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

1. Nisha Malhotra, Vancouver School of Economics and International Relations, Faculty of Arts, University of British Columbia. Childhood Stunting Associated With Solid fuel: The Role of Cooking Practices

2. What Is the Problem? 70% of the Indian population relies on solid fuels Solid fuels produce toxic pollutants Serious health consequences

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

4. NFHS III (2005-2006) – Regional Differences

5. 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) pyreneextracted 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)

6. 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)

7. 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?

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

9. Pathway • Stunting: • Bone age retardation and bone maturation in children (Schlipkoter et al. 1986) • Impair early childhood skeletal growth (coal – Czech) (Ghosh et. al. 2011) • Intrauterine Growth Retardation Birth weight and length, head circumference, cognitive skills at age 5 -Poland - PAHs (Jedrychowski et. all. 2004)) ; PM and PAHs (Dejmek et. all. 2000) • endocrine disruptors: Benzo[a]pyrene and phenanthrene • Inhibit insulinlike growth factors (embryonic development) and epidermal growth factors in placenta • Hayakawa et. all. (2009; Guyda et. all. (1991)

10. 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) - Kyuet. al. 2009 • Biofuel Smoke-Height for age Z score; Stunting • Biofuel smoke in India-Mishra & Retherford2007 • Biofuel Smoke - Anaemia and Stunting

11. Safe and Unsafe Fuel

12. The Energy Ladder-Wealth Index

13. The Energy Ladder- can be replicated with NFHS3

14. Answer the Question Childhood Stunting associated with Solid Fuel? DATA • NFHS III (2005-2006) • Children – Less than 3 years of age (~ 21,000) Outcome • Stunting - Height-for-age • 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%) • Natural Gas/LPG (26.85%); Kerosene (3.45%)

15. 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

16. Results

17. Fuel Security?

18. Why ? Solid fuel is used even among the wealthiest quintile Wealth Index 1 2 3 4 5

19. New reports might shed some light on some of the reasons - Source: www.tribuneindia.com LPG Scarcity Consumers turn to traditional fuels Mahesh Sharma, MandiAhmedgarh, January 2011 A woman burns cow dung cakes and wood Schools turn to wood as LPG costs dear Arun Sharma Bindrakh village (Punjab), November 2012 Cooking Staff preparing midday meals in a School

20. Affordability and Access

21. 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?-Suggestive • Can this association be mitigated - cooking practices?

22. CookingEnvironment

23. A one room house – Let’s add windows and set a separate kitchen.

24. Two-sample Kolmogorov-Smirnov test Combined K-S: (D= 0.0628) & (P value =0.000)

25. Results

26. Results

27. Learn • 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

28. 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.