Childhood Stunting Associated With Solid fuel: The Role of Cooking Practices

Nisha Malhotra, Vancouver School of Economics and International Relations, Faculty of Arts, University of British Columbia.

Ravi Prakash Upadhyay, Senior Resident, Department of Community Medicine, Vardhman Mahavir Medical College, New Delhi, India

What Is the Problem?

70% of the Indian population relies on solid fuels

Solid fuels produce toxic pollutants

Serious health consequences

NFHS III (2005-2006) – Use of Solid Fuels

NFHS III (2005-2006) – Regional Differences

Solid Fuel Smoke: The Pollutants

Biofuel smoke contain a large number of harmful pollutants.

Particular matter (PM)/SPM carbon monoxide Nitrogen dioxide Polycyclicaromatic hydrocarbons (PAHs) Benzo (alpha) pyrene extracted from SPM 1,3-butadiene, Benzene, selenium, formaldehyde,

Styrene, etc. (Kandpal et al. 1994)

Coal in addition also releases some toxic elements. Sulfur dioxide (SO2), Fluorine (F), Mercury (Hg), Arsenic

(As), Lead (Pb)

Health Consequences

Anaemia ARIs & Respiratory Illnesses (Tuberculosis) Cancer: Lung/Bladder/Kidney/Pancreatic Immunodeficiency disorders Cognitive decline

Ref: Martorell et al. (1996) ; Haas et al. (1995); Erikson et al (2001); Pelletier (1994)

What Is the Problem?

70% of the Indian population relies on solid fuels.

Solid fuels produce pollutants with serious health consequences.

Our Question Do they also lead to Childhood

Stunting?

Stunting Consequences

Higher likelihood of contracting illnesses, lower recovery rates lower likelihood of survival

▪ Future intellect▪ Future health status

Percentage of women with short stature varies strikingly according to the degree of stunting at 3 years of age

Martorell et al. (1992)▪ Reproductive performance▪ Predicts child’s birth size and survival

Martorell et al. (1996) ; Haas et al. (1995); Erikson et al (2001); Pelletier (1994)

Pathway

Stunting: Bone age retardation and bone maturation in children - F.R.G

region (Schlipkoter et al. 1986) Impair early childhood skeletal growth (coal – Czech) (Ghosh et.

al. 2011)

Intrauterine Growth RetardationBirth weight and birth length, head circumference, cognitive skills at age 5-Poland - PAHs (Jedrychowski et. all. 2004)) ; PM and PAHs (Dejmek et. all. 2000)

▪ Benzo[a]pyrene and phenanthrene recognized as endocrine disruptors.

▪ Inhibit insulinlike growth factors (embryonic development) and epidermal growth factors in placenta ▪ Hayakawa et. all. (2009; Guyda et. all. (1991)

Existing Evidence-Stunting Indoor Coal Use (Czech Republic) - Smith et. all

2005 Coal combustion Heating – Height for Age Z

score

Biofuel smoke in 7 developing countries (Cambodia, Nepal Dominican Republic, Haiti, Jordan,

Moldova, Namibia) - Kyu et. al. 2009

Biofuel Smoke-Height for age Z score; Stunting

Biofuel smoke in India-Mishra & Retherford 2007

Biofuel Smoke - Anaemia and Stunting

Safe and Unsafe Fuel

The Energy Ladder-Wealth Index

The Energy Ladder

NFHS III (2005-2006) – Use of Solid Fuels

NFHS III (2005-2006) – Regional Differences

Answer the Question

DATA NFHS III (2005-2006) Children – Less than 3 years of age (~ 21,000)Outcome Stunting - Standard indices of physical growth

that describe the nutritional status: Height-for-age (stunting)

Height: Height by Age Z score (HAZ )Exposure Solid Fuel- Coal/Charcoal (2.25%); Wood (50%);

Crop Waste & shrubs (6.84%) ; Animal Dung (9.8%)

Reference – Natural Gas/LPG (26.85%); Kerosene (3.45%)

Childhood Stunting associated with Solid Fuel?

Answer the Question

Control Variables: Wealth Index (D.V); Religion Dummies Diet: Breastfeeding; Other than BM; 4 Food

Groups; Iodine Salt City Density: Mega City, Large City D.V. Maternal Characteristic: Education; Work

status; Age; Autonomy (Decision to access health care), Mother Smokes; Media Exposure; Maternal Height

Child Demography: Male; Birth Order; Twin Birth; Age

Sanitation: Open Defecation; Water Treatment

Cooking Environment: Inside, Separate Kitchen, Window

Results

Wealth Index

Why?

Source: www.tribuneindia.com

LPG Scarcity Consumers turn to traditional fuels Mahesh Sharma, Mandi Ahmedgarh, January 2011

A woman burns cow dung cakes and wood

Schools turn to wood as LPG costs dear Arun SharmaBindrakh village (Punjab), November 2012

Cooking Staff preparing midday meals in a School

Affordability and Access

Stunting Causes

What Is the Problem?

70% of the Indian population relies on solid fuels.

Solid fuels produce pollutants with serious health consequences.

Our Question Do they also lead to Childhood Stunting?-

SuggestiveCan this association be mitigated -

cooking practices?

Cooking Environment

Add Drawback

Much of the research has centered on whether the stoves reduce IAP. For example, McCracken and Smith (1998), Ezzati and Kammen (2002), Ezzati, Saleh, and Kammen (2000), Ezzati, Mbinda, and Kammen (2000), and Albalak et al. (2001) have all found that various types of improved cooking stoves have resulted in reductions of toxic pollutants

S

Inside

No windows

No-separate Kitchen

Among those that live in HH using Solid Fuel– 33% live in these conditions

24% of children in the sample – live in these type of houses

Ghar - House : 4962

A one room house with no Windows

Combined K-S: (D= 0.0628) & (P value =0.000)

Two-sample Kolmogorov-Smirnov test

Results

Results

• Stunting is shown to be associated with the use of Solid Fuels• This association can be mitigated by following safer cooking practices

• Outside • Separate location for a kitchen• Ventilation – Window

Learn

Public health perspective

Efficient Cooking Stoves Replacing solid fuel with cleaner fuels

Substitution across solid fuels?

Ensuring proper ventilation We need a greater discussion on cooking

practices that can reduce “Pollution concentrations”- cumulative exposure.