Impact of Household Air Pollution upon Health and its Prevention across Pakistan by using Improved Cookstoves

Impact of Household Air Pollution upon Health and its Prevention across Pakistan by using Improved Cookstoves EMBA – Research Project Author’s Name: Imran Imtiaz Butt Date: 19/08/2018 Acknowledgement: I would like to show my appreciation and gratitude to Mr. Khizr Imran Tajammul (CEO – Jaan Pak Enterprises Pvt Ltd), who provided me immense support to undertake this project. His initiative in highlighting and quantifying the impact of household air pollution upon health due to improper means of cooking made me realize that this issue is most serious yet underestimated. This gave me motivation to write this report and present my own findings upon this issue. I would also like to thank my supervisor who motivated me and guided me regarding the technicalities of research project. Executive Summary: According to World Health Organization’s report upon household air pollution and health (2018), it has been estimated that globally around 3 billion of population uses kerosene and solid fuels (i.e. cow dung, charcoal, wood, coal and crop waste) for cooking food in ineffectual stoves and in open fires. However, the majority of the population lives in rural areas and has low income. As the process of such type of cooking is inefficient which results in producing high level of toxic compounds and gases within the surroundings of household, these gases then directly penetrates into the lungs causing health diseases. Such gases and compound fall into household air pollution or indoor air pollution categories. This report examined the impact of household air pollution upon the health of household members and the minimizing this impact through usage of efficient cookstoves (i.e. Jaan Pakistan Supreme Stove). The survey was conducted upon the respondents residing in some of the off-grid districts of Pakistan by asking questions regarding their own understandings of danger of household air pollution and feasibility of using efficient biomass fuel combustion technology and its impact upon their lives. Table of Contents: S. No Topic Page No. 1 Introduction 5 2 Review of Literature 9 3 Research Methodology 14 4 Results and Discussion 18 5 Conclusion 29 6 References 31 Chapter 1: Introduction Preamble: The use of solid fuels for cooking purpose has increased exponentially with respect to the population growth around the world. Many people in sub-urban and rural areas, having low incomes, usually use charcoal, agricultural residues, wood etc to cook their food. When they burn these fuels in their household boundaries in open or inefficient stoves, many injurious pollutants emit from their cooking area, these pollutants include carbon monoxides, sulfur oxides and other particulate matter (PM). These particulate matters with the diameter of 10 microns or less (PM10) are most commonly found in household air pollution (HAP), but particles having diameter of 2.5 microns or less (PM2.5) are considered to be most dangerous that causes detrimental effects into the respiratory system of the inhaler (Bruce et al, 2011). The PM2.5 can also be found in HAP in which women and children are mostly affected through it. This HAP can further result various diseases such as respiratory infections, pneumonia, stroke, ischaemic heart disease and lung cancer (Desai et al., 2004). More than 3.5 million people prematurely die every year through diseases caused by HAP due to the lack of proper and efficient cooking stoves (WHO, 2018). These deaths are further classified into five major categories in which mostly people die from pneumonia (27%) and ischaemic heart disease (27%), while 18% dies from stroke, 20% from chronic obstructive pulmonary disease and 8% from lung cancer (WHO, 2018). Figure 1: Deaths resulted from diseases caused by HAP in percentage Pakistan is the country where most of the population resides in rural areas. Due to the low per capita income, high inflation rates and lack of awareness regarding HAP, many off-grid localities use inadequate techniques of combusting cheaper biomass for cooking purpose and fulfilling their energy needs. In 1992, Pakistan Household Energy Study (HESS) was published which analyzed the biomass fuel consumption behavior of the citizens of Pakistan. According to the report, mostly people relied upon the biomass fuel for their cooking purpose (86%). However, this figure is substantial to take measures in order to control diseases from HAP. Unfortunately, furthers surveys are not performed till date in order to find exact proportion of biomass fuel consumers. Due to this lack of data, the exact magnitude of posed threat cannot be quantified as a whole. However, with the help of limited researches in this field, the idea of the problem can be estimated and corrective measures can be taken to rectify the issue. In this report, the analysis was performed on Jaan Pakistan’s product of biomass fuel combustion and the responses from the consumers of that product in order to determine the feasibility of the product. Jaan Pakistan Pvt Ltd is an organization dedicated to manufacture green products that can be affordable to low income individuals and families. This report will further discuss the impact of HAP upon the heath of people and how it can be prevented. Research Problem: The usability of Supreme Stoves, which are being manufactured by Jaan Pakistan, shall be discussed as well as its role in minimizing the HAP. The Supreme Stove is made up of mild steel sheet that is cheap, robust and abundant in Pakistan. This stove can accommodate wood or dung cakes as combustion fuel. However, there are various aspects of the product which still needs to be corrected and modified so that its efficiency can be increased. Purpose of Study: The purpose of study is to analyze the reviews and feedback from consumers of Supreme Stove so that proper measures can be taken in order to improve the product. Secondly, the analysis will also be performed upon the major concerns of people while cooking their food through combusting solid fuels. Research Question: The research question is based on the usability and serviceability of the Supreme Stove that how well it is applicable and suitable for the consumers of rural areas to cook their food without exposed to Household Air Pollution. Justification of the Study: The research is justifiable in such a way that proper measures can be taken to help people from getting infected through HAP by analyzing their concerns and responses. This report will also assess the impact of HAP upon the lives of poor families who cannot afford expensive means of cooking. Assumptions: The Supreme Stove is considered to be one of the most efficient biomass combustion stoves. Its durability, affordability and robustness make it more viable to be purchased and operated by poor families in off-grid areas where cooking food is dependent upon combusting solid fuels. Abbreviation of Keywords: COPD - Chronic Obstructive Pulmonary Disease DALYs - Disability Adjusted Life Years GACC - Global Alliance for Clean Cookstoves HAP - Household Air Pollution HAPIT - Household Air Pollution Intervention Tool IHD - Ischaemic Heart Disease ICS – Improved Cook Stove ISO - International Standardization Organization PM2.5 - Particulate Matter with a Diameter of Less than 2.5µm RSPN – Rural Support Programmes Network WHO - World Health Organization Chapter 2: Review of Literature Literature Review: Conventional biomass stoves and open fire pits used for cooking are accountable for producing immense amount of Household Air Pollution (HAP) due to their incompetent design, poor ventilation and partial combustion of fuels. These conventional cookstoves are indirectly responsible for generating serious diseases among the household members including women and children. These diseases include lung cancer, pneumonia, COPD and IHD, which also results in low birth rate and premature deaths (Bruce et al., 2000; Pope et al., 2010). The negative health impacts are caused by inhaling tiny filth particles which are equals to or less than 2.5 microns in diameter (Smith et al., 2009). The cookstoves not only contributing for adverse health effects but they also require more time to cook food which indirectly waste time and resources. In order to address these issues, improved cook stoves (ICS) were introduced with better design and proper ventilation system. These new stoves increased cooking efficiency as compared to their counterparts in terms of time saving in cooking, fuel gathering, better combustions and fuel requirements. The ICS not only contributed to fight against negative health impact of biomass combustion but it also helped in generating low emissions which further decreased the negative impact upon the environment. Despite all the advantages and positive impact upon the environments, these improved cookstoves also faced challenges in terms of promotion, diffusion in the society, supply chain and dissemination and installation due to lack of infrastructure and proper management (Michell, 2010). Initially, the untested products were distributed to unaware household members through unreliable channels and distribution agencies which resulted in divergence of research and failed attempt to collect responses from the demand side so that improvement can be done. But somehow, some evidences were received which have shown that there is a proper need to work on this segment as consumers are willing to acquire such type of clean cookstoves for their household in reasonable price (Pattanayak & Pfaff, 2009). Now major players have taken steps to promote and deploy improved cookstoves around the globe on a large-scale which includes improvement in existence design of the cookstoves, implementing credit options for poor families to purchase ICS, improving supply chain and distribution networks in remote areas and advertising the benefits of using ICS through awareness programs. The major players have also taken advantages in low income nations where prices of firewood of other solid fuels have increased due to forest reforms and scarcity, which helped them in promoting ICS. These factors collectively supported the cause of implementing ICS and its related products across the globe, and also led the foundation of Global Alliance for Clean Cookstoves (GACC) in 2010, which is a public-private partnership multi-stakeholder non-profit organization works under the umbrella of United Nation Foundation, aims to implement clean cooking solutions across the globe in 100 million families before 2020 (GACC, 2011). Developing countries such as India and Pakistan have major player who are helping families to adopt clean cooking solutions (Babar, 2004). In India, a new National Biomass Cookstoves have been launched in 2009 to provide around more than 150 Million ICS which run on solid fuels to poor families (Venkataraman et al., 2010). In Pakistan, Jaan Pak Enterprises have taken initiative to provide ICS at an affordable and cheap price to households in off-grid areas. Jaan Pak Enterprises launched their Supreme Stove, which they claim is best solution for those households who rely upon biomass fuel for cooking. The PM2.5 concentration level generated by any cookstove is measured through proper laboratory equipments. In order to measure the health impact of clean cookstoves, it is compulsory to compare its results of generating PM2.5 with the conventional cookstoves. The difference in PM2.5 emission can be used as an indicator which can tell that which cookstove should be beneficial for use. Furthermore, the average annual concentration can be calculated by using special software called HAPIT (Household Air Pollution Intervention Tool) designed by GACC, which can provide results of how many lives can be saved if the households switched to clean cookstoves. The Supreme Stove was tested in Nepal in order to acquire its PM2.5 concentration level. As a result, Supreme Stove gives 328µg/m³ as the indoor annual concentration of PM2.5, while comparing this result with conventional cookstove which gives 1,975µg/m³ as the indoor annual concentration of PM2.5, shows that Supreme Stove is highly efficient and harmless as compared to its counterpart (Jaan Pakistan, 2018). In order to give an idea of how many lives can be saved by using clean cookstoves, HAPIT requires data regarding the value of pre-intervention PM2.5 concentration level and post-intervention PM2.5 concentration level. More simply, when Jaan Pakistan Enterprises entered the values of pre-intervention concentration level of traditional cookstove (i.e. 1,975µg/m³) and post-intervention concentration level of Supreme Stove (i.e. 328µg/m³) in the software by assuming 711 households (Number of Supreme Cookstoves have been sold so far), the result had shown that almost 880 DALYs were averted and almost 21.590 deaths were averted. DALY is known as Disability Adjusted Life Years which is a parameter used to quantify the severity of disease, impact of disability and premature mortality. This means that if these Supreme Stoves are sold on large scale, then many lives can be saved from fatal emissions generated from burning biomass fuels (Jaan Pakistan, 2018). Scenario Pre-Intervention Post-Intervention Total DALYs Total Deaths Using Supreme Stove 1,975 328 880.0 21.590 Using Traditional Stove 1,975 1,975 0.0 0.000 Chart 1: Comparison of Supreme and Traditional Stove in terms of DALYs and Deaths saving The Supreme Stoves of Jaan Pak are marketed and sold across the rural areas of Pakistan through aspiring and motivated female entrepreneurs which are selected with the help of Rural Support Programme Network (RSPN). The concept of using female entrepreneurs for this job is that woman can well understand the problems of other woman as cooking is primarily done by females in the household (Jaan Pakistan, 2018). Figure 2: Supreme Stove V2.0, 2D model (left) and 3D model (right) Theoretical Framework: This study will investigate the standard of living of the households who participated in answering the questionnaire based on question regarding the use of biomass fuels for cooking purposes and also provide a useful insight into how and why the use of efficient and improved cookstoves should be acquired which will not only reduce the negative impact of harmful gases and smoke but also save households’ money in terms of utilizing less fuel through these smart cookstoves. Furthermore, this study will also highlight the importance of clean cooking which is the building block for ensuring environmental sustainability and eradicating disease, hunger and poverty amongst the members of families. The findings from this research may also be used by the major players of this sector for building up the case with more sophisticated planning and R&D so that more and more people can have benefit from the concept of clean cooking and use of ICS. Hypothesis: In this research, it was hypothesized that the socioeconomic variables such as income of households, fuel cost for cooking food, monthly household expenditures, number of earning members of the households and cooking time required to cook a meal shall have major impact upon the preference level for adopting improved and efficient cookstoves. Chapter 3: Research Methodology Research Design and Frame of Reference: The survey was conducted at the start of 2018 in Mehr Town, which is situated within the vicinity of sub-urban Lahore. This survey was originally conducted by Jaan Pakistan Enterprises and now it is used for this research in order to find the preference level for adopting clean cookstoves by low-income households. The people of this area are mostly dependent upon biomass fuel for their cooking purpose, so that is why this already conducted survey is considered to be most appropriate for this paper. The reason for conducting this survey on such type of rural area is to generalize the result with the overall inhabitants of rural Punjab, which is the biggest province of Pakistan in terms of population. The dynamics of this sub-urban area such as land tenure, topography, demography, living standards and livelihoods are almost the same with the neighboring villages of rural Punjab. The responses were collected by team members of Jaan Pakistan, where each team member was assigned with certain locality of the village. The team members then reached door to door with the semi-structured questionnaire having open-ended and close-ended questions in order to take responses from the households. The questionnaire was designed with questions related to socioeconomic characteristics of the participants. Sampling Method: In this survey, the cluster random sampling was used in order to collect data. The sub-urban area was selected as a cluster including large number of people. Then, random participants were selected and invited to take part in the survey from the cluster. However, in such type of surveys, clusters are predefined as a single geographical location such as a town or a village. But most of the time, the heterogeneity within the specified cluster cannot be achieved as the whole cluster works as a homogenous body. The homogeneity of the cluster can be seen with respect to same type of occupation, same standard of living and similar mindset. On the other hand, this type of sampling method is advantageous in terms of time and cost saving in data collection process as participants spread densely within the selected region (Yansaneh, 2003). Instrument Selection: The Ordinary Least Square (OLS) regression is used in this research in order to find the impact of socioeconomic factors upon the choice of preferring clean cooking methods. The OLS regression is the instrument which helps finding out the relationship between independent and dependent variables so that it can be hypothesize that one variable depends upon another variable or a set of other variables. Hence, this relationship may not be obvious only through naked eye, but special instruments are required such as OLS to evaluate the true relationship along with results (Hutcheson & Moutinho, 2008). Variables: Below is the list of variables that are used in the research. These variables fall into the category of independent, dependent and extraneous variables. Independent variables: COOKTIME: How much time on average is required for the household member to cook a meal (in mins). FUELCOST: What is the average cost incur for cooking as fuels expenses in PKR (Gas cylinder, firewood, dung cakes etc). FIREWOODQTY: Quantity of firewood used per month( In Mannes, where 1 Manne = 40KGs / Month). EXPENSE: Total household monthly expense in PKR. EARNMEMBER: Number of household members who are earning. INCOME: Total household monthly income in PKR. Dependent variable: INTERESTED: Interest level of the participant for acquiring improved cookstove for his/her household. Extraneous variables: MEMBERS: Number of individuals in the household. ROOFACCESS: Access to rooftop and/or an open outdoor space for the household. CONSUME: What do the households consume more often with their daily diet, roti or rice. MEALQTY: How often and what time of the day do household cook fresh food? (i.e. this does not include re-heating food) SCHOOLCHILDREN: Number of children who are school-going. The variables were then analyzed through using regression model and put into the equation of OLS through which the relationship analysis was being done. The equation is as follows: Regression: INTERESTED i = 0 + 1COOKTIMEi + 2FUELCOSTi +3FIREWOODQTYi +4EXPENSEi +5EARNMEMBERi +6INCOMEi + i Plan of Analysis: The responses were collected and put into Stata 13 for further analysis. Stata 13 is a data analysis software with complete smart statistical and data management tools that runs with simple commands with easy-to-use user graphical interfaces. After entering complete dataset into Stata, statistical tools were used in order to generate results. The reason of using OLS regression model instead of using binary logit model is that the independent variable is not dichotomous in nature and has more than two states (e.g. 0 for “No”, 1 for “Yes – Perhaps”, 2 for “Yes – enthusiastic”, 3 for “Yes – Highly enthusiastic). The descriptive analysis and results from the model are presented in the next chapter. Chapter 4: Results and Discussion Results: The total participants first filtered out and only those participant were selected who rely upon firewoods and dung cakes as their fuels for cooking. After filtration, out of 100, only 51 participants were finalized. In Table 1, the tabulation command was performed upon the participants’ total number of household members which clearly shows that majority of the participants have at least 6 household members. In Table 2, the summary of household members is presented which shows that on average each household have 7.96 members. Table 1: Number of household members of the participants Table 2: Summary sheet of household members Similarly, all independent and dependent variables were first being analyzed in order to get their mean values and standard deviations as shown in Table 3. Table 3: Means, Standard deviations, Ranges and Coding of important variables S. # Label Variable Mean St. Deviation Range Coding 1 Cooking time for meal COOKTIME 3.07 0.9347 1-5 from (1 = 30-60 mins) to (5 = 2-3 hours) 2 Cost upon Fuel for cooking FUELCOST 3.35 1.706 1-9 from (1 = less than Rs.1,000) to (9 = Above Rs.9,000) 3 Quantity of Firewood for cooking FIREWOODQTY 2.313 1.923 0-7 from (0 = 0 Manne) to (7 = Over 8 Mannes) 4 Total monthly household expense EXPENSE 4.588 1.951 1-9 from (1 = Less than Rs.5,000) to (9 = Over Rs.40,000) 5 Number of members in the household who earns EARNMEMBER 2.60 1.537 1-6 6 Total monthly household income INCOME 7.666 2.854 1-12 from (1 = Rs.3,000 to Rs.6,000) to (12 = Above Rs.36,000) 7 Interest of the participant to adopt improved cookstoves INTERESTED 2.196 0.872 0-3 from (0 = Not Interested) to (3 = Interested with high enthusiasm) However, the tabulation tables of total monthly household income and total monthly household expenditure are shown in table 4 and table 5 respectively so that responses can be properly seen: Table 4: Tabulation table of monthly household expenses of the participants Table 5: Tabulation table of monthly household income of the participants From the above tables, it has been obvious that most of the participants spend around Rs.15,000 upon their household expenditures which includes fuel for cooking, electricity bills, education fees of children, ration and miscellaneous expenses. However, as we can notice that most participants’ monthly household incomes lie around Rs.18,000; which in some point of view, most of the household lives from hand to mouth. And there is a better chance that they should adopt clean and efficient cookstoves so that they can save money in terms of less fuel consumption. It is hypothesize that these independent variables can play a major role for manipulating dependent variable (i.e. preference for ICS). The independent variables are thoroughly described below: Time required for cooking: The first independent variable in this research is the time required for cooking a meal. The participants were asked that how much time is required to prepare their meal; the participants responded that the around 1-1.5 hours are required to cook a meal with the mean value of (M=3.07). This independent variable can play a vital role in deciding whether or not the household should switch to efficient way of cooking, as more cooking time means more fuel to burn and more inhaling of harmful gases. As we can also see in Table 6, majority of the participants responded that they cook thrice a day which means more fuel is required. Table 6: Typical frequency of cooking meals of participants In Table 7, around 72.55% of the total participants emphasized that they usually cook more roti than rice for their daily food consumption. As we all know that cooking roti may requires more attention than cooking rice as one must stand in front of the stove to prepare it, indirectly more exposure to harmful smoke. Table 7: Food consumption of the participants Fuel cost for cooking and quantity of firewood required to cook food: Second and third independent variables are fuel cost which incurs while cooking food and quantity of firewood required to cook food. The participants were asked to give an rough estimate that how much money is being used for procuring fuels such as firewookds, dung cakes or even LPG for cooking. They were given 9 options which starts from 1 (less than Rs.1,000) to 9 (More than Rs.8,000). According to their responses, on average, Rs.2,000 to Rs.3,000 are required as fuel cost (M=3.35). Figure 3: Histogram of Fuel cost We can also observe through Table 8 that around 41.18% spends Rs.2,000 to Rs.3,000. Table 8: Tabulation of fuel cost On the other hand, the participants were also asked to tell the amount of firewood required per month for their domestic purposes, the majority of them (50.98%) replied that around 1-2 Mannes (e.g. 1 Mann = 40Kgs) are required per month for their domestic use, rest of the requirements are met through dung cakes. Table 9: Requirement of firewoods in the scale of mann Total monthly expense of household and Total monthly income of household: The independent variables such as total monthly expense and total income of household can also play crucial role for encouraging the individual to adopt ICS. If household cannot afford to waste their money in terms of wasting fuel and purchasing medicines for treatment of illness due to particulate matters and smoke, then they must switch to clean cookstoves in order to prevent themselves from these expenditures. Earning members of the households: The earning members of the household define the wealth of such household. The participants when asked about how many people in their home are earning, around 27.45% of them replied that only one household member is earning; around 29.1% said that they have two earning members; around 19.61% reiterated that 3 house members are breadwinners in the household. Figure 3: Histogram of earning household members Preference on adopting improved cookstoves: The only dependent variable of the study in which whole research is based on, this variable is “INTERESTED” which describes the preference for adopting clean and improved cookstoves for household. The participants were asked whether they would be interested in such type of cooker or stove that will not only consumes less fuels but at the same time generates less amount of harmful smoke and particulate matters; the majority of participants showed their overwhelming gesture and shown interest in such type of product. But according to the interviewer, the responses were then classified with respect to the level of enthusiasm. Those participants who said “No” to such kind of product were assigned “0” value; those participants who responded with “Yes” but with less enthusiasm were assigned with value “1”; those participants who replied with some more enthusiasm and shown interest were assigned with “2” value; but those participant who had shown tremendous interest and phenomenal enthusiasm were assigned with value “3”. Finally, the data was entered into the software which gave result in the form of table shown below: Table 10: Responses of participants over adopting ICS Discussion: From the above results of the survey, it is somehow confirmed that there is a need of promoting clean cooking technologies among the people of developing countries as these people still rely upon traditional cookstoves. The adoptions of such technologies are influenced by number of socioeconomic factors. In this research, it was previously hypothesized that factors such as cost of fuel per month, number of household earning members, monthly income, monthly expenditure and cooking times have major impact upon the adoption behavior of improved cookstoves by individuals. After analyzing the dataset with respect to the independent variables, then regression analysis was performed upon these variables through which results were received as mentioned in below Table 11: Table 11: OLS regression upon preference for adopting improved cookstoves The table 11 shows the result of OLS regression analysis upon preference of adopting improved cookstoves and independent variables. According to the result, it has been prominent that all of the analyses are statistically significant at least at the level of 10% significance. The first independent variable (i.e. COOKTIME) impacts positively upon preference level for ICS as it shows that the probability of adopting efficient and improved cookstoves increases at the rate of ≈ 0.03 as the cooking time for preparing meal increases, probably due to wastage of fuel for longer cooking time (1= 0.030, Std. Err.= 0.1505, t= 0.20, p<0.084). Moving forward, as per the OLS regression output, increase in fuel cost (FUELCOST) may also have a positive impact and it increases the probability of adopting ICS at the rate of ≈ 0.09, this may also be due to the fact that participants were interested in saving their fuel cost by adopting clean cooking methods (2= 0.090, Std. Err.= 0.114, t= 0.79, p<0.043). After analyzing third independent variable’s impact upon dependent variable, it has been cleared that by increasing the quantity of firewood by 1 Mann, it will increase the probability of adoption of ICS by ≈ 0.03, this is also due to the fact that people want to save their money so that they are willing to purchase such type of cookstove that can lessen their fuel consumption (3= 0.030, Std. Err.= 0.097, t= 0.31, p<0.075). While moving to fourth independent variable (i.e. Total monthly expense upon household), it shows that if the household expense goes up by around Rs.5,000 then the probability of adopting ICS will increase by ≈ 0.025, which gives impression that individuals will shift to clean cookstoves if their household expense will increase (4= 0.025, Std. Err.= 0.072, t= 0.35, p<0.072). Similar with the number of earning members of the household, the chances for adopting ICS increases by ≈ 0.008 with the increase in earning members of the household but the probability is very low as compared to other variables (5= 0.0085, Std. Err.= 0.0901, t= 0.09, p<0.092). Last but not the least, the impact of monthly income upon preference level has shown interesting result, as it shows that the rise in monthly income of Rs.3,000 of the household may decrease the probability of adopting clean and efficient cookstoves by ≈ -0.0085, this may be due to the fact that if household earns good amount of money on monthly basis then they would not be needed to save their fuel cost by adopting ICS. However, the probability is very little in terms of rejecting the efficient cookstoves (6= -0.0085, Std. Err.= 0.0511, t= -0.17, p<0.086). From the above results, it has been proved that socioeconomic factors play a major role in the decision making process of adopting clean cookstoves for the household, hence validating our hypothesis. It has also been observed that cooking time, monthly household expense, monthly fuel cost, firewood consumption and number of earning members of the household directly proportional to the choice of preferring improved and clean cookstoves over traditional cookstoves. In other words, by increasing the rate of these variables, the chances of acquiring clean cookstove by individual would be increased. However, the monthly household income is inversely proportional to the choice of preferring ICS according to the results of the research. In other words, if the household income is increased, then there is a probability that the chances of acquiring clean cookstove by the individual would be decreased. Chapter 5: Conclusion Section Conclusion: The aim of the research was to emphasize the importance of using improved cookstoves, especially in off-grid and rural areas of Pakistan, which is vital for health safety, environment sustainability and economical progress of poor families. The advantages of using such stoves nearly outweigh the cost incur in purchasing it. However, despite the multiple advantages, its adoption rate is still slow among the people. Developing countries like Pakistan needs more attention in this sector, where around 62% of the total population lives in semi-urban and rural areas, in which most of the people heavily dependent upon biomass fuel for cooking purposes (Ministry of Finance, 2010). However, some organizations like Jaan Pakistan Enterprises, are working round the clock to ensure that every individual, which resides in such rural areas should have the access to acquire clean cooking methods for their better future. But the key barriers which limit the progress of promoting efficient and clean cooking methods are economical, social, political and cultural factors (Aggarwal & Chandel, 2004). Some of the factors were analyzed in this report so that general idea can be taken to understand the core issue. Recommendations: The cluster sampling method is used in this research, which may decrease the reliability of the sample due to the reason that the whole sample act as a homogenous body or have similarities in their characteristics because of living in same locality. It is recommended that stratified sampling technique should be used in future researches to cope up with this limitation. There should be proper deployment of surveyors and frequent visits of them should also be considered while collecting data, through which proper conditions of households can be observed. The marketing and promotion of the product should be aggressive so that more and more people can have awareness over the issue. Area for further research: This survey was performed in the sub-urban area of Lahore which has limited audience. This type of survey should also be performed in regions of Khyber Pakhtunkhwa, Sindh and Balochistan so that more generalizability can be achieved. Moreover, the sample size should also be increased for further research so that more and more data can be processed which will help giving an accurate portrait of the problem. References Aggarwal, R.K. & Chandel, S.S. (2004) “REVIEW OF IMPROVED COOKSTOVES PROGRAM IN WESTERN HIMALAYAN STATE OF INDIA” Babar, K. (2004), “FINAL REPROT – TECHNICAL (JANUARY 2000 – DECEMBER 2004), ENVIRONMENTAL EDUCATION PROGRAMME, IN SUPPORT OF MOUNTAIN AREAS CONSERVANCY PROJECT (MACP)” Bruce, N., Perez-Padilla, R. and Albalak, R. (2002) “INDOOR AIR POLLUTION IN DEVELOPING COUNTRIES: A MAJOR ENVIRONMENTAL AND PUBLIC HEALTH CHALLENGE” Desai, M., Mehta, S., & Smith, K. (2004) “INDOOR SMOKE FROM SOLID FUELS: ASSESSING THE ENVIRONMENTAL BURDEN OF DISEASE AT NATIONAL AND LOCAL LEVELS ENVIRONMENTAL BURDEN OF DISEASE SERIES” World Health Organization (2018) “THE REPORT ON HOUSEHOLD AIR POLLUTION AND HEALTH” Global Alliance for Clean Cook stoves, (2011) “IGNITING CHANGE: A STRATEGY FOR UNIVERSAL ADOPTION OF CLEAN COOK STOVES AND FUELS. WASHINGTON DC: GLOBAL ALLIANCE FOR CLEAN COOK STOVES” Hutcheson, G. D. and Moutinho, L. (2008). “STATISTICAL MODELING FOR MANAGEMENT” Jaan Pakistan (2018) “INTRODUCING CLEAN COOKSTOVES ACROSS PAKISTAN” Pope, D.P, Mishra, V, Thompson, L, Siddiqui, A.R, Rehfuess, E.A, Weber, M, Bruce, N.G., (2010) “RISK OF LOW BIRTH WEIGHT AND STILLBIRTH ASSOCIATED WITH INDOOR AIR POLLUTION FROM SOLID FUEL USE IN DEVELOPING COUNTRIES” Smith-Silvertsen, T, Diaz, E, Pope, D, Lie, R.T, Diaz, A, McCracken, J., (2009) “EFFECT OF REDUCING INDOOR AIR POLLUTION ON WOMEN’S RESPIRATORY SYMPTOMS AND LUNG FUNCTION: THE RESPIRE RANDOMIZED TRIAL, GUATEMALA” Ministry of Finance, (2010) “ECONOMIC SURVEY OF PAKISTAN : GOVERNMENT OF PAKISTAN” Mitchell, A,. (2010) “INDOOR AIR POLLUTION: TECHNOLOGIES TO REDUCE EMISSIONS HARMFUL TO HEALTH: REPORT OF A LANDSCAPE ANALYSIS OF EVIDENCE AND EXPERIENCE” Pattanayak, S.K, Pfaff, A., (2009) “BEHAVIOUR, ENVIRONMENT AND HEALTH IN DEVELOPING COUNTRIES: EVALUATION AND VALUATION” Venkataraman, C, Sagar, A.D, Habib, G, Lam, N, Smith K.R., (2010) “THE INDIAN NATIONAL INITIATIVE FOR ADVANCED BIOMASS COOK STOVES: THE BENEFITS OF CLEAN COMBUSTION. ENERGY SUSTAINABLE DEVELOPMENT” Yansaneh I. (2003) “AN OVERVIEW OF SAMPLE DESIGN ISSUES IN HOUSEHOLD SURVEYS IN DEVELOPING COUNTRIES” 28