Cooking-Related Determinants of Respiratory Irritation Symptoms: A Cross-Sectional Study in Rwanda Público

Abstract

Household air pollution (HAP) exposure produced by the combustion of solid fuels (e.g. wood, charcoal, plant waste, animal feces, etc.) contributes to the deaths of 5.5 million people each year, including 500,000 children under 5 year of age. HAP is linked to the development of non-communicable respiratory illnesses that lead to premature deaths among those exposed such as chronic obstructive pulmonary disease (COPD) and lung cancer. This is particularly concerning for children under 5, because about half of the pneumonia deaths among young children are linked to HAP exposure. There is currently a large body of research that has confirmed the link between PM2.5 produced from burning solid fuels and the increase in the odds of developing chronic conditions such as lung adenocarcinomas 1.55 (95%CI: 1.05–2.29). However, research that explores the interconnectedness of the type of stove used to cook, the type of fuel to cook, and the location of where meals are prepared in relation to respiratory health outcomes is more limited. Moreover, there are a limited amount of studies that evaluate the relationship of these factors to the prevalence of respiratory irritation symptoms (RIS) that are potentially indicative of chronic disease development. Through this study, our main aim was to establish if the above cooking determinants significantly predicted the survey respondent’s and children under-five’s odds of reported RIS. Our analysis indicates that the cooking determinants were not as influential to respondents and children experiencing acute and chronic RIS as other factors such as age, sex, lighting used in the home, and smoking status of the respondent. This study faces several limitations that hinders the validity of the results, including low sample size and because it was cross-sectional, lack of follow-up with survey respondents. Although we did not find that cooking behaviors were associated with increased health risk in our survey population, these behaviors have been shown to increase risk in other settings, and this study has identified modifiable risk factors which can be targeted in addition to transitioning to cleaner cooking options.

Table of Contents

Chapter 1: Background………………….……………………………………………………...1

1.1.Introduction…………………………………………………………………………………...1

1.2.Contribution of Solid Fuel Combustion to HAP……………………………………………...1

1.3.Factors Associated with Elevated HAP in Rwanda…………………………………………..2

1.4.Risk Factors for HAP exposure and Related Illness………………………………………….3

1.5.Other Related Potential Health Effects……………………………………………………….4

1.6.Study Aims and Hypotheses………………………………………………………………….5

Chapter 2: Study Design and Methodology…………………………………………………....8

2.1.Study Population……………………………………………………………………………...8

2.2.Variables……………………………………………………………………………………....8

2.3.Sample Size Calculation………………………………………………………………………9

2.4.Sampling Strategy and Data Collection Methods ……………………………………….......10

2.5.Ethics………………………………………………………………………………………....11

2.6.Data Analysis Methods……………………………………………………............................11

Chapter 3: Results........................................................................................................................16

3.1. Descriptive Analysis………………………………………………………………………...16

3.1.1. Household and Survey Respondent Characteristics……………………………………....16

3.1.2. Method Used to Light Homes……………………………………………………………..18

3.1.3. Educational levels of Survey Respondents and Partners………………………………….19

3.1.4. Wealth Indicators………………………………………………………………………….19

3.1.5. Fuel Type and Stove Type Descriptive Statistics……………………………………….....20

3.1.6. Primary and Secondary Cooking Locations……………………………………………....21

 

3.2. Univariate Analysis………………………………………………………………………….23

3.2.1. Association between Cooking Location and Fuel Type ……………………………….....23

3.2.2. Association between Cooking Location and Primary Stove Type………………………..24

3.2.3. Acute RIS Experienced by Children………………………………………………………25

3.2.4. RIS Experienced by Survey Respondents over the Past Day and Past 6 Months…………28

3.2.5. RIS and Non-RIS Symptoms Experienced During Cooking and Non-Cooking Periods....31

 

3.3. Multivariate Analysis………………………………………………………………………..32

3.3.1. Survey Respondent Acute and Chronic RIS Symptoms…………………………………..32

3.3.2. Child Acute RIS…………………………………………………………………………...34

3.3.3. Correlation between Child and Adult Acute RIS…………………………………………36

3.3.4. Acute non-RIS Symptoms for Cooks……………………………………………………..37

 

Chapter 4: Discussion and Limitations………………………………………………………..38

Chapter 5: Conclusion and Recommendations……………………………………………….45

References……………………………………………………………………………………….48

Appendix A……………………………………………………………………………………...53

Appendix B……………………………………………………………………………………...56

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Environmental Sciences Environmental Health
Palavra-chave	symptoms household air pollution respiratory irritation disease
Committee Chair / Thesis Advisor	Clasen, Thomas, Emory University
Committee Members	Tolbert, Paige, Emory University Kirby, Miles, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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