Assessment of Effectiveness of ICS in Reducing Indoor Air

Pollution and Improving Health in Nepal1

B. Tuladhara,*, I. Gurunga, B. Shresthaa, A. Singha, K. Karkia, A. Pillarisetti b,
K. Bajracharyac
a
Environment and Public Health Organization (ENPHO), Kathmandu, Nepal
b
Full Bright Scholar
c
Alternative Energy Promotion Center/Energy Sector Assistance Programme (ESAP), Ministry of Environment,
Science and Technology

Abstract

A popular technology to reduce indoor air pollution (IAP) in rural homes of Nepal is the mud brick improved cook stoves (ICS) which is
being promoted by the National Biomass Energy Support Programme of Energy Sector Assistance Programme (ESAP) / Alternative Energy
Promotion Centre (AEPC), as well as other agencies and so far more than 230,000 ICS have been installed in the country. A research
conducted by Environment and Public Health Organization (ENPHO) for the Biomass Energy Programme of AEPC/ESAP has found that
the average concentration of PM2.5 and CO in houses that use traditional cook stoves is very high but the mud brick ICS was able to reduce
the PM2.5 by 65.7% and CO by 62.3% after three months and 63.2% and 60.0% respectively after one year of installation of the ICS. The
study, which was conducted in three districts (Dolakha, Ilam and Dang), followed the “Before-After” design; hence both pollution
measurements and questionnaires survey were conducted twice for each of the 36 participating households: first before the installation of
ICS or with traditional cook stoves (TCS) and the second after the installation of ICS. A cross-sectional study done at the same time in 72
households in Kavre district also had similar results. The average PM2.5 concentration in households with ICS was 66.4% less than the
households with traditional stoves. Similarly the concentration of CO was 62.3 % less in households with ICS. The reduced pollution level
also results in major health benefits. However as the pollution levels are still higher than WHO guideline values even after installation of
ICS, there is a need for more improvement in areas such as ventilation and kitchen management.

Keywords: indoor air pollution, ICS, PM2.5, CO, health

1. INTRODUCTION indoor air pollution and improving the health. The

With more than 80 percent of the population
depending on solid biomass fuel, such as wood,
dung and agricultural residues, for cooking, indoor
air pollution (IAP) is a major problem in Nepal.
WHO estimates that 2.7 percent of Nepal’s national
burden of disease is attributed to solid fuel use and
this causes 7500 deaths per year (WHO, 2007). In
order address this problem, different government
and non-government organizations, as well as
private companies and international agencies have
initiated various programmes and introduced a
variety of technologies to reduce IAP in Nepal. One
of the most simple and popular technologies to
reduce IAP in rural homes in Nepal has been the
improved cook stoves (ICS). The mud brick ICS is
being promoted by the Energy Sector Assistance
Programme (ESAP) of the Alternative Energy
Promotion Centre (AEPC), as well as other
agencies. So far more than 230,000 such stoves have
been installed in the country and AEPC/ESAP plans
to install 500,000 stoves in its second phase (2007-
2012).
Realizing the need for effective monitoring and
evaluation, AEPC/ESAP assigned Environment and
Public Health Organization (ENPHO) to conduct an
assessment of the effectiveness of ICS in reducing
1
Paper presented at International Conference on Renewable Energy Technology for Sustainable Development,
Kathmandu, Nepal, 2009
study had two major activities: (i) measurement of
24-hr mean concentrations of two principal indoor
air parameters – particulate matter of size less than
2.5 micron (PM2.5) and carbon monoxide (CO); and
(ii) questionnaire survey and observation for both
indoor air pollution and health impact assessment.
2. STUDY DESIGN
The design for this study was developed by ENPHO
together with AEPC/ESAP in consultation with
experts from the Centre for Entrepreneurship in
International Health Development (CEIHD),
University of California, Berkeley in order to ensure
that it was technically sound and comparable to
other international studies of similar nature. It is
based on the international best practices, a review of
recent literature on study design for similar studies
and optimum utilization of available resources in
terms of time, funding and equipment The study
followed the “Before-After” design; hence both
pollution measurement and questionnaires survey
were conducted three times for each household: first
before the installation of ICS or with traditional
cook stoves (TCS), second: three months after the
installation of ICS – two pot-hole mud brick stove to
see immediate impacts and the third: one year after
installation of ICS to assess long term impacts.

Particulate matter less than 2.5 microns (PM2.5) and
carbon monoxide (CO) were selected as the key
pollution parameters for this study as these
parameters are generally regarded by experts,
including the World Health Organization and the
University of California Berkeley, as the two best
indicators of IAP. The concentration of PM2.5 was
measured using UCB particle monitors while CO
concentration was measured using HOBO CO
loggers. Both these equipment were purchased new
from CEIHD and calibrated at the Indoor Air
Pollution Laboratory of University of California
Berkeley. Both of these equipments contain data
loggers, which store the minute-by-minute data over
the entire measurement period. After monitoring,
these data are then downloaded into a personal
computer and analyzed. In both ‘Before’ and ‘After’
phases of IAP monitoring, the sampling was done
for 24 hours for both PM2.5 and CO following
standard protocols developed by CEIHD so that the
data can be compared with WHO Guideline Values.
For the questionnaire survey, two different sets of
questionnaires one for IAP and the other for health
impact assessment were administered in both phases
of study. The questionnaires were designed based on
international guidelines and experiences of Nepalese
environmental health experts.
In order to get representative samples from
households across Nepal, the study was done in
three different districts representing different
ecological zones and cultural settings. Data for
before installation of ICS was collected from 47
households in three different districts – Boch VDC
in Dolakha, representing high hills of Nepal, Mabu
VDC in Ilam representing mid-hills and Laxmipur
VDC in Dang in the plains. The data for three
months after installation of the ICS was collected
from 36 of the same households, while the one year
data was collected from 34 of the same households.
The field studies were done between October 2007
and February 2009.
Parallel to this study, ENPHO also conducted a
cross-section study in Kavre District in the mid hills
in 36 households with ICS and 36 households
without ICS using the same equipment in 2008.
The required sample size for both the studies was
determined based on statistical rules and sampling
techniques designed by the CEIHD for the
Household Energy and Health Project. According to
Edwards et al (2007), the sample size required to
detect a statistically significant difference in the
mean indoor air pollution levels before and after the
installation of the ICS depends on the percent
difference in those means and in the variability in
the differences in those means (Before – After).
The coefficient of variation (COV) is an indicator of
the variability in measurements, and reflects the
range of air pollution concentrations in different
homes in comparison to the mean concentration in
the same homes. It is equal to the standard deviation
(SD) divided by the mean. Based on a conservative
COV of 1.0 and a detectable difference of 50%, it
was decided that at least 31 households would be
required to be sampled both before and after the
installation of ICS.
3. KEY FINDINGS
Some of the major findings of the study are as
follows:
• The average 24-hr mean PM2.5 concentration
was 2.127 mg/m3 in before phase (kitchens with
TCS) and 0.728 mg/m3 the after three months
and 0.762 mg/m3 after one year of switching to
ICS. The average 24-hr mean CO concentration
was 22.174 ppm with TCS and 8.349 ppm with
the ICS after three months and 8.621 ppm after
one year. The average percent change of the
IAP concentration between the TCS and ICS
were therefore 65.7% and 63.2% after three
months and after one year for PM2.5 and 62.3%
and 60.0% after three months and after one year
for CO. The data shows that the pollution levels
in houses that use TCS are very high and the
ICS that is promoted in Nepal is quite
successful in reducing IAP. However the fact
that the pollution levels are still higher than
WHO guideline values even after installation of
ICS shows that there is a need for more
improvement in areas such as ventilation and
kitchen management. The WHO guideline
values for ambient air quality for PM10 and
PM2.5 is presented in Table 1. WHO does not
have specific guideline values for indoor air
quality but the ambient air quality guidelines is
also applicable to all non-occupational
environments, including indoors.
Table 1: WHO Air Quality Guidelines
Annual 24 hr. Average
PM10 PM 2.5 PM10 PM2.5
Interim 70 35 150 75
Target 1
Interim 50 25 100 50
Target 2
Interim 30 15 75 37.5
Target 3
Guideline 20 10 50 25
Value
Source: WHO, 2005
• By district, the highest and lowest 24-hr
average mean PM2.5 and CO concentrations
were measured in Dolakha and Ilam
 respectively in both ‘before’ and ‘after’ 100
measurements. In Dolakha, the measured mean 90
concentrations of PM2.5 were 3.374mg/m3 with
80
TCS and 1.429mg/m3 with the ICS and for CO

% reduction in PM2.5 in individual HH

these were 38.557ppm with TCS and 70
17.172ppm with ICS. In Ilam, the mean PM2.5 60
and CO were respectively 0.889mg/m3 and
50
8.660ppm with the TCS; and 0.728mg/m3 and
3.337ppm with the ICS. The large difference in 40

pollution levels in the two districts both before 30

and after the installation of the ICS shows that
20
other factors, besides the stove design, such as
ventilation and cooking habits are also very 10

important in determining IAP levels. 0

-10

Figure 1: Absolute differences of PM2.5

Table 2: Pollution levels before and after
concentrations in each household (each bar
installation of ICS
represents a household)
Parame Mean Value Avg %
100
ter (mg/m3) reduction
after 1 yr
Before 3 mo 1 yr. 75
% reduction in CO in individual household

Dolkha
PM2.5 3.374 1.429 1.312 59.3 50

CO 38.657 17.217 15.210 58.3

Ilam 25
PM2.5 0.889 0.308 0.368 51.6
CO 8.660 3.337 3.854 55.5 0
Dang
PM2.5 2.653 0.749 0.818 70.6
-25
CO 26.269 8.320 8.571 67.4
Mean
-50
PM2.5 2.127 0.728 0.762 63.2
CO 22.174 8.349 8.621 60.0 Figure 2: Absolute differences of CO concentrations
in each household (each bar represents a household)
• The percent reduction in pollution level is also
significantly different in the different • The correlation between the concentration
households. While a few houses it was found levels of 24-hr CO and PM2.5 measurements
that the level of PM2.5 decreased by over 90 both in TCS and ICS combined together (N=72;
percent, in one house the PM2.5 concentration Pearson’s Correlations Coefficient = 0.841) was
actually increased. This again shows that the also found highly significant.
while the potential for pollution reduction by
the mud brick ICS is very high, there are • According to the main cook, remarkable
several other factors which need to be improvements in the health condition of both
considered. These include operation and the women and young children were observed
maintenance of the stoves, ventilation and following the installation of ICS. Major health
kitchen management. outcomes included upper respiratory infections
such as cough, phlegm, influenza,
whistling/wheezing of the chest, headaches and
eye irritation; the occurrence of these health
outcomes were substantially reduced after ICS
installation. Reported coughing events
decreased from 55.6% to 16.7% after ICS
installation in adults. In children, a similar
change was reported from 96.2% to 46.2% after
installation. However, as there was only a three
month gap between the installation of the ICS
 and second phase of the assessment, the actual
health impacts of ICS may not be very clear.
• The concentration levels of IAP were found to
be affected by a number of factors. Major
among them included ventilation condition, fuel
types and condition, users’ behavior,
geographical and climatic condition, and to
some extent, installation and use of the ICS.
Thus 69% of the households were reported
occasional problem of smoke coming back into
the kitchen.
• The results of the cross-sectional study was
very similar to the result from the before &
after study. The cross sectional study done in 72
households found that the average PM2.5
concentration in households with ICS was
66.4% less than the households with traditional
stoves. Similarly the concentration of CO was
62.3 % less in households with ICS.
• The findings of this study are similar to the
findings of other similar studies in other countries
including Two recent studies were performed
following a similar 'before and after' study design
and using identical equipment in regions of India.
Outside of Pune, India, the Appropriate Rural
Technology Insitute (ARTI) evaluated indoor air
pollution levels in 110 homes between August 2004
and December 2005. Two types of improved stoves
were installed in this region – the Laxmi stove and
the Bhagyalaxmi stove. One year after the
installation of these stoves, ARTI noted a 24%
reduction in mean PM2.5 concentrations for the
Laxmi stove and a 49% reduction for the
Bhagyalaxmi stove. CO concentrations were
similarly reduced by 39% in Laxmi and 38% in
Bhagyalaxmi stoves (Dutta et. al, 2007). In the
Bundelkhand region of India, Development
Alternatives (DA) evaluated improvements in IAQ
after ICS installation in 60 households. One year
after installation of the stoves, 48 hour CO
concentrations were reduced by 70% and 48-hour
PM concentrations were reduced by 44%
(Chengappa, et. al., 2007).
4. CONCLUSIONS
Overall, the study has found very high levels of
indoor air pollution from burning of biomass fuels,
particularly in houses with poor ventilation. This
can be a major health hazard, particularly for
women and children. However, the study has also
clearly shown that the simple, low-cost and locally
built mud brick ICS can reduce the pollution levels
as indicated by concentration of PM2.5 and CO by
more than 60 percent. The study also indicates that
the ICS also results in significant health benefits as
well as other benefits such as reduced firewood
consumption, cleaner kitchens, and reduced time for
cooking. Overall the ICS users are satisfied with
their new stoves and feel that reduced smoke,
improved health and reduced firewood consumption
are the main benefits of the stoves. However, there
is a need for more awareness programmes for
scaling up ICS throughout the country. The findings
of this study can be used as a tool for motivating
people to install ICS. The study also shows that
proper operation and maintenance of the ICS is
essential for fully achieving its desired results and
other aspects such as improved ventilation and
kitchen management are also equally important.
AEPC/ESAP and ENPHO is currently conducting a
follow up monitoring the same households one year
after installation of the ICS. This will provide more
valuable information on operation and maintenance
of the ICS and its performance over a long period.
ACKNOWLEDGEMENT
The authors are grateful to the support provide by
AEPC/ESAP for conducting this study and the
technical support provided by CEIHD and
Partnership for Clean Indoor Air (PCIA) in
designing the study and procuring the necessary
equipment. In the field, the Regional Renewable
Energy Service Centers of AEPC/ESAP particularly
Centre for Rural Technology (CRT), Namsaling
Community Development Center (NCDC) and
Resource Management and Rural Empowerment
Center (REMREC), and their staff were very
helpful.
__________________
* Corresponding Author: Tel: +977-1-4468641, E-mail:
enpho@mail.com.np
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