| Cooking and heating with solid fuels, such as dung, wood, agricultural residues, charcoal, and coal, remains the most widespread traditional source Of indoor air pollution exposure on a global scale. From a policy standpoint, although it is health effects that drive concern, it is too late by the time they occur to use disease rates as an indicator of the need for action in particular places. It is necessary to develop ways of determining pollution exposure, as an indicator of where the health effects are likely to be. The tiered exposure assessment framework presented in this dissertation offers a scaling up approach to assessing the magnitude of exposures to indoor air pollution associated with household solid fuel use. I examine how different exposure measures are linked, i.e., what economic parameters can be used to predict fuel-use patterns, and to what extent can fuel-use patterns in the community or household can be used to predict actual household air pollution concentrations.; Solid fuel use at a national level can be estimated using information on urbanization (percentage rural population), location within an oil-producing region (Middle Eastern Region EMR), income (log transformed GNP per capita), and per capita petroleum use. Around half of the world continues to rely on solid fuels as their primary source of household energy. Even with increasing income and urbanization taking place in many countries, indoor air pollution from solid fuel use will continue to be a problem over the next several decades. If the current levels of solid fuel use continue, young children (under five years of age) will experience over 610 million indoor air pollution related DALYs from lower respiratory infections over the next 10 years.; Using rural areas of three districts of Andhra Pradesh, India, as a case study, a model combining survey data from household questionnaires on housing and fuel characteristics to predict indoor air concentrations of particulate matter was developed. While solid fuel use is used as a proxy for particulate matter, the use of information on fuel use alone results in a great deal of misclassification of low concentration households. Addition of information on kitchen ventilation or kitchen type improved this misclassification considerably, with little impact on the classification of high concentration households.; In the future, if studies collect information on housing characteristics as well as information on solid fuel use, the misclassification of high concentration households cannot be eliminated, but at least minimized considerably. Employing the model should have the impact not only of increasing relative risk estimates but also improving study power. There must be a focus on access to solid fuels and access to improved ventilation. And perhaps most importantly, there are cost-effective ways to reduce exposures in the short term, until the longer-term goal of providing everyone with access to cleaner fuels can be attained. |
