Cundale Katie, Thomas Ranjeeta, Malava Jullita Kenala, Havens Deborah, Mortimer Kevin, Conteh Lesong
Health Economics Group, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Pl, London W2 1PG, UK.
Health Economics Group, School of Public Health, Imperial College London, St Mary's Hospital, Norfolk Pl, London W2 1PG, UK; Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St Mary's Campus), Imperial College London, London, Norfolk Pl, London W2 1PG, UK.
Soc Sci Med. 2017 Jun;183:1-10. doi: 10.1016/j.socscimed.2017.04.017. Epub 2017 Apr 13.
Pneumonia is the leading cause of mortality for children under five years in sub-Saharan Africa. Household air pollution has been found to increase risk of pneumonia, especially due to exposure from dirty burning biomass fuels. It has been suggested that advanced stoves, which burn fuel more efficiently and reduce smoke emissions, may help to reduce household air pollution in poor, rural settings. This qualitative study aims to provide an insight into the household costs and perceived benefits from use of the stove in Malawi. It was conducted alongside The Cooking and Pneumonia Study (CAPS), the largest village cluster-level randomised controlled trial of an advanced combustion cookstove intervention to prevent pneumonia in children under five to date. In 2015, using 100 semi-structured interviews this study assessed household time use and perceptions of the stove from both control and intervention participants taking part in the CAPS trial in Chilumba. Household direct and indirect costs associated with the intervention were calculated. Users overwhelming liked using the stove. The main reported benefits were reduced cooking times and reduced fuel consumption. In most interviews, the health benefits were not initially identified as advantages of the stove, although when prompted, respondents stated that reduced smoke emissions contributed to a reduction in respiratory symptoms. The cost of the stove was much higher than most respondents said they would be willing to pay. The stoves were not primarily seen as health products. Perceptions of limited impact on health was subsequently supported by the CAPS trial data which showed no significant effect on pneumonia. While the findings are encouraging from the perspective of acceptability, without innovative financing mechanisms, general uptake and sustained use of the stove may not be possible in this setting. The findings also raise the question of whether the stoves should be marketed and championed as 'health interventions'.
肺炎是撒哈拉以南非洲地区五岁以下儿童死亡的主要原因。研究发现，家庭空气污染会增加患肺炎的风险，特别是由于接触燃烧不清洁的生物质燃料所致。有人提出，先进的炉灶能够更高效地燃烧燃料并减少烟雾排放，这可能有助于减少贫困农村地区的家庭空气污染。这项定性研究旨在深入了解马拉维使用这种炉灶的家庭成本和感知效益。该研究是与“烹饪与肺炎研究”（CAPS）同步进行的，CAPS是迄今为止针对五岁以下儿童预防肺炎的先进燃烧炉灶干预措施进行的最大规模的村级随机对照试验。2015年，本研究通过100次半结构化访谈，评估了参与奇隆巴CAPS试验的对照组和干预组参与者的家庭时间使用情况以及对炉灶的看法。计算了与该干预措施相关的家庭直接和间接成本。用户绝大多数都喜欢使用这种炉灶。报告的主要好处是烹饪时间减少和燃料消耗降低。在大多数访谈中，健康益处最初并未被视为该炉灶的优点，不过在被提示后，受访者表示烟雾排放减少有助于减轻呼吸道症状。炉灶的成本远高于大多数受访者表示愿意支付的价格。炉灶并未主要被视为健康产品。CAPS试验数据随后支持了对健康影响有限的看法，该数据显示对肺炎没有显著影响。虽然从可接受性的角度来看，这些发现令人鼓舞，但如果没有创新的融资机制，在这种情况下，这种炉灶可能无法得到广泛采用和持续使用。这些发现还引发了一个问题，即这种炉灶是否应作为“健康干预措施”进行推广和倡导。
