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Objectives: Approximately 2½ billion people worldwide rely on solid/biomass fuel as fuel for cooking/heating the home. Environmental exposure to the smoke associated with biomass fuel burning has been associated respiratory diseases, cardiac disorders, and altered blood pressure. Therefore, a systematic review and meta-analysis was conducted to study this relationship across multiple studies. Methods: Searches were performed using PRISMA guidelines for articles using Web of Science, PubMed, Toxline, and Web of Science of peer reviewed papers with no beginning time restriction until February 2017. The search yielded 10 manuscripts after application of inclusion criteria, which encompassed 93 724 participants. Outcomes included (a) the proportion of people with a clinical diagnosis of hypertension in an exposed (vs. unexposed) population or (b) correlation coefficients examining degree of exposure and systolic/diastolic blood pressure. Results:The four studies reporting effect sizes for hypertension (N = 92 042) had a weighted mean effect size of r = .12 [−0.02, 0.27], z = 1.66, p = 0.097. The six studies reporting effect sizes for systolic and diastolic blood pressure (N = 1682) had weighted mean effect sizes of r = .15 [0.06, 0.24], p = 0.001, and r = .09 [0.03, 0.15], p = 0.002, respectively. Conclusion:These analyses revealed that there is a small-but-significant relationship between biomass fuel exposure and an increase in both systolic and diastolic blood pressure, but the relationship between biomass fuel and hypertension specifically remains unclear.

Poverty alleviation and health promotion programs have become part and parcel of life in rural Zambia. It is critical to track the performance of these programs to assess the impact they have on the people involved. The purpose of this study is to ascertain barriers, specifically related to market access and crop yields, faced by smallholder groundnut farmers in Eastern Zambia following implementation of the PROFIT+ program. Focus group discussion and informants were selected based on participation in the PROFIT+. Interview data were then qualitatively analyzed to determine consistent themes among farmers. Farmers highlight three general barriers/risks that impacted both their economic well-being and health. In some cases, these barriers may act as feedback loops, health affecting economic productivity and vice versa. These include (a) a lack of adequate storage facilities (b) exposure to aflatoxins produced by the Aspergillus fungus (c) and exposure to pesticides due to a lack of personal protective equipment. Generally, groundnut farmers have benefitted from the efforts of PROFIT+, though challenges remain. Farmers consistently report increased their crop yields; however, access to outside markets has yet to materialize. Exposure to both aflatoxins and pesticides are concerning, particularly in areas of high stunting rates as these chemicals may exacerbate the effects of malnutrition. Further, changing weather patterns in the context of climate change increase issues faces by smallholder farmers.