‘Pneumonia has gone’: exploring perceptions of health in a cookstove intervention trial in rural Malawi

Abstract

IntroductionAir pollution through cooking on open fires or inefficient cookstoves using biomass fuels has been linked with impaired lung health and with over 4 million premature deaths per annum. However, use of cleaner cookstoves is often sporadic and there are indications that longer-term health benefits are not prioritised by users. There is also limited information about how recipients of cookstoves perceive the health benefits of clean cooking interventions. We therefore conducted a qualitative study alongside the Cooking and Pneumonia Study (CAPS).MethodsQualitative methods and the participatory methodology Photovoice were used in an in-depth examination of health perceptions and understandings of CAPS trial participants. Fifty participants in five CAPS intervention villages collected images about cooking. These were discussed in village-level focus groups and in interviews with 12 representative participants. Village community representatives were also interviewed. Four female and eight male CAPS fieldworkers took part in gender-specific focus groups and two female and two male fieldworkers were interviewed. A thematic content approach was used for data analysis.ResultsWe found a disconnect between locally situated perceptions of health and the biomedically focused trial model. This included the development of potentially harmful understandings such as that pneumonia was no longer a threat and potential confusion between the symptoms of pneumonia and malaria. Study participants perceived health and well-being benefits including: cookstoves saved bodily energy; quick cooking helped maintain family harmony.ConclusionA deeper understanding of narratives of health within CAPS showed how context-specific perceptions of the health benefits of cookstoves were developed. This highlighted the conflicting priorities of cookstove intervention researchers and participants, and unintended and potentially harmful health understandings. The study also emphasises the importance of including qualitative explorations in similar complex interventions where potential pathways to beneficial (and harmful) effects, cannot be completely explicated through biomedical models alone.

‘Why would they spend all this money and give us these items for free?’: Exploring precarity and power in a cleaner cookstove intervention in rural Malawi

“…Therefore, exploring and reflecting on how power was enacted and resisted within CAPS can contribute to ethical decision making about whether and how similar interventions should proceed. Further findings related to understandings of health and gender within CAPS are reported elsewhere [26,27].…”

“We threw away the stones”: a mixed method evaluation of a simple cookstove intervention in Malawi

“…In rural Malawi, where experiences of precarity, scarcity and food insecurity are common, these contextual realities often take precedence over externally proposed agendas such as ours. In a recent study exploring Malawian communities' perceptions of health within a trial of advanced cookstoves 8 , participants linked good health primarily to food security 9 . Thus the research imperative in such contexts should be for cleaner air solutions which avoid amplifying existing daily challenges for residents, as well as appropriately addressing shared concerns.…”