Use of biomass briquettes: its effect on household air pollution and on pneumococcal nasopharyngeal carriage in Gambian women and young children. A randomized controlled trial

Pneumonia is one of the leading causes of death in children <5 years, accounting for 1 million of the 5.9 million children <5 who died in 2015, of which more than 98% occurred in low-resource countries. Pneumococcal pneumonia, caused by the bacteria Streptococcus pneumoniae (pneumococcus), is responsible for 30-50% of pneumonia related deaths [3] . Pneumococcal carriage is a precondition for developing pneumococcal pneumonia. Ten of the most common serotypes are estimated to account for 62% of invasive disease worldwide. Exposure to household air pollution (HAP) from solid fuels has been shown to be a risk factor for developing pneumonia. In 2012, over 4 million people died prematurely from illnesses attributed to HAP exposure from cooking with solid fuels, estimated to contribute 2.7% to the global burden of disease and 36% to contributing risk factors for acute respiratory infections globally. In Africa, 94% of rural populations and 73% of urban populations use solid fuels as their primary source of energy. To better understand the relationship between pneumococcal carriage and HAP, including possible interventions to reduce HAP in cookhouses, an intervention study using biomass briquettes and alternative biomass cookstoves was conducted in rural Gambia among women and young children. HAP levels were measured and nasopharyngeal swabs samples were collected to measure the effect that potential reduced HAP pollutant levels had on pneumococcal carriage. This study also assessed the cost of the intervention and whether participants would likely use such an intervention in lieu of the 3-stone stove and wood. No difference in HAP levels between the two cooking methods was found in this study, nor a difference in pneumococcal carriage. Further research needs to be conducted to explore cleaner, more efficient, and less costly methods of cooking in low- and middle-income nations.