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

Acceptability of improved cook stoves-a scoping review of the literature

Improved cooking stoves (ICS) are intended to reduce indoor air pollution and the inefficient use of fuel yet there is often reticence to shift permanently to ICS. Drawing on a scoping review, this article aims to provide a comprehensive overview of factors affecting the acceptability of ICS. A scoping review was carried out using a systematic search strategy of literature. All articles identified in three major databases that included Pubmed/Medline, Scopus and Web of Science underwent screening followed by content analysis to generate major and minor themes using a structured social level analysis. The analysis identified factors at micro, meso, and macro-social levels that potentially contribute to an adoption of an improved cooking stove (ICS). The findings from the review were discussed and refined among a group of experts identified based on their prior academic or commercial contributions related to ICS. Adoption of ICS was dependent on functional outputs (e.g. cleanliness, and cooking efficiency) while meeting local social and cultural demands (e.g. cooking large meals, traditional meals, and taste). Health and cost benefits played an important role in the adoption and sustained use of ICS. The adoption of ICS was enabled by use among neighbors and other community members. Sustained use of ICS depended on fuel supply, fuel security and policies promoting its use. Policies offering subsidies in support of supply-chain garnered institutional trust among community members and resulted in the sustained use of ICS. In addition to design attributes of ICS that could meet both scientific and social demands, policies supporting promotion of clean energy, subsidies and supplies can substantially enhance the adoption of ICS.

Exploring the use of solid fuels for cooking and household air pollution in informal settlements through photovoice: The Fuel to Pot study in Ndirande (Malawi) and Mukuru (Kenya)

INTRODUCTION

Worldwide, 2.4 billion people rely on solid fuels such as wood or charcoal for cooking, leading to approximately 3.2 million deaths per year from illnesses attributable to household air pollution. Across Africa, household air pollution generated by solid fuel use accounts for nearly 700,000 deaths each year. Most studies to date have focused either household air pollution exposure, its impacts on particular health outcomes or on the efficacy of mitigation interventions. However, the economic, social, and cultural determinants of household air pollution in Africa are still poorly understood. The purpose of this study was to explore people's experience of using solid fuels for cooking in two informal settlements, Ndirande in Malawi and Mukuru in Kenya, and the associated harms caused by household air pollution.

METHODS

We adopted a community-based participatory method, photovoice, which was conducted with 9 participants in Ndirande and 10 participants in Mukuru. Participants took pictures reflecting their experiences and perceptions of household air pollution harms over a two-week period, and later discussed, sorted and analysed those in a series of meetings. Thematic analysis was used to analyse the data.

RESULTS

With their pictures, participants described fuel stacking and switching behaviours in their communities. They described a mix of charcoal, firewood and other biomass fuels use. They also expressed their awareness and perceptions of the harms caused by smoke when cooking. Participants explained the simple behaviours used by residents to minimize the harms of household air pollution to themselves and within their own household. Other themes explored the roles and responsibilities for procuring fuels in the home, and the stated solutions required to address the issues and manage the transition to cleaner fuels in those informal settlements.

CONCLUSION

This study highlights not only the need to understand the daily life, priorities and concerns of those who use solid fuels on informal settlements, but also the urgency to place them and their experience at the heart of the solutions that will reduce the health harms of household air pollution.

The effect of chimney fitted improved stove on kitchen fine particulate matter (PM2.5) concentrations in rural Ethiopia: Evidence from a randomized controlled trial

BACKGROUND

Millions of Ethiopian people cook with biomass fuels using traditional stoves, releasing harmful pollutants and contributing to a significant public health crisis. Improved stoves offer a potential escape route, but their effectiveness needs close scrutiny. This study delves into the impact of chimney-fitted stoves on kitchen PM2.5 concentrations in rural Ethiopian households.

METHOD

We conducted a randomized controlled trial with 86 households equally divided (1:1 ratio) between intervention and control groups. The 24-h average kitchen PM2.5 concentrations was measured using Particle and Temperature Sensor (PATS+) at baseline and after intervention. All relevant sociodemographic and cooking related characteristics were collected at baseline and dynamic characteristics were updated during air monitoring visits. Three distinct statistical models, including independent sample t-tests, paired sample t-tests and one-way analysis of variance were used to analyze the data using Statistical Package for the Social Sciences (SPSS) software for Windows (v 24.0).

RESULT

At baseline, the average 24-h kitchen PM2.5 concentrations were 482 μg/m3 (95% CI: 408, 557) for the control and 405 μg/m3 (95% CI: 318, 492) for the intervention groups. Despite remaining elevated at 449 μg/m3 (95% CI: 401, 496) in the control group, PM2.5 concentrations reduced to 104 μg/m3 (95% CI: 90,118) in the intervention group, indicating a statistically significant difference (t = 6.97, p < 0.001). All three statistical analyses delivered remarkably consistent results, estimating a PM2.5 reductions of 74% with the before-and-after approach, 76% when comparing groups, and 74% for difference in difference analysis. Beyond the overall reduction, homes with primary school completed women, larger kitchens, smaller family size, and those specifically baking Injera (the traditional energy-intensive staple food), witnessed even greater drops in PM2.5 levels.

CONCLUSION

Pregnant women in our study encountered dangerously high PM2.5 exposures in their kitchens. While the intervention achieved a significant PM2.5 reductions, unfortunately remained above the WHO's safe limit, highlighting the need for further interventions.