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

摘要 暴露于使用传统能源造成的家庭空气污染是发病率的十大风险因素 和死亡率。家庭中传统能源的排放造成了不健康的环境污染。 家庭空气污染和问题是普遍存在的。大约有30亿人依赖木材等燃料， 木炭和煤油，以满足烹饪、取暖和照明等需求。约80%的 卢旺达的人口使用这种燃料，使暴露于家庭空气污染的第三大贡献者， 这个国家的疾病负担暴露于家庭空气污染也是发达国家的一个问题。 世界近3000万美国人燃烧固体燃料作为他们的主要取暖能源。 近50年来对“更清洁”的家庭能源技术的研究表明，全球范围内只有少量的 影响，由于经济，文化和技术障碍的组合，阻止访问和使用 清洁能源。另一个限制是，迄今为止，几乎所有家庭能源干预措施都侧重于 仅替换单个能量源（即，用更现代的技术取代烹饪或照明。 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）侧重于总的 家庭能源（2）在一个表示愿意采用替代能源形式的国家，（3）通过建立一个公共- 建立私营伙伴关系，促进以消费者为中心和市场可持续的技术解决办法，（4） 通过调查临床上可操作且与发病率/死亡率密切相关的结局指标，以及 (5)通过开发项目产出，使决策者了解成本效益信息。我们假设 全屋能源干预（用更清洁的能源取代家中所有原始形式的能源， 现代形式）将产生有意义的减少家庭空气污染和健康福利在农村卢旺达 木屋.随机对照试验将取代传统形式的家庭能源（用于烹饪的生物质 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 随访3年，重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。主要健康终点将包括血压， 成年女性和男性以及儿童的肺功能增长;次要健康终点包括血压 儿童和成人肺功能的变化。 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， 卢旺达农村家庭空气污染减少和健康效益，以阐明 燃料补贴水平和家庭空气污染暴露之间的关系，并证明可扩展的解决方案， 家庭空气污染疾病负担可通过公私政府伙伴关系实现。

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.