Women’s Perceptions and Attitudes to Household Air Pollution Exposure and Capability to Change Cooking Behaviours in Urban Rwanda

Abstract

Household air pollution (HAP) from cooking on biomass fuel presents significant health, environmental and socioeconomic consequences worldwide. However, there is a lack of understanding of the factors influencing cooking behaviours that affect HAP exposure in Rwanda (e.g., cooking location, removing children from the cooking area). Sixteen qualitative in-depth interviews were undertaken with women living in an underprivileged neighbourhood in Kigali, Rwanda. Deductive thematic analysis was carried out using the Behaviour Change Wheel (Capability—ability to engage with chosen activity, Opportunity—factors which are beyond the individual’s control and Motivation—brain processes which direct behaviour: COM-B) to determine the thoughts and perceptions around cooking location and removing children from the cooking area. Facilitators and barriers were subsequently identified within the COM-B framework for the following HAP mitigation interventions: outdoor cooking, removing children from the cooking area and Liquid Petroleum Gas (LPG) use. Of the 16 interviewed, 12 cooked outdoors (75%), two (12.5%) cooked indoors (in the main home) and two (12.5%) in a separate kitchen. Despite the majority cooking outdoors, this was reported not to be a favourable cooking location. Levels of awareness of HAP sources and knowledge of the health effects of air pollution were observed to be limited, reducing women’s capability to change, along with stated barriers of cost, housing constraints and safety. Factors out of the individuals’ control (opportunities) included weather, socio-economic and educational factors. Preconceived beliefs, experiencing smoke reduction and the briefly described short-term health effects, directed motivation. Furthermore, participants identified a need for community-based education as a facilitator to changing their behaviour. Despite a high level of observed motivation towards reducing HAP exposure, many women lacked the capability and opportunity to change their behaviour. There are research and policy implications concerning development of community-based interventions which involved end-users and relevant stakeholders in the development process.

Pregnant women’s perception on the health effects of household air pollution in Rural Butajira, Ethiopia: a phenomenological qualitative study

“…They identified eye irritation and respiratory problems like coughing, sneezing and asthma were the major health problems caused by household air pollution exposure. This finding corresponds with previously published research [ 27 , 30 , 31 ]. Evidence also suggests air pollution can cause oxidative stress and inflammation in the smaller airways, leading to the exacerbation of asthma and chronic bronchitis, airway obstruction and decreased gas exchange.…”

“…The barriers to tackle household air pollution are complex and multifaceted, with financial constraints; spouse negligence, lack of full autonomy by the women and lack of knowledge were some of the major challenges mentioned by the study participants. This was also mentioned in previous research in Nepal, Rwanda and Kenya [ 27 , 30 , 31 , 41 ], and possibly due to the lack of involvement of men in maternal healthcare services. It is known in many developing countries that men are the key decision-makers and chief providers of economic resources for their wives and their role is highly influential in women’s health care activities, especially in indoor health [ 42 ].…”

Health risk perceptions of household air pollution and perceived benefits of improved stoves among pregnant women in rural Ethiopia: a mixed method study

“…Both quantitative and qualitative data in this study indicated that the interviewed pregnant women have a relatively high health risk perception related to exposure to HAP. This is in agreement with other qualitative73–75 and mixed76 77 studies that reported most participating women were familiar with the health effects of HAP from biomass fuel use 78 79. Similarly, a study in Rwanda showed that almost all of the respondents reported being concerned for their and their family’s health associated with HAP 80.…”

“…The reported high health risks perception of HAP and perceived benefit of improved stove in this study are promising for the effectiveness of future prevention efforts. The health risk perception of any hazards and perceived benefits of certain intervention are reported as key component of many health behaviour change theories 45 47 75 100. Consequently, any public health interventions aimed at reducing HAP in this setting in particular and in LMICs in general need to consider local culture including perception towards the health risk and benefits of intervention for effective adoption and use of interventional technologies as evidenced in previous studies 50 113…”

Pollution from cooking in rural and poor urban households of Africa: A methodological review

“…Even after accounting for the environmental advantages of conserving trees, the LPG is ahead of biomass stoves. Woolley et al (2022) reported that in Rwanda, levels of HAP source awareness and understanding of the health impacts of air pollution were low among women, reducing their capability to change their behaviour, along with barriers of cost, housing constraints and safety. Abera et al (2021) reported that lack of air pollution regulations were present in 45% of African nations, except for Cameroon, that implemented the WHO guidelines for NO 2 , ozone (O 3 ), PM 10 and PM 2.5 .…”