A Behavioural Intervention to Reduce Child Exposure to Indoor Air Pollution

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A Behavioural Intervention to Reduce Child
Exposure to Indoor Air Pollution

• Brendon Barnes, Angela Mathee, Halina Rollin
  Nkosingiphile Mngadi

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Indoor air pollution and acute lower respiratory
tract infections

• 50 of the worlds population and
• 90 of rural households in developing countries
  still reliant on biomass fuels.
• Children living in homes burning polluting fuels
  are 9.3 times more likely to develop ALRIs in
  South Africa.
• ALRIs account for 33 of all deaths of infectious
  diseases.
• 27 of the entire burden of infectious disease.
• 80 occurs in children under 5 years.
• In South Africa, ALRIs account for 14 of all
  deaths of children under 5.
• At the minimum, 7 times higher than estimates in
  Western Europe.

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Energy Ladder
Electricity Gas Kerosene Increase cost
Coal Increase health Wood Crop
Residues Animal Dung
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Aims

• To highlight why the current emphasis on
  behaviour change in relation to Indoor Air
  Pollution (IAP).
• To present the methodology and preliminary
  findings of a study currently being conducted in
  South Africa.

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Why study behaviour change to prevent exposure to
IAP?

• Possibly less expensive and more sustainable than
  other prevention interventions.
• Technical interventions
• Costly
• Socio-cultural factors

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Why study behaviour change to prevent exposure to
IAP?

• Not much is known about the relationship between
  behaviour change and the prevention of exposure
  to IAP.

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The study of behaviour change to reduce child
exposure to IAP in South Africa

• Aim to design, implement and evaluate a
  behavioural intervention to reduce child exposure
  to IAP.
• Divided into two phases
• Phase 1 formative phase
• Phase 2 design, implementation and evaluation
  phase

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Phase one aim

• To inform the design of the behavioural
  intervention to be designed, implemented and
  evaluated in phase 2.

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Phase one objectives

• To describe all fuel use practices that might
  affect child exposure to IAP.
• To describe and understand how practices might
  differ between a high and a low ALRI group.
• To classify those practices as potentially
  positive or negative.
• To understand the factors that influence those
  practices.
• To make recommendations as to which negative
  practices should be improved and in what ways.

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Setting

• Brooksby and Ensulsrust (North West Province of
  South Africa).
• Setswana
• High levels of poverty and unemployement.
• Rural, isolated, flat, dry and extremely cold
  during winter.
• High levels of IAP ALRIs.
• Children were in the burning room during burning.
• Ventilation practices declined during winter.
• Distinct lack of ambient air pollution.

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Research Participants

• 72 households (36 high ALRI and 36 low ALRI).
• Child under 5 years of age.
• Child present throughout the day.

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Sampling

• Community wide survey of ALRIs.
• ALRI sampling questionnaire.
• Background.
• ALRI symptoms in the past 2 weeks
• ALRI symptoms in the past 6 months.
• ALRI diagnoses in the past 6 months.
• Environmental conditions, immunization status,
  smoking and crowding

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Sampling criteria

• High ALRI group
• Been diagnosed with an ALRI in the past 6 months
  OR
• Been taken to a doctor in the past 6 months 5
  or more symptoms in the past 6 months (including
  the past 2 weeks).

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Sampling criteria

• Low ALRI group
• Never been diagnosed with an ALRI in the past 6
  months
• Could have been taken to a doctor/health worker
  in the past 6 months for respiratory illness BUT
  
• 4 or less symptoms in the past 6 months
  (including the past 2 weeks).

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Sample
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Observations

• 20 high and 20 low ALRI households.
• Observation instrument
• Background information.
• Fuel use (type, appliance, location, length of
  burning, purpose).
• Child location in relation to mother and others.
• Activities.
• Ventilation.
• First to the last burning activity (06h30 to
  19h00).

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Interviews

• After each observation.
• Semi-structured interview schedule.
• Factors underlying practices (based on
  observations).
• Audio-tape recorded.

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Air quality monitoring

• Continuous (24 hour) respirable dust monitoring
  (PM10).
• 4 households.
• 4 days.
• After observations and interviews.

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Focus group interviews

• Yet to be completed.
• 8-12 high ALRI and 8-12 low ALRI, 2 focus groups
  each.
• To identify community norms.
• Validate findings in semi-structured interviews.
• To fill in information gaps identified in
  preliminary analysis.

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Preliminary results

• All households burned indoors.
• Location and burning time varied.
• Wood most commonly used, followed by animal dung,
  paraffin and maize cobs.
• This varied by socio-economic status and time of
  the month.
• Fuel sharing.

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Preliminary results ctd.

• Appliances coal stove and paraffin stove.
• Handed down through generations.
• No coal used.
• Often in state of disrepair
• Combinations varied
• Purpose for cooking, space heating and water
  heating.

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Preliminary results ctd.

• All observation children exposed to at least some
  level of IAP.
• Young children carried on mothers backs.
• Older children kept near the stove Better near
  the stove and warm than outside and sick.
• Better within eyesight than getting up to
  mischief.
• Exposure time and location varied.
• Outside during the afternoons.

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Preliminary results ctd.

• Ventilation varied from no windows/doors open to
  all windows/doors open.
• Most common practice is open until smoke
  disappears then close.
• Smoke equals danger, no smoke equals safety.

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Way forward

• To complete analysis of phase 1.
• To select the key negative practices for
  intervention.
• Phase 2
• To design a possible intervention/s.
• TIPs phase.
• Implementation and evaluation phase.