A Systematic Review and Meta-Analysis Assessing the Impact of Improved Cookstove Technology Trials (ICTs) on Household Air Pollution and Human Health in Sub-Saharan Africa.

Abstract

A major contributor to household air pollution (HAP) in sub-Saharan Africa (SSA) is unclean cooking fuel. Improved cookstove technology (ICT) interventions have been promoted as a solution, but their impacts on health are unclear. Our aim is to conduct a systematic review to explore the impacts of ICT interventions on health outcomes in SSA. We conducted a systematic review, following PRISMA guidelines, on ICT interventions in SSA from 2000-present. We performed this search in MEDLINE, PubMed, Web of Science, Web of Science CABI, and EMBASE via ProQuest. Two reviewers assessed each study using predefined inclusion/exclusion criteria and extracted data. We evaluated each study on participant selection, exposure assessment, control comparability, outcomes, analyses, and biases. From 4,461 articles, k = 23 (n = 31,261 individuals) articles described results of ICT interventions on health outcomes. Pooled mean exposure estimates for fine particulate matter (PM2.5) in control and intervention groups were 102.88 µg/m3 (95% confidence interval [CI]I: 52.63, 153.14; I2 96.9%) and 101.76 µg/m3 (95%CI: 57.47, 146.06; I2 98.2%), respectively. Estimates for pooled mean carbon monoxide (CO) were 2.40 ppm (95% CI: 0, 8.33; I2 99.0%) and 1.66 ppm (0, 4.91; I2 98.5%) respectively. Of health outcomes, 19.4% were reported as significantly different between control and intervention groups. There is mixed evidence that ICT interventions influence health outcomes due to heterogeneity in study designs, sample size, stove stacking, etc. ICT interventions may decrease HAP, but other sources of air pollutant exposure are not addressed by improved cookstoves.