Indoor Stoves Killing Millions in Third World, WHO Says

The mother stoked a crude stove with wood, broken bits of particleboard, chunks of coal--and a large, white plastic bag.

“The plastic bag gets very hot and will melt into coal,” Nontisha Langbell maintained, as the year-old daughter strapped to her back turned away to avoid the acrid plume. Children gathered around the stove that will cook the family meal of potatoes and gravy and keep them warm.

Just a few miles from this Johannesburg township, health and environmental officials meeting at the World Summit on Sustainable Development are seeking ways to break this daily ritual common in the Third World. Air pollutants trapped inside homes from stoves that burn coal, wood or cow dung have been linked to the premature deaths of 2.1 million women and children each year, the World Health Organization says.

“The No. 1 killer of children under the age of 5 is pneumonia, an acute respiratory illness,” said Yasmin von Schirnding, an epidemiologist with the WHO.

Officials at the international summit, who have spent days haggling over an environmental master plan, readily agreed that indoor air pollution is a global threat. The extensive document calls for providing cheap and cleaner energy to the poorest and most distant corners of the globe, “particularly to reduce dependence on traditional fuel sources for cooking and heating, which affect the health of women and children.”

Throughout the 10-day conference that began Monday, various groups and nations will roll out projects to tackle the problem, which experts say is only now receiving the attention it deserves.

“It’s a major priority of this summit,” said Nitin Desai, the gathering’s secretary-general. “It brings together the health of women and children and the environmental dimension of saving forests and reducing air pollution. I think it’s fixable if we put our minds on it.”

The Bush administration may announce as soon as today the U.S. government’s approach to solving the problem: the “Partnership for Clean Indoor Air,” a joint project with other nations, some nonprofit groups, including the Shell Foundation, and UC Berkeley’s Renewable and Appropriate Energy Laboratory.

Details are still being worked out. But the project aims at inspiring the development and local production of cheap, reliable and efficient stoves with vents to the outdoors, and lining up new kinds of fuel to replace coal, animal waste, straw and other crop refuse gleaned from the fields or nearby forests.

“It may mean substituting dung and straw and wood with methane from the landfill to power the village,” said John C. Beale, deputy assistant administrator of the U.S. Environmental Protection Agency. Other solutions include use of solar power or small canisters of cleaner-burning gas that wouldn’t require a hefty outlay of cash.

Kui-Nang Mak, chief of the United Nations’ energy program, said international groups have worked for the last decade on pilot projects to bring modern sources of energy to the 2 billion people who do without. These programs, he said, have taken on a greater urgency with widening recognition of the health implications.

Such a realization struck Mak two years ago when he revisited the small village in China where he spent his childhood in the late 1940s and early ‘50s. His mother died at a young age of cancer.

“I remember vividly,” he said. “She was carrying me on her back as a boy as she was cooking using rice stalks and branches from trees. There was smoke everywhere. It was awful. When I took my kids to my village two years ago, they were still doing it.”

More than half of the world’s households cook or heat using unprocessed solid fuels such as wood and agricultural waste. In India, about 75% of households use these fuels. Typically they are burned in open fires or primitive stoves, mostly in rooms that lack adequate ventilation or chimneys. Without ventilation, women and children around the home are regularly exposed to high concentrations of carbon monoxide, nitrogen dioxide, sulfur dioxide, formaldehyde and carcinogens such as benzene.

Kirk Smith of UC Berkeley’s School of Public Health studied such practices and concluded: “Half a million children and women die each year from indoor air pollution in India.”

China accounts for another heavy concentration of smoke-related illness and death. But such cooking practices also are widespread in sub-Saharan Africa and in many poor and rural areas of Latin America, including Guatemala, Nicaragua and Mexico.

Maged Younes, a WHO toxicologist, said it is not easy to pinpoint precisely how many of the 2.1 million premature deaths a year are caused exclusively by indoor air pollution and how much other factors--such as outdoor air pollution and poor nutrition--might play a role. Yet studies have shown repeatedly that children are much more prone to chest infections, coughs, colds and middle-ear infections if exposed to indoor smoke.

One study in the African nation of Gambia showed that children who were carried on their mothers’ backs were six times more likely to develop acute respiratory illness. Another study in Tanzania found that children younger than 5 who died of respiratory infection were almost three times more likely to have slept in a room with an open stove than healthy children of the same age.

Researchers have linked stillbirths, low birth weight, blindness and suppressed immune systems of newborns to indoor smoke exposure and carbon monoxide poisoning.

Von Schirnding, the WHO epidemiologist, once participated in a study of women and children in households in Soweto, another Johannesburg township. “We were surprised at the number of mothers who had no idea that air pollution had any role in their children’s respiratory illness,” she said.

Catherine Mvelase, director of the Alexandra Health Center, said that’s no longer the case. The women know, she said, but they have no money to buy expensive fuel or fancy stoves.

“We get a lot of children coming in with pneumonia,” she said. “If that weren’t enough, in the winter we get a lot of carbon monoxide poisoning.” That usually happens when mothers fall asleep and forget to take the brazier outside for the rest of the night.

“Carbon monoxide poisoning causes a lot of death here,” said Dr. Thabo Mnisi, who works at the clinic.

Langbell said she always remembers to take the brazier outside before she falls asleep. She is also careful to start the wood and scavenged charcoal burning outside, to let most of the smoke escape, before she takes the stove inside her 12-by-10-foot shack made mostly of corrugated iron.

“When I take it in the house, it makes me dizzy,” Langbell said, as she began to feed her five children. But she has her own folk remedy to fortify herself against the smoke. “I take a little bit of the coals and put it in a little bit of water and drink it a little bit and then it will not affect me.”