Indoor Air Pollution Not A Public Health Issue in Zimbabwe

LOVING memories of my grandmother’s cooking hut in the backyard of Zimbabwe are still fresh inside me like morning dawn. Yet, I also remember how the hut would fill up with smoke that choked my throat and stung my eyes and how I sat through it all enjoying a meal or engaged in conversation with loved ones.  Little did I know that it was a health hazard. Like most Zimbabweans – approximately 70 per cent of the population lives in rural areas – it was a normal facet of our lives. In fact, if one revealed any lack of resilience against the smoke, they would be regarded as a snobbish urbanite. And not many people are willing to be associated with such a tag.

The health risks of being exposed to indoor smoke are barely known and even if they were, there is no real alternative. But the problem is not unique to Zimbabwe: nearly 3 billion people, most living in low-income countries, rely on solid fuel for cooking, lighting and heating.

“The greatest challenge we face is that people are unaware of the problem, particularly those most vulnerable to it.  Moreover, the diseases that women get from the smoke exposure occur only after many years of exposure and this means that they are unlikely to make the connection between the exposure and the disease. The best way to inform people and engage them for change is to select 'change agents' in the community who are affected by the problem,” said Professor Donald A Enarson, Scientific Advisor on lung health, TB, indoor air pollution to the International Union Against Tuberculosis and Lung Disease (The Union) in an email interview.

Rudimentary wood-fired cook stoves and open fires emit fine particles, carbon monoxide, and other pollutants at levels up to 100 times higher than the recommended limits set by the World Health Organization (WHO). Mortality and burden of disease attributable to selected major risks, indoor air pollution is responsible for 2.7% of the global burden of disease.

Three types of lung diseases have been shown to have a strong association with solid fuel smoke: acute lower respiratory infections (ALRIs) in children, chronic obstructive pulmonary disorder (COPD) in women, and lung cancer in women exposed to coal smoke. WHO estimates that nearly 2 million people die each year from diseases caused by unhealthy cook stove technologies, including more than 1 million people, mostly women, who die from COPD. Nearly half of deaths among children under 5 years old from ALRIs are due to particulate matter inhaled from indoor air pollution from household solid fuels. Close to 1 million children under 5 die each year from pneumonia. 1.5% of annual lung cancer deaths are attributable to exposure to carcinogens from indoor air pollution.

“Indoor air pollution from biomass fuel smoke is an important issue because this is a fuel source that is widely used by poor people and is associated with serious health issues that make poor people even poorer.  It particularly affects women and children in poor communities.  The clearest health consequence of breathing this smoke is in women who can develop lung cancer and serious and chronic lung disease that result in death,” said Enarson.

“In addition, the smoke promotes the development of pneumonia in small children, the most important cause of death in this age group.  It is particularly important because it is possible to avoid these consequences with rather simple procedures that even poor people are able to introduce.” In Africa, particularly in rural areas, indoor pollution is rampant, but it is not regarded as a serious public health issue, and therefore very little is being done yet with a few, simple steps it is possible to stop unnecessary deaths.

“There are a series of steps that can be taken.  Clearly, the most dangerous situation is with open fires (for heating or cooking) within the same rooms that people inhabit.  The first step is to move the cooking from inside the house to a 'shed' in the back yard with a roof but relatively open walls to improve ventilation.  The second step is to make a protection around the fire (the best is to use an enclosed 'stove' made of ceramic or metal) so that the smoke can be directed away from people. The final step is to improve the ventilation for the smoke from the stove by constructing a stove pipe to direct the smoke out of doors and / or to open ventilation paths (either under the eaves of the house or through windows) to reduce the level of the smoke in the living area,” said Enarson. He added that all of these steps can be taken with very little cost and can be done by the people themselves without outside assistance.

“Obviously a shift to energy sources using natural gas or electricity goes a long way to improving the situation but this is dependent on actions of the authorities outside the community itself and costs a great deal more than the simple steps that can already reduce the problem substantially,” he said.

Chief K Masimba Biriwasha - CNS
(The author, born in Zimbabwe, is an Editor, a children's writer, poet, playwright, journalist, social activist and publisher. He has extensively written on health. His first published book, 'The Dream Of Stones', was awarded the Zimbabwe National Award for Outstanding Children's Book for 2004)

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