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Go BackWELL FACTSHEET - Regional Annex for East AfricaIndoor air pollution Author: Gerald Rukunga, AMREF, Kenya Quality Assurance: Adam Biran
Globally,
almost 3 billion people rely on biomass fuels (wood,
charcoal, crop residues and dung) and coal as their
primary source of domestic energy. Biomass fuels
have been associated with Indoor Air Pollution (IAP),
which is a major risk factor accounting for 4% of
the global burden of disease measured by Disability
Adjusted Life Years (DALYs) lost. In
developing countries 28% of deaths in children under
5 years of age are associated with Acute Respiratory
Infections (ARI). The sources of fumes and
particulates are either outdoor or indoor.
Indoor exposures are of greater concern
because concentrations are often much higher and
greater time is spent indoors by vulnerable
population sub-groups, including young children (USAID
1997). In
Sub Saharan Africa, around 80% of the rural
communities depend on biomass fuels for their
domestic energy. In all the Countries of East
Africa, the majority of the populations live in the
rural and peri-urban areas where poverty is rampant
leading to extensive use of biomass as source of
energy. Exposure to IAP from the combustion of
solid fuels is a predisposing factor contributing to
morbidity and mortality in developing countries and
the worst levels of exposure are closely associated
with the poorest households. Indoor
Air Pollution is an emerging area of focus in the
health sector due to its increasing risks to Acute
Respiratory Infections particularly among children
under five years of age. In the East African region,
there are policy guidelines for the implementation
of interventions on the control of childhood
diseases. However, there are no specific policies
targeting IAP and the existing ARI policy focuses
mainly on curative rather than both curative and
preventive interventions. In Kenya for example, ARI
policy does not include control measures targeting
environmental factors linked to child health and by
extension IAP . Consequently, ARI diseases are
addressed mainly through case management and seeking
prompt treatment, totally ignoring the role of
IAP and other environmental factors in transmission
of ARI and its appropriate interventions. Experiences
and lessons learned from past and current
interventions have been documented but these are yet
to be replicated or incorporated into existing
policies. One of the Government of Kenya strategic
objectives is to reduce underfives morbidity and
mortality attributed to measles, pneumonia,
diarrhoea, malaria and malnutrition from 70% to 40%
in the period 1999 – 2004. This is achieved
through replacement of vertical programmes such as
those for Acute Respiratory Infections with
Integrated Management of Childhood Illnesses (IMCI) The
importance of interventions to reduce exposure to
IAP is reflected in the Millennium Development Goals
(MDGs) in many ways. With less time spent on fuel
collection, people will have more time available for
education for children and Income Generation
Activities (IGAs) for women that are likely to
contribute to eradicating extreme poverty. As most
of the disease burden due to IAP falls on children
under five years of age, interventions will help
achieve a significant reduction in child mortality
and consequently contribute to the fourth MDG. The
World Bank has identified three key considerations
in the successful implementation of IAP
interventions. These include the policy and
regulatory context; making sure that all relevant
sectors / perspectives are considered and local
community involvement in technology design and
application. In
East Africa various interventions are ongoing with
the aim of reducing the risks and mitigating the
health effects of IAP. The interventions focus on
improving ventilation in houses, extraction of smoke
and improving combustion of fuels. In improving
house ventilation, the main activities include
provision of windows and eaves spaces in the
existing houses. The pilot work on this aspect has
focused on Manyattas (igloo like structures) and
other traditional houses in the rural areas. With
regard to smoke extraction, a number of appropriate
technologies have been employed. These include
construction of smoke hoods, chimneys and flues.
Introduction of improved cooking stoves has been the
main intervention in improving the combustion of
fuels but the experiences need to be disseminated
widely for replication. Although
IAP has been a problem mainly in rural areas, lately
it has become a source of concern in the informal
settlements where the slum houses are constructed
back-to-back inhibiting proper ventilation. In most
cases these houses are often overcrowded and low
socio-economic status forces occupants to use low
cost incombustible fuels. The net effect of these
problems is high prevalence of acute respiratory
infections among children and eye problems resulting
from constant contact with a smoky environment. The following are benefits from the current IAP interventions:
As work on IAP evolves there remain several challenges to be addressed:
To effectively address issues related to IAP, there is a need for policies that recognize the linkage between environmental causes of IAP and related interventions. Similarly, sector coordination involving key stakeholders whose activities contribute to, or would influence, Indoor Air Pollution interventions should be enhanced. http://wbln0018.worldbank.org/HDNet/hdocs.nsf/0/dcd3ac172990f3fb85256ba00059fd76 Rukunga G K (2002): Towards Environmental Health Justice for Children in Kenya.I 12th Eastern Africa Environmental Network Conference Proceedings: Nairobi, Kenya http://ehis.niehs.nih.gov/members/2002/110p1057--1068ezzati/EHP110p1057PDF.pdf GoK, Ministry of Health (2000): Integrated Management if Childhood Illness (IMCI), National technical guidelines on the acute respiratory infections. Government Press. Nairobi, Kenya. Government of Kenya (1999): The National Health Sector Strategic Plan (NHSSP) 1999-2004, Ministry of Health. Government Printers, Nairobi, Kenya World Health Organization: Indoor Air Pollution and the Millennium Development Goals, available at http://www.who.int/indoorair/mdg/en/ accessed 29th April 2004. World Bank (2003): Indoor Air Pollution - at a glance, available at: http://wbln0018.worldbank.org/HDNet/hdocs.nsf/0/dcd3ac172990f3fb85256ba00059fd76/ $FILE/IAP%20AAG%209-03.pdf accessed 30th April 2004 Intermediate Technology Development Group http://www.otdg.org
This Regional Annex was developed by Gerald Rukunga, AMREF Kenya (2004) under the WELL Partnership. For further information contact: rukungag@amrefke.org
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