Objectives Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs).
Design Systematic review and meta-analysis of (quasi-)experimental studies identified from 13 electronic databases (last update: 6 April 2018), reference and citation searches and via expert consultation.
Participants Women and children
Interventions Improved biomass cookstoves
Main outcome measures Low birth weight (LBW), preterm birth, perinatal mortality, paediatric acute respiratory infections (ARIs) and COPD among women.
Results We identified 53 eligible studies, including 24 that met prespecified design criteria. Improved cookstoves had no demonstrable impact on paediatric lower ARIs (three studies; 11 560 children; incidence rate ratio (IRR)=1.02 (95% CI 0.84 to 1.24)), severe pneumonia (two studies; 11 061 children; IRR=0.88 (95% CI 0.39 to 2.01)), LBW (one study; 174 babies; OR=0.74 (95% CI 0.33 to 1.66)) or miscarriages, stillbirths and infant mortality (one study; 1176 babies; risk ratio (RR) change=15% (95% CI –13 to 43)). No (quasi-)experimental studies assessed preterm birth or COPD. In observational studies, improved cookstoves were associated with a significant reduction in COPD among women: two studies, 9757 participants; RR=0.74 (95% CI 0.61 to 0.90). Reductions in cough (four studies, 1779 participants; RR=0.72 (95% CI 0.60 to 0.87)), phlegm (four studies, 1779 participants; RR=0.65 (95% CI 0.52 to 0.80)), wheezing/breathing difficulty (four studies; 1779 participants; RR=0.41 (95% CI 0.29 to 0.59)) and conjunctivitis (three studies, 892 participants; RR=0.58 (95% CI 0.43 to 0.78)) were observed among women.
Conclusion Improved cookstoves provide respiratory and ocular symptom reduction and may reduce COPD risk among women, but had no demonstrable child health impact.
Registration PROSPERO: CRD42016033075
- COPD epidemiology
- paediatric lung disaese
- clinical epidemiology
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MT and PAWN contributed equally.
Contributors MT and PAWN performed electronic searches and study selection, extracted data and performed risk-of-bias assessment for (quasi-)experimental studies and wrote the first version of the manuscript. EAB and JFK extracted data and performed risk-of-bias assessment for longitudinal observational studies and assisted in updating electronic searches and study selection. TF checked the extracted data and performed meta-analyses. GRB co-wrote the manuscript. OCPvS and JVB supervised the various stages of the study and writing of the manuscript. All authors were involved in designing the study and interpreting the findings and have read and approved the final version of the manuscript.
Funding GRB is supported by an Intermediate Fellowship by the Wellcome Trust DBT India Alliance (Clinical and Public Health Research Fellowships). JVB is supported by fellowships from the Netherlands Lung Foundation (4.2.14.063JO) and the Erasmus MC.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Full data set and statistical codes are available from the corresponding author.
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