ICS being promoted in the field.
- A suite of interventions should be promoted alongside cleaner stoves, including cleaner lighting, alternatives to burning crops and rubbish, drying of wood and adequate wood storage, smoking reduction, improved ventilation, outdoor cooking, and behavioural interventions, such as smoking cessation, reduced time spent close to the fire, use of pot lids and wonderbags to reduce cooking times, and burning of rubbish away from households. These options can be presented to communities to enable them to identify feasible interventions to implement in their own settings.
- The Malena offers a relatively cheap cookstove with Tier 4 benefits in relation to HAP reduction. The question remains as to whether an adapted Malena design, built to meet the cooking needs of households in the poorest communities in Africa and Asia, might offer a feasible alternative given that chimney stoves show promise in reducing HAP. This merits greater exploration for the poorest communities in Africa and Asia as an interim measure over the next twenty years.
- The cookstove sector should actively work with local communities at the planning stage of any intervention, in order to introduce approaches that are tailored to the community and take their views into account. Issues of affordability, accessibility, sustainability, and acceptability are crucial and point to the importance of focusing on the needs and perspectives of the user. Local communities provide valuable insights and are well positioned to identify enablers and barriers in relation to certain practices and contribute to identifying solutions. They should therefore be involved throughout all stages of programme or project development and implementation aimed at reducing HAAP.
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Name of Stove||Cost (US$)||Stove Characteristics||Country of Manufacture||Indoor Emissions|
|Canarumwe||3–4||Household, Built in place, Ceramic-lined, Traditional||Rwanda||1||1|
|Berkeley Darfur V.14||25–35||Non-traditional, Pot skirt, Sunken pot, Multiple burners, Rocket, Portable, Household||India||1||2|
|Ezystove||25–75||Household, Rocket, Non-traditional, Portable, Side-feed||China||1||1|
|Augusta||40 to 45||Side-feed, Non-traditional, Household, Portable, Rocket||Bolivia||1||2|
|Prime square granular regular||25–45||Non-traditional, Portable, Gasifier (TLUD), Household, Batch loaded||Indonesia,||1||2|
|Smartsaver wood||N/A||Household, Portable, Non-traditional||Information Not available||1||2|
(pellets and wood)
|5–12||Household, Portable, Batch loaded, Gasifier (TLUD)||Vietnam||2||0|
(pellets and woodchips)
|18–22||Household, Portable, Batch loaded, Gasifier (TLUD), Fan, Pot skirt||Vietnam||2||0|
|Prime square F’wood regular||25–45||Portable, Batch loaded, Gasifier (TLUD), Non-traditional, Household||Indonesia,||2||2|
|40–70||Fan, Thermoelectric generator, Non-traditional, Household, Portable, Side-feed, Pot skirt||China||2||2|
|Prime square fuelwood regular||25–45||Portable, Batch loaded, Gasifier (TLUD), Non-traditional, Household||Indonesia||2||2|
|Kuniokoa||N/A||Non-traditional, Household, Portable, Side-feed, Rocket||Kenya||2||2|
|Ace 1||N/A||Non-traditional, Household, Portable, Gasifier (TLUD), Ceramic-lined, Fan||Lesotho||3||3|
|GAMA1411||N/A||Traditional, Portable, Heating, Chimney, Non-traditional, Household, Side-feed||Bolivia and Peru||3||2|
|Oorja (pellets)||N/A||Batch loaded, Gasifier (TLUD), Non-traditional, Portable, Fan, Ceramic-lined||India||3||2|
|Malena||50–70||Non-traditional, Household, Built in place, Rocket, Chimney, Sunken pot, Side-feed||Bolivia||4||2|
|Mimi moto||40–65||Non-traditional, Household, Portable, Batch loaded, Gasifier (TLUD), Fan, Solar: Panel||China||4||4|
|Authors||No. of Included Studies||HAP Estimates and Health Outcomes|
|Thomas et al. 2015 ||36—variety of study designs, including 11 RCT’s||The majority of studies produced a positive effect on HAP levels with an improved cookstove. Meta-analysis not feasible due to different measurements used.|
|Thakur et al. 2017 ||53—variety of study designs, including 21 RCT’s||No impact on paediatric lower respiratory tract infections, severe pneumonia, miscarriage, stillbirth or infant mortality. Significant reduction (self) reported for cough, wheezing, breathing difficulties and conjunctivitis.|
|Pope et al. 2017 ||42 studies included (no of RCT’s not reported in main paper). Some studies included use of cleaner fuels as well as biomass.||Large reductions in pooled kitchen PM2.5 of 41% (29–50%) for advanced combustion stoves. Biomass stoves with chimneys performed better than those without. However, post-intervention kitchen PM2.5 levels remained well above WHO IAQ recommended limits.|
|Quansah et al. 2017 ||55—variety of study designs, including 11 RCTS||PM2.5 was reduced by up to 67% but this differed by stove type. Levels however were still significantly above WHO IAQ guidelines Current ‘stand-alone’ HAP interventions yield little benefit. Findings on health outcomes inconclusive.|
|Onakomaiya et al. 2019 ||5 studies|
Including 3 RCTs
|Limited findings but some evidence that effects on blood pressure are significant demonstrating a lowering in systolic and diastolic blood pressure.|
|Saleh et al. ||14 studies, 12 testing improved cookstoves—all included studies were RCTs||No studies demonstrated a significant benefit in child pneumonia outcomes. Improvements seen with reported respiratory symptom outcomes with some, but self-reporting made these outcomes vulnerable to bias.|
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