Air Quality, Atmosphere & Health

, Volume 10, Issue 7, pp 809–819 | Cite as

Evaluation of short-term health effects among rural women and reduction in household air pollution due to improved cooking stoves: quasi experimental study

  • Tanzil Jamali
  • Zafar FatmiEmail author
  • Afshan Shahid
  • Aneeta Khoso
  • Muhammad Masood Kadir
  • Nalini Sathiakumar


An improved efficient stove is the mainstay intervention to reduce household air pollution (HAP) associated with biomass fuel use. It potentially addresses the adverse health outcomes by reducing smoke exposure, fuel consumption, and cooking time. This study evaluated two stove intervention programs and compared them for health effects (respiratory and eye symptoms, lung function, blood pressure and burns) among women who were the main cook of the household. A total of 83 and 134 improved and 209 and 179 traditional stoves in Sindh and Punjab provinces of Pakistan, respectively, were evaluated after 3 months of installation, during June to September, 2014. Twenty-four-hour particulate matter (<2.5 μm) (PM2.5) and carbon monoxide (CO) levels were measured in the kitchens in a subsample (n = 40). Multivariate logistic regression and general linear model were used to determine the health impact of improved stoves among women. PM2.5 and CO levels were significantly less in improved stove kitchens. Among women in Sindh program, significantly less cough (aRR 0.27, CI 0.20, 0.38), phlegm (aRR 0.27, CI 0.18, 0.40), shortness of breath (aRR 0.16, CI 0.11, 0.22), chest tightness (aRR 0.23, CI 0.17, 0.31), attack of asthma (aRR 0.33, CI 0.22, 0.49) (p < 0.001), sandy eyes (aRR 0.63, CI 0.47, 0.97), and itching in eyes (aRR 0.62, CI 0.41, 0.95 (p < 0.050) were present. While in Punjab program, risk reduction for phlegm (aRR 0.60, CI 0.45, 0.81) and protection from burns (aRR 0.56, CI 0.34, 0.91) were observed among women. Mean peak expiratory flow was higher among women using improved stoves in Sindh program (31.58, CI 17.90, 45.25 L/min) only. Overall, the positive health impact was greater among those women using closed kitchens. Interventions with improved stoves can have favorable health impact among women. However, variations in health gains were noted among the two programs, as well as greater impact among women using closed kitchen.


Intervention Stove Health impact Women Pakistan 



We are thankful to Ms. Zakia Tabassum and Mr. Mohammad Jamil for the logistic support for the project and Mr. Nayab Ali Shah and Ms. Rukhsana Sabir for data collection and management. The work was supported by Supplementary grant of International Training and Research in Environmental and Occupational Health (no. 3D43TW005750-10S1) from the Fogarty International Centre at the National Institute of Health, awarded to University of Alabama at Birmingham, AL, USA.

Compliance with ethical standards

Ethical considerations

Approval was taken from the Ethics Review Committee of the Aga Khan University, Karachi. Written informed consent was taken from all participants before the questionnaire administration and procedures.

Competing interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Tanzil Jamali
    • 1
  • Zafar Fatmi
    • 2
    Email author
  • Afshan Shahid
    • 3
  • Aneeta Khoso
    • 4
  • Muhammad Masood Kadir
    • 2
  • Nalini Sathiakumar
    • 5
  1. 1.Department of Community Health SciencesJinnah Medical and Dental CollegeKarachiPakistan
  2. 2.Department of Community Health SciencesAga Khan UniversityKarachiPakistan
  3. 3.Department of Community MedicineFoundation UniversityIslamabadPakistan
  4. 4.Department of Community Health SciencesLiaquat National Hospital & Medical CollegeKarachiPakistan
  5. 5.Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamUSA

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