Household Air Pollution and Health Outcomes in Malawi: What Scope for Interventions to Reduce Exposure?
*Names in bold indicate Presenter
We find that primary cooks in rural areas have significantly higher odds of all cardiopulmonary symptoms analyzed (e.g., chest pain, difficulty breathing, rapid breathing etc.), and respiratory symptoms such as persistent phlegm and cough, relative to their urban counterparts. Controlling for individual- and household-level confounding, low quality firewood is associated with significantly higher odds of primary cooks experiencing shortness of breath while climbing, cough and phlegm at night, itchy skin rash, difficulty concentrating, forgetfulness, and dizziness compared to high quality firewood. Charcoal has a significant protective effect on chest pain and difficulty breathing, but significantly higher odds of persistent phlegm and itchy skin rash, compared to high quality firewood, when including confounders. Use of crop residues as a fuel has a significant association with higher odds of shortness of breath at rest, phlegm at night, dry irritated eyes, forgetfulness, dizziness but protective effect on cough in the morning, relative to high quality firewood, controlling for confounders. The addition of covariates removes significant association between traditional stove use or indoor cooking, and the odds of any respiratory, cardiopulmonary, irritation and neurological symptoms.
Our findings underscore the importance of promoting higher-quality biomass fuels along with improved cooking technologies, in heavily biomass-dependent Malawi. Policy-makers must target separate interventions for rural and urban areas that differ in their stove use (charcoal stove-users are largely concentrated in urban areas) and fuel availability. Given evidence of lagging improved cookstove adoption in sub-Saharan Africa, and our findings related to the influence of reliance on low quality fuelwood on health outcomes, future interventions could involve tree planting for high quality fuelwood and encouraging cultivation of crops like pigeon pea that meet dual household needs of fuel and food.