IDPCC Policy Brief:Chronic Respiratory Diseases and Household Air Pollution in Rural Zambia

By: Isabella Frymoyer, Siobhan Mehrotra, Marianna Gutierrez Herrera

Abstract

Within rural Zambia, household air pollution (HAP) from open-flame cooking is one of the leading causes of chronic respiratory illness and premature death in women and children. Our policy presents an interim intervention combining both educational awareness and structural changes according to house type in order to minimize exposure and consequently mitigate the health effects of HAP.

Within rural Zambia, household air pollution (HAP) from open-flame cooking is one of the leading causes of chronic respiratory illness and premature death in women and children. Our policy presents an interim intervention combining both educational awareness and structural changes according to house type in order to minimize exposure and consequently mitigate the health effects of HAP.

Impacts of Household Air Pollution

Indoor pollution is the 6th highest factor in cause of death according to a Global Health risk report by WHO. 1 Cooking using biomass releases harmful pollutants such as carbon monoxide into the household atmosphere. 2 These pollutants are composed of particles measuring >10 microns (PM10) in diameter with those >2.5 microns (PM2.5) penetrating deep in the lungs causing many respiratory (and non-respiratory) diseases (Figure1). 3 Through our inter ventions, mortality related to particulate matter (PM) exposure can be significantly reduced, thus following SDG Targets 3.4, 3.9 & 7.b. 4

This policy aims to implement interim interventions using a mixed method approach. One half of the project will focus on the implementation and follow-through of an awareness raising education program. The second half will be focused on the construction of devices to improve ventilation which will vary for house type.

Policy Recommendations; Pre- Phase Work

1) Setting up the project would be under the guidance of the Zambian Ministry of Community Development and Social Services 5 that focuses on women’s empowerment and community development.

2) Hiring translators and local guides.

3) Establish a base to work out of in Kitwe.

4) Gain access to local rural leaders who can help us access affected populations.

5) Include female input to learn about domestic activities.

Phase 1: Increase Awareness

A study revealed that the annual rate of physican-diagnosed asthma in Z ambia is estimated at only 3%, 6 which suggests under-representation of affected people. 7

Suggested Methods:

1) Hire people to work as leaders.

2) Spread Awareness with local NGOs such as Citizen’s Environmental and Social Concern (CESCO). Diffusion of information through a radio shows would extend the reach of the project beyond the region.

3) Hold information sessions within the community.

Phase 2: Education Among Women

Potential Areas to Address:

1) Keeping children out of the kitchen. 2) Moving Cooking Outside 3) Limiting time in the kitchen. 4) Altering preparation practices.

Phase 3: Ventilation Construction

Suggested Targets:

1) Construct stove hoods in the stone and mortar houses and screen doors in mud houses. 2) The National Housing Authority of Z ambia could help with construction efforts. 7

Policy Mechanisms

This policy is within the greater international interest of reducing the effects of poverty as the consequences of poor energy infrastructure discourage autonomous development. 8 Although there is a lack of air quality standards in developing countries, political persuasion can be achieved through the incidence avoided of premature mortality, thus decreasing damage costs and the burden of disease. 9 Just as there is an incentive to decrease costs politically, the public will have an opposite mechanism within this policy. Our education program will help support the success of the structural interventions by outlining the impacts of HAP specifically to the local women. In order to avoid the health impacts related to CRDs, the willingness-to-pay of the people will increase in order to avoid these high damage costs, therefore increasing their willingness to purchase, maintain and keep the structural interventions.

Success of the Policy

The education program will measure success according to the number of schools enrolled and listeners on the radio show. The structural interventions will measure success according to the number of new stove hoods/screen doors installed according to the percentage of homes with adequate ventilation. The success of these policies overall will be measured according to: mortality rate attributed to household and ambient air pollution 10 , mortality rate attributed to CRDs, annual mean concentration of less than 2.5 um as an exposure indicator of ambient air pollution, a reduction in the measured pollutant carbon monoxide (CO), and the reported pollution reductions sustained over time.

Long Term Sustainability

While countries with similar levels of HAP have managed to adapt other recommendations, the socio-economic and political infrastructure within Zambia’s rural population would not be able to maintain these. For example, electricity and hydropower would not be cost-effective due to unstable power grids, and the environmental sustainability of alternative fuels such as kerosene and liquefied petroleum gas would create greater disadvantages in the short and long term. Even if implemented, other socio-cultural factors with cooking such as speed, ease of use, tradition, and safety make alternative stove and ventilation options unfavoured by the public which can reduce the efficiency of clean fuel policy implementation. 11 If ignored, this can cause fuel/stove stacking and mixing wherein traditional fuels/stoves are used alongside the intervention method, reducing its effectiveness. Therefore, we believe that a mixed-use approach will help aid the implementation of both interventions in the long term. Other limitations to consider are that even at relatively low concentrations, particulate matter (PM) can produce adverse effects on health, with no evidence of a safe level of exposure or a threshold below which no adverse health effects occur. 12 Therefore, our goal is to minimize exposure to a reasonable extent, making changes depending on the level of success seen.

Endnotes

1 - World Health Organization. Publication. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. WHO Library Cataloguing-in-Publication Data, 2009. 2 - Bruce, Nigel, Rogelio Perez-Padilla, and Rachel Albalak. “Indoor air pollution in developing countries: a major environmental and public health challenge.” Bulletin of the World Health organization 78 (2000): 1078-1092. 3 - Bruce, Nigel, Rogelio Perez-Padilla, and Rachel Albalak. “Indoor air pollution in developing countries: a major environmental and public health challenge.” Bulletin of the World Health organization 78 (2000): 1078-1092. 4 - United Nations. “The 17 Goals.” Sustainable Development Goals. Accessed February 27, 2022. https://sdgs.un.org/goals. 5 -“Home.” Ministry of Community Development and Social Services, 2022. https:// www.mcdss.gov.zm/. 6- Jumbe Marsden, E., Wa Somwe, S., Chabala, C. et al. Knowledge and perceptions of asthma in Zambia: a cross-sectional survey. BMC Pulm Med 16, 33 (2016). https:// doi.org/10.1186/s12890-016-0195-3. 7 - “National Housing Authority Zambia.” Be Forward Real Estate, 2019. https://real-estate-zambia.beforward.jp/2019/01/11/national-housing-authority-zambia/. 8 - González-Eguino, Mikel (2015). “Energy Poverty: An Overview.” Renewable and Sustainable Energy Reviews 47: 377–85. 9- Hunt, A. (2011), “Policy Interventions to Address HealthImpacts Associated with Air Pollution, Unsafe Water Supply and Sanitation, and Hazardous Chemicals”, OECD Environment Working Papers, No. 35, OECD Publishing. http://dx.doi. org/10.1787/5kg9qx8dsx43-en. 10 - United Nations. “SDG Indicators.” Sustainable Development Goals. United Nations. Accessed February 27, 2022. https://unstats.un.org/sdgs/metadata/?Text=&- Goal=3&Target=. 11 - Esong, M.B., Goura, A.P., Mbatchou, B.H.N. et al. Distribution of sources of household air pollution: a cross-sectional study in Cameroon. BMC Public Health 21, 318 (2021). https://doi.org/10.1186/s12889-021-10350-6. 12 - World Health Organization Europe. Publication. Air Quality and Health. WHO Europe Factsheets on Sustainable Development Goals, n.d.