The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old

Int J Environ Res Public Health. 2018 Sep 5;15(9):1936. doi: 10.3390/ijerph15091936.


Household air pollution is estimated to cause half a million deaths from pneumonia in children worldwide. The Cooking and Pneumonia Study (CAPS) was conducted to determine whether the use of cleaner-burning biomass-fueled cookstoves would reduce household air pollution and thereby the incidence of pneumonia in young children in rural Malawi. Here we report a cross-sectional assessment of carbon monoxide (CO) exposure and carboxyhemoglobin (COHgB) levels at recruitment to CAPS. Mean (SD; range) 48-h CO exposure of 1928 participating children was 0.90 (2.3; 0⁻49) ppm and mean (SD; range) COHgB level was 5.8% (3.3; 0⁻20.3). Higher mean CO and COHgB levels were associated with location (Chikhwawa versus Chilumba) (OR 3.55 (1.73⁻7.26)); (OR 2.77 (1.08⁻7.08)). Correlation between mean CO and COHgB was poor (Spearman's ρ = 0.09, p < 0.001). The finding of high COHgB levels in young children in rural Malawi that are at levels at which adverse neurodevelopmental and cognitive effects occur is of concern. Effective approaches for reducing exposure to CO and other constituents of air pollution in rural sub-Saharan African settings are urgently needed.

Keywords: CAPS; child health; environmental monitoring; personal exposure.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollution, Indoor / analysis*
  • Carbon Monoxide / analysis*
  • Carboxyhemoglobin / analysis*
  • Child, Preschool
  • Cooking / methods*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Incidence
  • Infant
  • Malawi / epidemiology
  • Male
  • Pneumonia / epidemiology*
  • Rural Population


  • Carbon Monoxide
  • Carboxyhemoglobin