Effect on blood pressure and eye health symptoms in a climate-financed randomized cookstove intervention study in rural India

Air pollution from cooking with solid fuels is a potentially modifiable risk factor for increased blood pressure and may lead to eye irritation. To evaluate whether a climate motivated cookstove intervention reduced blood pressure and eye irritation symptoms in Indian women. Households using traditional stoves were randomized to receive a rocket stove or continue using traditional stoves. Systolic (SBP) and diastolic blood pressure (DBP), and self-reported eye symptoms were measured twice, pre-intervention and at least 124 days post-intervention in women > 25 years old in control (N = 111) and intervention (N = 111) groups in rural Karnataka, India. Daily (24-h) fine particle (PM2.5) mass and absorbance (Abs) were measured in cooking areas at each visit. Mixed-effect models were used to estimate before-and-after differences in SBP, DBP and eye symptoms. We observed a lower SBP (−2.0 (−4.5, 0.5) mmHg) and DBP (−1.1 (−2.9, 0.6) mmHg) among exclusive users of intervention stove, although confidence intervals included zero. Stacking or mixed use of intervention and traditional stoves contributed to a small increase in SBP 2.6 (−0.4, 5.7) mmHg) and DBP (1.2 (−0.9, 3.3) mmHg). Exclusive and mixed stove users experienced higher post-intervention reductions, on average, in self-reported eye irritation symptoms for burning sensation in eyes, and eyes look red often compared to control. Median air pollutant concentrations increased post-intervention in all stove groups, with the lowest median PM2.5 increase in the exclusive intervention stove group. Health benefits were limited due to stacking and lower-than-predicted efficiency of the intervention stove in the field. Stove adoption and use behavior, in addition to stove technology, affects achievement of health co-benefits. Carbon-financing schemes need to align with international guidelines that have been set based on health outcomes to maximize health co-benefits from cookstove interventions. •Health benefits from a climate-financed cookstove intervention were limited.•Blood pressure changes were not significant in homes using intervention stoves.•Eye-irritation generally improved, suggesting unmeasured exposures or reporting bias.•Stove adoption and use behavior, in addition to stove technology, can complicate attainment of health benefits.