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Childhood Pneumonia and Diarrhea. Lancet, April 12, 2013

Summary

The Lancet Series on Childhood Pneumonia and Diarrhoea, led by Aga Khan University, Pakistan, provides evidence for integrated control efforts for childhood pneumonia and diarrhoea. The first paper assesses the global burden of these two illnesses, comparing and contrasting them, and includes new estimates of severe disease and updated mortality estimates for 2011. Findings from the second paper show that a set of highly cost-effective interventions can prevent most diarrhoea deaths and nearly two thirds of pneumonia deaths by 2025, if delivered at scale. Furthermore, the paper estimates what the cost of scale up will be. The third paper presents the results of consultations with several hundred frontline workers in high-burden countries and explores the barriers and enablers they face in dealing with these two diseases and potential ways forward. The final paper represents a call to action and discusses the global and country-level remedies needed to eliminate preventable deaths from these illnesses by 2025.

Papers

Global burden of childhood diarrhoea and pneumonia

Christa L Fischer Walker, Igor Rudan, Li Liu, Harish Nair, Evropi Theodoratou, Zulfiqar A Bhutta, Katherine L O’Brien, Harry Campbell, Robert E Black

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Interventions to address deaths from childhood diarrhoea and pneumonia equitably: what works and at what cost?

Zulfiqar A Bhutta, Jai K Das, Neff Walker, Arjumand Rizvi, Harry Campbell, Igor Rudan, Robert E Black, for The Lancet Diarrhoea and Pneumonia Interventions Study Group

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Bottlenecks, barriers, and solutions: results from multi-country consultations focused on reduction of childhood diarrhoea and pneumonia deaths

Christopher J Gill, Mark Young, Kate Schroder, Liliana Carvajal-Velez, Marion McNabb, Samira Aboubaker, Shamim Qazi, Zulfiqar A Bhutta

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Ending of preventable deaths from pneumonia and diarrhoea: an achievable goal

Mickey Chopra, Elizabeth Mason, John Borrazzo, Harry Campbell, Igor Rudan, Li Liu, Robert E Black, Zulfiqar A Bhutta

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Three Steps to Stop Kitchen Smoke from Killing More Women and Children | Source: S. VIJAY IYER, World Bank, Apr 3, 2013 |

I’m back from the 2013 Clean Cooking Forum in Phnom Penh, and impressed with the insights shared by practitioners and household fuel experts from around the world. It’s good to see clean cooking at the center of the global development agenda. But to live up to expectations, we’ll need to keep working hard.

Growing up in the 1960s in a household of modest means in India, I saw my mother’s acute distress as she cooked our meals on the floor of our small kitchen — using sawdust, charcoal or wood. She suffered from chronic respiratory illness and died well before her time. Today, 2.8 billion people, mostly women, still cook as my mother did, using traditional stoves and fuels. We have to change that reality. With such tremendous attention on clean cooking, what can we do to ensure a future where women (and children) do not die because they cook meals for their families?

A lot is happening in this space. The passion and commitment of entrepreneurs, government agencies and non-government actors at the Forum was inspiring.  We are making steady progress, but the challenge is huge and we need to get on a steeper results curve. I suggested that we need “accelerators” for faster results. These accelerators, or “game changers”, are actions we can take to address the most critical barriers and drastically shift from business-as-usual. 

Three such accelerators emerged as really important ones in the discussions during the conference:

1)    Coordinate multiple sectors and government bodies to create enabling conditions for clean cooking interventions at the national, city and local levels.

2)    Bridge the gap between those seeking finance and those able to provide it– foundations and non-government agencies, local financial institutions and equity investors.  Often, we need to bundle smaller projects to remove obstacles such as transaction costs and lack of access to willing financiers. This is also true for gaining access to carbon finance opportunities in this sector, often too small and dispersed to interest carbon credit buyers.

3)    Create a body of knowledge, best practice and market information that is available as a public good to potential entrepreneurs and market makers, and that helps reduce barriers to their entry. In this area, the UN Practitioners Network, the Global Alliance for Clean Cookstoves and the Sustainable Energy for All Initiative can play important roles.

The World Bank’s recent report One Goal, Two Paths: Achieving Universal Access to Modern Energy in East Asia and the Pacific illustrates how some of these accelerators have transformed the path to universal modern cooking solutions in East Asia Pacific (EAP) countries  such as China, Indonesia, Thailand, Cambodia, the Philippines, and Vietnam.

What do you think of when you hear— China, Thailand, Cambodia and Indonesia? Fastest economic growth in the last decade? True. But did you know that half of the East Asia/Pacific countries’ population—one billion people—still relies on solid fuels for cooking and heating? This causes over 600,000 premature deaths each year in the region.

A persistent challenge, as I mentioned in my previous blog post, is that clean cooking remains a “poor person’s problem.” Few business people see a viable market in it. So selling affordable clean cooking fuels (natural gas, liquefied petroleum gas, and biogas) and improved cookstoves needs a financing accelerator.

The One Goal, Two Paths report reviews experience in the EAP countries, and recommends collaborative action by governments, donors, the private sector and NGOs. The report’s suggested “path” has the EAP countries achieving the Sustainable Energy for All objective of universal access to modern cooking solutions by 2030.

The agenda of the “path”:

  • Promote clean and efficient cookstoves by making these affordable and profitable

China’s National Improved Stoves Program, a government initiative, distributed over 100 million stoves country-wide. Cambodia’s NGO-led program trained traditional stove makers to produce improved stoves and integrated them into the supply chain. One million improved stoves with guaranteed service and quality were sold in Cambodia from 2003 to 2010.

  • Expand liquefied petroleum gas (LPG) usageLPG is a clean, affordable household fuel, and especially efficient in densely populated settings. Policies that encourage faster adoption of LPG are recommended. By granting privileges to LPG suppliers/distributors and keeping LPG’s price low, Thailand’s LPG promotion program has boosted LPG use by 10% a year since 1990.
  • Develop biogas energy systems

Biogas energy systems that transform biomass into clean burning gas for cooking have huge potential. China has about 25 million biogas systems in place following its National Rural Biogas Program. Complementing China’s national program, the World Bank recently financed an Eco-farming Project that installed 33,000 biogas digesters in households. These digesters generate gas from animal waste.

The Bank Group’s East Asia and Pacific Clean Stoves Initiative, introduced at the Clean Cooking Forum, provides policy support, capacity building, and knowledge sharing for China, Indonesia, Mongolia, and Laos PDR. It has already published several important studies.

With concerted action and knowledge of the game changers, EAP countries’ household clean energy access could soon match their outstanding economic performance. I’m convinced that the world can learn from their experience and work together. Then, we’ll make real, large-scale differences in the lives of the two-fifths of humanity still tied to traditional stoves and fuels.

Related Studies from East Asia Pacific Clean Stoves Initiative

Cleaner cooking solutions to achieve health, climate, and economic co-benefits. Environ. Sci. Technol., DOI: 10.1021/es304942e; April 3, 2013

Susan Casper Anenberg , Kalpana Balakrishnan , James J. Jetter , Omar Masera , Sumi Mehta , Jacob Moss , and V. Ramanathan

Abstract – Nearly half the world’s population must rely on solid fuels such as biomass (wood, charcoal, agricultural residues, and animal dung) and coal for household energy, burning them in inefficient open fires and stoves with inadequate ventilation. Household solid fuel combustion is associated with four million premature deaths annually; contributes to forest degradation, loss of habitat and biodiversity, and climate change; and hinders social and economic progress as women and children spend hours every day collecting fuel.

Several recent studies, as well as key emerging national and international efforts, are making progress towards enabling wide-scale household adoption of cleaner and more efficient stoves and fuels. While significant challenges remain, these efforts offer considerable promise to save lives, improve forest sustainability, slow climate change, and empower women around the world.

Dangers of air pollution worse than previously thought, UN health agency warns

8 April 2013 – The dangers posed by air pollution are far larger than previously thought, the United Nations World Health Organization (WHO) has announced, as it renewed its call for rapid global action in reducing what it described as one of “the greatest hazards to human health.”

The warning came at the latest meeting of the UN Environment Programme’s (UNEP) Climate and Clean Air Coalition (CCAC), held in Paris, France, over the weekend, where health advocates were told that indoor air pollution had become the leading risk factor for “burden of disease” in South Asia while it was ranked second in Eastern, Central and Western Sub-Saharan Africa and third in Southeast Asia.

“The estimations we have now tell us there are 3.5 million premature deaths every year caused by household air pollution, and 3.3 million death every year caused by outdoor air pollution,” Dr. Maria Neira, the WHO’s Director of Public Health and Environment, told the CCAC meeting.

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Bonn International Cooking Energy Forum: Progress towards the “100 million by 2020” goal | Bonn, GermanyJune 26-28, 2013

During the last two years, the topic of clean cooking has gained tremendous momentum on the international agenda with the 2010 creation of the Global Alliance for Clean Cookstoves. The Alliance seeks to enable 100 million households to adopt clean cooking solutions by the year 2020. More efficient and alternative cooking energy systems are under continuous development – however, access to affordable, sustainable and clean cooking energy for two thirds of the world’s population still remains a challenge. Therefore, the German Federal Ministry of Economic Cooperation and Development and the Global Alliance for Clean Cookstoves invite you to the Bonn International Cooking Energy Forum. The conference will build upon the discussions held at the March 2013 International Clean Cooking Forum in Cambodia.

Objective of the Forum
The Forum intends to arrive at a set of best practice recommendations to strengthen the commitment of European partners and build new partnerships with and within the Global Alliance for Clean Cookstoves.
Around 150 representatives from relevant ministries, the private sector and non-governmental organizations in European and developing countries, as well as implementing agencies are invited to develop recommendations on how best to advance and harmonize their contributions to reach the “100 million by 2020” goal by boosting
sustainable markets for modern cooking energy along the entire value chain from fuel production to energy use.

This issue features new data sources and studies/reports on the health impacts of household air pollution (HAP). Included are 2013 studies on HAP and the impact on blood pressure, tuberculosis, respiratory diseases, stillbirths and other health issues. Also featured is a new community of practice on the Health Impacts of Household Air Pollution that  is facilitated by WASHplus and the Global Alliance for Clean Cookstoves. Please contact WASHplus if you have other HAP and health-related studies or resources to add to future issues on this topic.

COMMUNITY OF PRACTICE

  • Health Impacts of Household Air Pollution Community of Practice(Link)
    This new community of practice, hosted on the community space of the Global Alliance for Clean Cookstoves and facilitated by the USAID WASHplus project, was created to support information sharing and discussions on the health impacts of household air pollution. Participation is open to all, but registration on the Alliance website is required to sign up.

DATA SOURCES

  • Children: Household Air Pollution by Country. Global Observatory Health Data Repository, World Health Organization. (Link)
    Data on child deaths, by country, due to indoor air pollution.
  • Household Air Pollution. Global Observatory Health Data Repository, World Health Organization. (Link)
    Data on: Burden of Disease; Population using solid fuels; Solid cooking fuels; Non-solid cooking fuels

GENERAL/OVERVIEW STUDIES

  • Energy and Human Health. Annu. Rev. Public Health, (34) 2013. K Smith. (Full text)
    Energy use is central to human society and provides many health benefits, but each source of energy entails some health risks. This article reviews the health impacts of each major source of energy, focusing on those with major implications for the burden of disease globally. The biggest health impacts accrue to the harvesting and burning of solid fuels, coal and biomass, mainly in the form of occupational health risks and household and general ambient air pollution.
  • The Global Burden of Air Pollution on Mortality: The Need to Include Exposure to Household Biomass Fuel–Derived ParticulatesEnv Health Perspec, Mar 2013. J Rylance, Liverpool School of Tropical Medicine. (Full text)
    Interventions that have significantly reduced exposure to HAP improve health outcomes and may reduce mortality. However, there is a lack robust, specific and field-ready biomarkers to identify populations at greatest risk, and to monitor the effectiveness of interventions. New scientific approaches are urgently needed to develop biomarkers of human exposure that accurately reflect exposure or effect.
  • Kirk Smith Presentation on the Health Impacts of Household Air Pollution at the Clean Cooking Forum, 2013(Video)
    Kirk Smith, of the University of California at Berkeley, speaks at the Clean Cooking Forum 2013 in Phnom Penh, Cambodia. The goal of the Forum is to further a market-based approach to the global adoption of clean cooking solutions, and drive innovations in research, market development, standards and testing, project finance, behavior change, awareness-raising, and policy change.
  • Tackling the Health Burden from Household Air Pollution: Development and Implementation of New WHO GuidelinesAir Quality and Climate Change, Feb 2013. N Bruce. (Abstract)
    Building on previous air quality guidelines, WHO is developing new guidelines focused on household fuel combustion, covering cooking, heating and lighting, and although global, the key focus is low and middle income countries reflecting the distribution of disease burden. These guidelines will include reviews of a wide range of evidence including fuel use in homes, emissions from stoves and lighting, household air pollution and exposure levels experienced by populations, health risks, impacts of interventions on HAP and exposure, and also key factors influencing sustainable and equitable adoption of improved stoves and cleaner fuels.

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Adult lung cancer in southern Africa: epidemiology and aetiology. African Journal of Respiratory Medicine Vol 8 No 2 March 2013.

J Sheridan and A M Collins

This article aims to review current literature on the burden and causes of lung cancer in southern Africa and highlight areas that may require intervention or further research.

Conclusion
In southern Africa, while the incidence and mortality rates are currently relatively low, the increasing use of
tobacco has yet to show its full effect. When equivalent smoking rates occurred in the UK, the incidence of cancer was 80–100 per 100000, worryingly less than that of southern Africa at present. Five-year survival rates for lung cancer are low; 14% in one part of southern Africa compared with 17.1% in the UK. To prevent rates of lung cancer in southern Africa increasing to those currently seen in developed countries, research and preventative measures in many areas need to be urgently addressed with high quality studies to explore the relationship between HIV and the risk of lung cancer needed along with public health initiatives to:

  • Reduce outdoor air pollution by promotion of public transport and regulation of the industrial pollutant emission;
  • Reduceindoor air pollution by promotion of the use of cleaner household fuels and improved cooking stoves and household ventilation;
  • Reduce tobacco use by higher taxes on cigarettes, increased education on the consequences of smoking, banning aggressive tobacco company marketing techniques, no smoking permitted in public areas, and increased smoking cessation advice and services;
  • Reduceoccupationalexposure by improved occupational health and increased government regulation on the exposure to carcinogens in the workplace.

Dear Colleagues,

I’m pleased to share with you that the United States Agency for International Development (USAID) and Winrock International are soliciting applications for a 24-month grant award or awards to strengthen the private sector commercial distribution of fuel-efficient biomass cookstoves in Kenya. Winrock anticipates awarding one or more grants, individually ranging in size from $250,000 (minimum) to $750,000 (maximum).

This Request for Applications (RFA) encourages non-traditional entrants into the sector  in order to increase collaboration and partnerships between cookstove designers/enterprises and entities with expertise in retail, distribution, logistics, and financing. Winrock encourages applicants to propose innovative solutions and partnerships to overcome distribution and financing bottlenecks in the cookstove arena.

This RFA is open to all groups that meet the eligibility requirements set forth in section 3 Applicant Eligibility of the attached RFA. Organizations interested in this funding opportunity should submit to Winrock an application by Friday, April 26, 2013, 5pm Eastern Daylight Time (EDT) following the guidelines set forth in section 5 Submission Instructions noted in the RFA. Only applicants that meet the eligibility criteria and follow the submission instructions will be reviewed.

If you seek clarification on the information included in this document, please send questions to Katie Gross, kgross@winrock.org and copy Elisa Derby, ederby@winrock.org before April 3, 2013, 5pm Eastern Daylight Time (EDT) with the subject line “Questions on Kenya Cookstoves Competition.” Winrock will not provide individual responses, but all submitted questions will be compiled and responded to publicly. For that reason, please do not include any proprietary or confidential information in your questions about this solicitation.

Please note that the attached solicitation is also posted online here: http://www.relwa.org/KenyaCookstovesRFA.  Please feel free to forward this announcement further.

Best regards,

Elisa Derby on behalf of Katie Gross

Elisa Derby Senior Program Officer

Winrock International | www.winrock.org

office 617.524.0466 | fax 612.233.2394 | e-mail ederby@winrock.org

India Cookstoves and Fuels Market Assessment, 2013.

Global Alliance for Clean Cookstoves.

The “India Cookstoves and Fuels Market Assessment” was conducted by Dalberg Global Development Advisors on behalf of the Global Alliance for Clean Cookstoves (“the Alliance”). It is one of a series of country assessments completed by the Alliance to:

  • Enhance sector market intelligence and knowledge;
  • Contribute to a process leading to the Alliance deciding which regions/countries it will prioritize; and
  • Support the Alliance in developing its strategy and approach to country level interventions.

This document is meant to provide a snapshot of the cookstoves sector in India in terms of the overall trends in supply and demand, and emerging opportunities and challenges. It can and should be used in conjunction with a number of research papers, consumer surveys and other sources (most published on the Alliance’s website) to enhance the sector’s understanding of the market.

Environ Health Perspect. 2013 Mar 19.

Acute Lower Respiratory Infection in Childhood and Household Fuel Use in Bhaktapur, Nepal.

Bates MN, Chandyo RK, Valentiner-Branth P, Pokhrel AK, Mathisen M, Basnet S, Shrestha PS, Strand TA, Smith KR. Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, USA.

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BACKGROUND: Globally, solid fuels are used by about 3 billion people for cooking and heating. These fuels have been associated with many health effects, including acute lower respiratory infection (ALRI) in young children. Nepal has a high prevalence of use of biomass for cooking and heating.

OBJECTIVE: This case-control study was conducted among a population in the Bhaktapur municipality, Nepal, with the objectives of investigating the relationships of cookfuel type to ALRI in young children.

METHODS: Cases with ALRI and age-matched controls were enrolled from an open cohort of children 2-35 months old, under active monthly surveillance for ALRI. A questionnaire was used to obtain information on family characteristics, including household cooking and heating appliances and fuels. The main analysis was carried out using conditional logistic regression. Population-attributable fractions (PAF) for stove types were calculated.

RESULTS: 917 children (452 cases and 465 controls) were recruited into the study. Relative to use of electricity for cooking, ALRI was increased in association with any use of biomass stoves (OR = 1.93; 95% CI: 1.24, 2.98), kerosene stoves (OR = 1.87; 95% CI: 1.24, 2.83), gas stoves (OR = 1.62; 95% CI: 1.05, 2.50). Use of wood, kerosene or coal heating was also associated with ALRI (OR = 1.45, 95% CI: 0.97, 2.14), compared with no heating or electricity or gas heating. PAFs for ALRI were 18.0% (95% CI: 8.1, 26.9%) and 18.7% (95% CI: 8.4%-27.8%), for biomass and kerosene stoves, respectively.

CONCLUSIONS: The study supports previous reports indicating that use of biomass as a household fuel is a risk factor for ALRI, and provides new evidence that use of kerosene for cooking may also be a risk factor for ALRI in young children.