Household Woodsmoke and Health in Guatemala
in PCIA Bulletin Issue 7, June 2006
Kirk Smith, RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects)
Acute lower respiratory infections (ALRI) kill nearly 2 million children under five in developing countries, but well-established risk factors such as malnutrition incompletely account for their scale. More than a dozen observational studies have found consistent associations with household use of solid fuels and other indicators of indoor air pollution (IAP), but fall short of fully establishing causality and exposure-response relationships. Due to resource constraints, most were also not able to employ methods to confidently distinguish lower from upper respiratory infections, the latter presenting little serious risk to children.
To improve knowledge of IAP risks and to isolate the benefit of a real intervention on confirmed ALRI, a randomized controlled trial using improved woodstoves with chimneys has been undertaken by an international team in the US, Europe, and Guatemala. Primary funding for RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects) was provided by the US National Institute of Environmental Health Sciences (NIEHS). After unsuccessful efforts in the 1980s to fund a study in Nepal, an international committee was established in 1991 by the Child and Adolescent Health office of the World Health Organization in Geneva to locate the best site. Based on criteria related to local health, IAP exposure, logistics, and institutional conditions, a dozen sites were examined
in Asia, Africa, and Latin America. Highland Guatemala was chosen and a range of pilot studies undertaken in the 1990s to develop data needed to design and successfully fund RESPIRE, which began in 2001 to examine effects in young
children and their mothers.