Sustainable Household Energy Adoption in Rwanda (SHEAR): Promoting Rural Health with Solar and Natural Gas

摘要 暴露在使用传统能源造成的家庭空气污染中是发病率的十大风险因素 以及全球范围内的死亡率。家庭中传统能源的排放会造成不健康的水平 家庭空气污染，这个问题无处不在。大约有30亿人依赖木头等燃料， 木炭和煤油，以支持烹饪、取暖和照明等需求。约80%的 卢旺达人使用这种燃料，使暴露在家庭空气污染中成为导致 这个国家的疾病负担。在发达国家，暴露于家庭空气污染也是一个问题 世界。近3000万美国人使用固体燃料作为主要的取暖能源。 近50年来对更清洁的家用能源技术的研究表明，在全球范围内 影响，由于经济、文化和技术障碍的组合，阻碍了获取和使用 清洁能源。另一个限制是，到目前为止，几乎所有的家庭能源干预都集中在 用更现代的技术取代单一的能源(例如，仅仅取代烹饪，或者仅仅是照明)。 我们建议通过进行一项随机对照试验来解决这些问题，该试验(1)侧重于 家庭能源(2)在一个表明愿意使用替代能源的国家，(3)通过形成一个公众- 促进以消费者为中心和市场可持续的技术解决方案的私人伙伴关系，(4) 通过调查临床上可操作并与发病率/死亡率密切相关的结果指标，以及 (5)开发可向决策者提供成本效益信息的项目产出。我们假设 全屋能源干预(用更清洁的能源取代家庭内所有原始形式的能源， 现代形式)将显著减少卢旺达农村地区的家庭空气污染和健康效益 家。随机对照试验将取代传统形式的家庭能源(生物质用于烹饪 在卢旺达农村地区使用太阳能和液化石油气炉灶)。参与者将 跟踪3年，反复测量家庭空气污染暴露(24小时细颗粒物 物质和黑碳)、能源使用和健康。主要健康终结点将包括 成年男女与儿童肺功能发育；次要健康终点包括血压 儿童和成人的肺功能变化。 这项研究的长期目标是增加对健康影响的临床知识基础 家庭空气污染，以证明全屋能源干预将产生有意义的 卢旺达农村家庭的家庭空气污染减少和健康益处，以阐明两者之间的关系 燃料补贴水平和家庭空气污染暴露之间的关系，并展示可扩展的解决方案 家庭空气污染疾病负担可以通过公共-私营-政府伙伴关系实现。

Abstract Exposure to household air pollution from the use of traditional energy sources is a top-ten risk factor for morbidity and mortality worldwide. Emissions from traditional energy sources in the home create unhealthy levels of household air pollution and the issue is pervasive. Approximately 3 billion people rely on fuels like wood, charcoal, and kerosene to support needs such as cooking, heating, and lighting. Approximately 80% of the population in Rwanda uses such fuels, making exposure to household air pollution the 3rd leading contributor to the burden of disease in this country. Exposure to household air pollution is also a problem in the developed world. Nearly 30 million Americans burn solid fuels as their primary source of heating energy. Nearly 50 years of research on ‘cleaner’ household energy technologies has demonstrated only modest global impact, due to a combination of economic, cultural, and technologic barriers that prevent access to and usage of clean energy. A further limitation is that nearly all household energy interventions, to date, have focused on replacing only a single energy source (i.e., replacing just cooking, or just lighting) with a more modern technology. We propose to address these issues by conducting a randomized controlled trial that (1) focuses on total household energy (2) in a country that evinces readiness for alternative forms of energy, (3) by forming a public- private partnership to promote technological solutions that are consumer-focused and market sustainable, (4) by investigating outcome measures that are clinically actionable and strongly linked to morbidity/mortality, and (5) by developing project outputs that can inform policymakers with cost-benefit information. We hypothesize that a whole-house energy intervention (replacing all primitive forms of energy within the home with cleaner, modern forms) will produce meaningful reductions in household air pollution and health benefits in rural Rwandan homes. The randomized controlled trial will substitute traditional forms of household energy (biomass for cooking and kerosene for lighting) with solar power and liquefied petroleum gas stoves in rural Rwanda. Participants will be followed for 3 years with repeated measurements of household air pollution exposure (24-hour fine particulate matter and black carbon), energy usage, and health. Primary health endpoints will include blood pressure in adult women and men and lung-function growth in children; secondary health endpoints include blood pressure in children and lung-function change in adults. The long-term goals of this research are to increase the clinical knowledge-base on the health effects on household air pollution, to demonstrate that a whole-house energy intervention will produce meaningful household air pollution reductions and health benefits in rural Rwandan homes, to elucidate the relationship between fuel subsidy levels and household air pollution exposure, and to demonstrate that scalable solutions to the household air pollution disease burden are achievable via public-private-governmental partnerships.