Saleh Sepeedeh, Sambakunsi Henry, Makina Debora, Kumwenda Moses, Rylance Jamie, Chinouya Martha, Mortimer Kevin
Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
Malawi-Liverpool Wellcome trust Clinical Research Programme, Blantyre, Malawi.
Wellcome Open Res. 2022 Jun 10;7:52. doi: 10.12688/wellcomeopenres.17544.3. eCollection 2022.
Air pollution exposure is responsible for a substantial burden of respiratory disease globally. Household air pollution from cooking using biomass is a major contributor to overall exposure in rural low-income settings. Previous research in Malawi has revealed how precarity and food insecurity shape individuals' daily experiences, contributing to perceptions of health. Aiming to avoid a mismatch between research intervention and local context, we introduced a simple cookstove intervention in rural Malawi, analysing change in fine particulate matter (PM ) exposures, and community perceptions. Following a period of baseline ethnographic research, we distributed , locally-made cookstoves, to all households (n=300) in a rural Malawian village. Evaluation incorporated village-wide participant observation and concurrent exposure monitoring using portable PM monitors at baseline and follow-up (three months post-intervention). Qualitative data were thematically analysed. Quantitative analysis of exposure data included pre-post intervention comparisons, with datapoints divided into periods of combustion activity (almost exclusively cooking) and non-combustion periods. Findings were integrated at the interpretation stage, using a convergent design mode of synthesis. Individual exposure monitoring pre- and post-cookstove intervention involved a sample of 18 participants (15 female; mean age 43). Post-intervention PM exposures (median 9.9μg/m [interquartile range: 2.2-46.5]) were not significantly different to pre-intervention (11.8μg/m [3.8-44.4]); p=0.71. On analysis by activity, background exposures were found to be reduced post-intervention (from 8.2μg/m [2.5-22.0] to 4.6μg/m [1.0-12.6]; p=0.01). Stoves were well-liked and widely used by residents as substitutes for previous cooking methods (mainly three-stone fires). Commonly cited benefits related to fuel saving and shorter cooking times. The cookstove intervention had no impact on cooking-related PM exposures. A significant reduction in background exposures may relate to reduced smouldering emissions. Uptake and continued use of the stoves was high amongst community members, who preferred using the stoves to cooking over open fires.
全球范围内，接触空气污染是导致呼吸系统疾病的一个主要负担。在农村低收入地区，使用生物质燃料做饭造成的家庭空气污染是总体接触污染的一个主要因素。此前在马拉维开展的研究揭示了不稳定和粮食不安全状况如何塑造个人的日常经历，并影响人们对健康的认知。为了避免研究干预措施与当地实际情况脱节，我们在马拉维农村地区引入了一项简单的炉灶干预措施，分析细颗粒物（PM）接触情况的变化以及社区的认知。在进行了一段时间的基线人种学研究之后，我们向马拉维一个农村村庄的所有家庭（n = 300）分发了当地制造的炉灶。评估工作包括在全村范围内进行参与式观察，并在基线和随访阶段（干预后三个月）使用便携式PM监测仪同步监测接触情况。对定性数据进行了主题分析。对接触数据的定量分析包括干预前后的对比，数据点分为燃烧活动期（几乎全是做饭）和非燃烧期。研究结果在解读阶段采用趋同设计综合模式进行整合。炉灶干预前后对18名参与者（15名女性；平均年龄43岁）进行了个人接触监测。干预后PM接触量（中位数9.9μg/m³[四分位距：2.2 - 46.5]）与干预前（11.8μg/m³[3.8 - 44.4]）相比无显著差异；p = 0.71。按活动进行分析时发现，干预后背景接触量有所减少（从8.2μg/m³[2.5 - 22.0]降至4.6μg/m³[1.0 - 12.6]；p = 0.01）。炉灶很受居民欢迎，并被广泛用作先前烹饪方式（主要是三块石头生火）的替代品。普遍提到的好处包括节省燃料和缩短做饭时间。炉灶干预措施对与做饭相关的PM接触量没有影响。背景接触量的显著减少可能与闷烧排放减少有关。社区成员对炉灶的接受度和持续使用率很高，他们更喜欢使用炉灶做饭，而不是明火做饭。
