Date of Award

January 2024

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Krystal G. Pollitt

Abstract

Indoor air pollution (IAP) from burning solid biomass fuel is a major global health challenge, especially in resource-limited settings without access to electricity or reliable fuel sources. In the Kingdom of Bhutan, where, despite a reported 99% of households having access to electricity, the vast majority of rural households still use biomass fuels for cooking and indoor heating. Given the resource limitations and access challenges associated with Bhutan’s remote highlander and herding communities, few solutions for or details about their exposure to IAP are available – especially during nomadic periods where families may spend months beyond the reach of infrastructure services. Conducted in parallel with a stove intervention rollout effort in one such community, this study used portable low-cost air pollution sensing technology and a wearable passive air sampler (Fresh Air clips) to generate baseline data in support of more extensive public health research and action on IAP among remote Himalayan communities. Active pollution sampling results indicate that total concentration of particulate matter 2.5 microns or below in diameter (PM2.5) can exceed World Health Organization (WHO) Interim Targets in participants’ homes by more than an order of magnitude. Targeted analysis of emerging environmental contaminants using Fresh Air clips indicate that participants were exposed to high levels of several priority pollutants, including non-combustion-associated compounds such as pesticides, phthalates, and flame retardants. In particular, total polycyclic aromatic hydrocarbon (PAH) exposure was estimated to be 2-to-4.6 times acceptable levels according to U.S. regulatory authorities. Clinical evaluations and health questionnaires suggest that potentially IAP-associated health challenges may be contributing to significant burdens on participants’ wellbeing and quality-of-life. Questionnaire results and pollution comparisons suggest that the modified traditional stove used in the pilot intervention are not only highly context-relevant and widely acceptable to participants, but are also somewhat effective at reducing exposure burdens. Overall, this study indicates that nomadic herders in Bhutan likely face significant IAP exposure burdens, while also providing initial evidence that a promising, scalable solution exists.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/07/2025

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