A health intervention or a kitchen appliance? Household costs and benefits of a cleaner burning biomass-fuelled cookstove in Malawi

Abstract

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’.

Inflammatory health effects of indoor and outdoor particulate matter

“…In Malawi and Guatemala studies tested interventions to enhance cleanerburning biomass-fueled cook stoves, with the goal to reduce pneumonia incidence in young children. 117,118 However, there is not sufficient evidence to confirm that biomass-burning particle exposure is linked to the increasing risk of pneumonia in children. A better design of stove or fuel interventions producing lower average exposures than current chimney stoves might be needed to substantially reduce pneumonia in populations heavily exposed to biomass fuels.…”

Drivers and Barriers to Clean Cooking: A Systematic Literature Review from a Consumer Behavior Perspective

“…• Household composition [4,8,15,29,33,34,37,40,65,70,71,74,[96][97][98] Household size has a negative effect on ICS adoption because ICS are perceived as too small for large families. Abundant labor force to collect fuel also reduces the intention to adopt ICS, while the number of children can increase ICS adoption.…”

“…Convenience and uses [4,29,39,46,57,78,83,84,87,88,92,[95][96][97][98][99] Households perceive the convenience of ICS in terms of ease of use and time savings. ICS do not produce enough warmth and light.…”

“…Health-related impacts [43,78,81,84,96,100,101] Households generally show low awareness about the risks related to the use of traditional stoves. However, they associate ICS with the improvement of health (e.g., reduced coughing, eye pain, allergy, headache).…”

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“…Furthermore, a unique feature of many energy-related technologies is the capacity to reduce women's time burden for daily and/or arduous tasks. For example, moving from traditional biomass stoves to cleaner and more efficient cookstoves and fuels, such as improved biomass stoves or liquefied petroleum gas (LPG), has been shown to significantly reduce time required for cooking and eliminate the need to forage for fuel (Cundale et al 2017;Gould and Urpelainen 2018). Therefore, women energy entrepreneurs who sell these types of energy-related technologies are able to benefit from the technologies themselves.…”