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

Abstract

Background: Air pollution exposure is responsible for a substantial burden of respiratory disease globally. Household air pollution from cooking using biomass is a major contributor to overall exposure in rural low-income settings. Previous research in Malawi has revealed how precarity and food insecurity shape individuals’ daily experiences, contributing to perceptions of health. Aiming to avoid a mismatch between research intervention and local context, we introduced a simple cookstove intervention in rural Malawi, analysing change in fine particulate matter (PM2.5) exposures, and community perceptions. Methods: Following a period of baseline ethnographic research, we distributed ‘chitetezo mbaula’, locally-made cookstoves, to all households (n=300) in a rural Malawian village. Evaluation incorporated village-wide participant observation and concurrent exposure monitoring using portable PM2.5 monitors at baseline and follow-up (three months post-intervention). Qualitative data were thematically analysed. Quantitative analysis of exposure data included pre-post intervention comparisons, with datapoints divided into periods of combustion activity (almost exclusively cooking) and non-combustion periods. Findings were integrated at the interpretation stage, using a convergent design mode of synthesis. Results: Individual exposure monitoring pre- and post-cookstove intervention involved a sample of 18 participants (15 female; mean age 43). Post-intervention PM2.5 exposures (median 9.9μg/m3 [interquartile range: 2.2–46.5]) were not significantly different to pre-intervention (11.8μg/m3 [3.8–44.4]); p=0.71. On analysis by activity, background exposures were found to be reduced post-intervention (from 8.2μg/m3 [2.5–22.0] to 4.6μg/m3 [1.0–12.6]; p=0.01). Stoves were well-liked and widely used by residents as substitutes for previous cooking methods (mainly three-stone fires). Commonly cited benefits related to fuel saving and shorter cooking times. Conclusions: The cookstove intervention had no impact on cooking-related PM2.5 exposures. A significant reduction in background exposures may relate to reduced smouldering emissions. Uptake and continued use of the stoves was high amongst community members, who preferred using the stoves to cooking over open fires.

Improved cookstoves to reduce household air pollution exposure in sub-Saharan Africa: A scoping review of intervention studies

“…Cookstoves were excluded if there was no reduction in HAP, no health benefit, not available, and not affordable. The ten articles selected to inform the user perspectives of the six cookstoves (C hitetezo Mbaula [ 64 , 69 , 70 ], Mirt [ 53 , 68 ], Firewood Jambar [ 23 ], Gyapa [ 67 ], Kuniokoa [ 56 ], Save80 [ 44 , 45 ] ) is presented in the PRISMA diagram ( Fig 6 ).…”

“…Overall, users liked the ICS and found several advantages to their use compared to the TCS/TSF. For example, in all the studies, participants reported significant time-saving benefits with the ICS from cooking and fuel collection [ 64 , 69 ], with food cooking faster [ 64 , 67 ], and less time required to supervise the stove [ 23 , 44 , 45 , 64 ]. This allowed participants to multi-task [ 23 , 56 ] and resulted in more time for leisure and social activities [ 56 ].…”

“…Users also reported reduced back pain [ 70 ] from less bending and fuel collection [ 56 ] and less eye irritation [ 67 ]. Other reported advantages of the ICS included reduced fuel use [ 69 , 70 ], suitability of use for various cooking tasks [ 69 , 70 ], stoves being lightweight, portable and durable [ 67 , 69 ], affordability [ 69 , 70 ], and better shielding from wind and dust [ 23 , 64 ] compared to baseline TCS/TSF.…”