Community Perspectives on Barriers and Facilitators to Haap Reduction; Situating Practices in Context

Abstract

BACKGROUND: Sub-Saharan Africa (SSA) bears the greatest burden of adverse health outcomes linked to Household and Ambient Air Pollution (HAAP) with mortality rate of 187.1 per 100,000. Previous HAAP studies in SSA have focused on top-down supply based research on effectiveness of improved cook-stoves (ICS), their uptake, sustainability and safety among others. Little demand led HAAP research driven by community and bottom-up perspectives of the targeted poor communities has been done.. We conducted a qualitative study aimed at understanding community perspectives on barriers and facilitators to uptake of HAAP reduction strategies in a rural village in southern Malawi. METHODS: Our study was baseline of a larger project that used acommunity-led-mixed-methods participatory settings approach’ to determine if a suite of interventions would reduce HAAP in a Malawian rural setting. Our data collection approaches included focus group discussions (FGDs), and photo-voice with consenting community members.. Data on community practices contributing to household and ambient pollution facilitators and barriers were isolated. FGDs were recorded, transcribed verbatim in the local language and translated into English using standard procedures. Transcripts and notes were analyzed thematically aided by Dedoose qualitative data analysis software (version 9.0.54). RESULTS: A majority of study participants were aware of health and environmental risks associated with behaviours and practices such as usage of the traditional three-stone-fire for cooking and open burning of household and agricultural waste. However, limited access to improved cook stoves due to availability, and affordability were cited as key barriers to adoption and uptake.. On the other hand, study participants mentioned perceived health benefits from using HAAP reduction technologies, their efficiency when cooking or lighting, portability and durability among others as facilitators of adoption and uptake. CONCLUSION: Studies and interventions aimed to empower, change or modify HAAP related health risk in poor communities of SSA such as Nsungwi village in Malawi are integral for equity in development and for targeted gains in global health. The current study presents hope that if grassroots communities are empowered, involved and given the opportunity to decide, map out and guide their developmental options; development change is possible.. The study also demonstrates that if communities are allowed to own projects there is room for sustainability of efforts.