Article Text

Download PDFPDF
Eye discomfort, headache and back pain among Mayan Guatemalan women taking part in a randomised stove intervention trial
  1. Esperanza Díaz1,
  2. Tone Smith-Sivertsen1,
  3. Dan Pope2,
  4. Rolv T Lie1,
  5. Anaite Díaz3,
  6. John McCracken4,
  7. Byron Arana3,
  8. Kirk R Smith5,
  9. Nigel Bruce2
  1. 1Department for Public Health and Primary Health Care, University of Bergen, Bergen, Norway
  2. 2Division of Public Health, University of Liverpool, Liverpool, UK
  3. 3MERTU, University del Valle, Guatemala city, Guatemala
  4. 4Harvard University, Boston, Massachusetts, USA
  5. 5Department of Environmental Health Sciences, University of California, Berkeley, California, USA
  1. Correspondence to:
 Dr E Díaz
 Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, N-5018 Bergen, Norway;esperanza.diaz{at}


Background: Indoor air pollution (IAP) from combustion of biomass fuels represents a global health problem, estimated to cause 1.6 million premature deaths annually.

Aims: RESPIRE (Randomised Exposure Study of Pollution Indoors and Respiratory Effects) Guatemala is the first randomised controlled trial ever performed on health effects from solid fuel use. Its goal is to assess the effect of improved stoves (planchas) on exposure and health outcomes in a rural population reliant on wood fuel.

Methods: Questions about symptoms were asked at baseline and periodically after the intervention, to an initial group of 504 women (259 randomly assigned to planchas (mean (standard deviation) age 27.4 (7.2) years) and 245 using traditional open fires (28.1 (7.1) years)). Levels of carbon monoxide (CO) in exhaled breath, a biomarker of recent exposure to air pollution from biomass combustion, were measured at each visit. In addition to reducing IAP levels, the plancha may also have a positive health effect by changing the working posture to an upright position.

Results: A high prevalence of eye discomfort, headache and backache was found. The odds of having sore eyes and headache were substantially reduced in the plancha group relative to the group using open fires for the follow-up period (odds ratio (OR) 0.18, 95% confidence interval (CI) 0.11 to 0.29 and (OR) 0.63, 95% CI 0.42 to 0.94, respectively). Median CO in breath among women in the intervention trial was significantly lower than controls.

Conclusion: In addition to reducing discomfort for women, tangible improvements in symptoms experienced by a substantial proportion of women may help to gain acceptance and wider use of planchas.

  • ALRI, acute lower respiratory infections
  • BHeQ, Baseline Health Questionnaire
  • BHS, Baseline Health Survey
  • IAP, indoor air pollution
  • PM2.5, particulate matter of aerodynamic diameter <2.5 μm
  • RESPIRE, Randomised Exposure Study of Pollution Indoors and Respiratory Effects

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interest: None.

  • The study was approved by the respective research ethics committees in Berkeley, Guatemala, Liverpool and Bergen. No adverse events were assessed.

Linked Articles

  • In this issue
    Carlos Alvarez-Dardet John R Ashton