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INTRODUCTION

Worldwide, 2.4 billion people rely on solid fuels such as wood or charcoal for cooking, leading to approximately 3.2 million deaths per year from illnesses attributable to household air pollution. Across Africa, household air pollution generated by solid fuel use accounts for nearly 700,000 deaths each year. Most studies to date have focused either household air pollution exposure, its impacts on particular health outcomes or on the efficacy of mitigation interventions. However, the economic, social, and cultural determinants of household air pollution in Africa are still poorly understood. The purpose of this study was to explore people's experience of using solid fuels for cooking in two informal settlements, Ndirande in Malawi and Mukuru in Kenya, and the associated harms caused by household air pollution.

METHODS

We adopted a community-based participatory method, photovoice, which was conducted with 9 participants in Ndirande and 10 participants in Mukuru. Participants took pictures reflecting their experiences and perceptions of household air pollution harms over a two-week period, and later discussed, sorted and analysed those in a series of meetings. Thematic analysis was used to analyse the data.

RESULTS

With their pictures, participants described fuel stacking and switching behaviours in their communities. They described a mix of charcoal, firewood and other biomass fuels use. They also expressed their awareness and perceptions of the harms caused by smoke when cooking. Participants explained the simple behaviours used by residents to minimize the harms of household air pollution to themselves and within their own household. Other themes explored the roles and responsibilities for procuring fuels in the home, and the stated solutions required to address the issues and manage the transition to cleaner fuels in those informal settlements.

CONCLUSION

This study highlights not only the need to understand the daily life, priorities and concerns of those who use solid fuels on informal settlements, but also the urgency to place them and their experience at the heart of the solutions that will reduce the health harms of household air pollution.

引言

在全球范围内，24亿人依靠木材或木炭等固体燃料做饭，每年约有320万人因家庭空气污染导致的疾病死亡。在非洲，使用固体燃料产生的家庭空气污染每年造成近70万人死亡。迄今为止，大多数研究要么聚焦于家庭空气污染暴露情况、其对特定健康结果的影响，要么关注缓解干预措施的效果。然而，非洲家庭空气污染的经济、社会和文化决定因素仍鲜为人知。本研究的目的是探讨在马拉维的恩迪兰德和肯尼亚的穆库鲁这两个非正式定居点中，人们使用固体燃料做饭的经历以及家庭空气污染造成的相关危害。

方法

我们采用了基于社区的参与式方法——摄影之声，在恩迪兰德对9名参与者、在穆库鲁对10名参与者开展了该研究。参与者在两周时间内拍摄反映他们对家庭空气污染危害的经历和看法的照片，随后在一系列会议中对这些照片进行讨论、分类和分析。采用主题分析法对数据进行分析。

结果

参与者通过照片描述了他们社区中的燃料堆放和转换行为。他们描述了木炭、柴火和其他生物质燃料混合使用的情况。他们还表达了对烹饪时烟雾造成危害的认识和看法。参与者解释了居民为将家庭空气污染对自身及家庭内部的危害降至最低而采取的简单行为。其他主题探讨了家庭中采购燃料的角色和责任，以及在这些非正式定居点解决问题和管理向更清洁燃料过渡所需的既定解决方案。