Effectiveness of a Household Energy Package in Improving Indoor Air Quality and Reducing Personal Exposures in Rural China

We evaluated whether an energy package comprising a low-polluting semigasifier cookstove with chimney, water heater, and pelletized biomass fuel would improve air pollution in China. We measured the stove use, 48-h air pollution exposures (PM2.5, black carbon), and kitchen concentrations (PM2.5, black carbon, carbon monoxide, nitrogen oxides) for 205 women, along with ambient PM2.5. Over half (n = 125) were offered the energy package after baseline assessment, forming treated and untreated groups, and we repeated the measurements up to 3 occasions over 18-months. Kitchen carbon monoxide did not change, and nitrogen oxides increased in summer but decreased in winter for both groups. Summer geometric mean exposures and kitchen concentrations of PM2.5 and black carbon decreased by 24-67% in women who received the energy package, but greater reductions (48-70%) were observed in untreated homes, likely due to increased use of gas stoves. After adjusting for differences in outdoor PM2.5, receiving the energy package was associated with decreased winter exposures to PM2.5, (-46%; 95% CI: -70, -2) and black carbon (-55%; -74, -25) and the summer increases were smaller (PM2.5: 8%; -22, 51 and black carbon: 37%; -12, 113). However, PM2.5 exposures remained 1.5-3 times higher than those of health-based international air pollution targets.