Using mixed methods and community participation to explore household and ambient air pollution practices in a rural community in Malawi

Abstract

Aim: Globally, household and ambient air pollution (HAAP) accounts for almost 7 million premature deaths each year. Over half of these are from incomplete biomass fuel combustion in open fires and inefficient cookstoves. Solutions to the problem remain challenging due to cost, people’s perception of pollution and unsuitability to meet user needs. Subject and methods: We used mixed methods and participatory approaches to measure and understand practices and beliefs relating to HAAP in a low-resource community in Malawi. Eighty-six households were randomly sampled for the survey, fine particulate matter (PM2.5) levels were measured in 46 kitchens and four ambient locations, and 38 households were engaged during participatory transect walks. We analysed the data using descriptive and thematic analysis. Results: Kitchen PM2.5 levels far exceeded the World Health Organization’s recommended safe levels. Open-burning practices further contributed to ambient air pollution in the community. While there was high awareness of smoke in cooking areas, participants did not associate it with adverse health outcomes. Availability and affordability of cleaner alternatives influenced household energy choices. Integrating participatory methods alongside quantitative data allowed an in-depth understanding of the community’s practices and relationship with HAAP. Conclusion: The findings demonstrate that energy poverty is a key factor in access to clean energy sources and highlight the importance of engaging communities to design HAAP interventions that meet their physical, socioeconomic and cultural needs.