Exposure to household air pollution among women and children in Ethiopia: Socio-cultural factors and the association with airway health

Abstract: Abstract Using solid fuel generates emissions of many health-damaging pollutants including inhalable fine particulate matter (PM2.5). Such exposure is known to cause morbidity and mortality in low- and middle-income countries, including Ethiopia, where solid fuel, mainly wood, is a primary source of energy. This thesis aimed to explore the reasons of using solid fuel and traditional stoves and to determine the levels of pollution and associated effects on the respiratory health of mothers and their children. Qualitative exploration in the first paper showed that economic status, lack of commitment, cultural views and concern along with safety and security issues were barriers to change from traditional to cleaner means of cooking in rural areas of Butajira, Ethiopia. The com-munity perceived wood smoke to have negative health effects on their eyes and respiratory health but as beneficial for postpartum mothers and newborns, ridding the house of bad smells and insects. The second paper involved 545 mothers from urban and rural settings to assess the association between solid fuel use and self-reported respiratory symptoms and lung function, as determined by spirometry with reversibility testing. Significantly higher prevalence of cough, phlegm, wheeze and irritation of nose and lower forced expiratory volume in the first second (FEV1) were found among mothers using solid fuels than among those using cleaner fuels. The odds of developing at least one respiratory symptom were twice as high for women who cooked inside the house when compared with those using cleaner fuels. In the third paper, nasopharyngeal swabs were taken from 168 mothers and 175 children and analyzed for bacteria and virus by multiplex PCR. Detection of Streptococcus pneumoniae and Haemophilus influenzae was significantly more frequent among solid fuel users, when compared with those using cleaner energy. In the fourth paper, measurements of PM2.5 were conducted in 147 rural households for 24 hours during both rainy and dry seasons. The 24-hour mean level of PM2.5 was 410 µg/m3, 16 times higher than the WHO 24-hour mean air quality guideline of 25 µg/m3. Based on the high level of PM2.5 emission and sole reliance on solid fuel use, there is an unaddressed threat for the health of Ethiopian women and children. Sustainable measures to shift to the use of cleaner energy along with education for awareness of their health and cultural myths, need to be addressed to solve this problem.