Biomass Cooking Fuels and Health Outcomes for Women in Malawi

Abstract

In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy.

Household Air Pollution from Burning Biomass for Cooking and Heating – A Review of Health Hazards and Intervention Programs

“…Burning crop residues is associated with chest pains, shortness of breath, phlegm, dizziness, and dry eyes. Though the researchers found charcoal emitted less PM than wood and other biomass, they would not recommend switching to charcoal due to diminishing forest reserves, and very high CO exposure from burning it [18].…”

“…In Malawi, researchers found that compared to closed kitchens, kitchens with air exchange reduced PM2.5 1 hour concentrations by 93-98%. They also cited a 57-73% reduction in exposure for outdoor vs. indoor kitchens [18].…”

“…In Malawi, researchers found that the exposure and impact on health depended on choice of fuel (rural -high and low quality firewood, urbancharcoal), stove type (rural -traditional three-stone, urban -metal charcoal stoves), and other environmental exposures (rural -biomass burning, urban -garbage burning, and vehicle emission exposure) [18].…”

Environmental Health Research in Africa: Important Progress and Promising Opportunities

“…Respiratory disease represented another major health outcome impacted by indoor air pollution; evaluated as the primary outcome of interest or a relevant co-morbidity in 77 of the identified indoor air pollution articles. This included articles describing general child respiratory health (Albers et al, 2015), acute lower respiratory tract infections in children (Buchner and Rehfuess, 2015), shortness of breath (Das et al, 2017), and asthma. Asthma and related morbidities were characterized in 37 articles and included outcomes such as asthma diagnosis and severity (Oluwole et al, 2017), asthma control (Kuti et al, 2017), allergen sensitization , and atopy (Morcos et al, 2011).…”

Land use and household energy dynamics in Malawi

“…While demand for biomass fuel grows in sub-Saharan Africa, rapid land use change is reducing the supply of high quality biomass and leading individuals to shift collection away from forests toward locations such as farms and fields that typically yield much lower per hectare quantities of biomass (Ahrends et al 2010; DeFries et al 2010; Jagger and Shively 2014). Changes in the supply of locally-available biomass fuels have implications for household fuel use and the exposure of women and children to harmful gasses and particulate matter associated with the incomplete combustion of low-quality biomass (Jagger and Shively 2014; Das et al 2016). Insights into the combined spatial and behavioral dynamics of woodfuel supply and demand are needed (Masera et al 2006; Rehfuess et al 2010).…”