Indoor Air Pollution: Key Determinants

Problem Definition: Every year, 3-4% of all deaths around the world are linked to Indoor Air Pollution.  

As you can see, I have changed my problem definition again, however, not as drastically this time.  I realized that my previous problem statement did not really focus on the major issue behind indoor air pollution, which is the overwhelmingly mortality rates associated.  My new problem definition captures that and allows me to discuss decreases in indoor air pollution as intervention strategies. 

With indoor air pollution, there are many ways that death can result.  In other words, there are many key determinants and many intervention strategies.  Therefore, we must consider all carefully and then determine which one has the best possibility of helping. 

The first determinant that comes to mind is the use of biomass fuels such as dung and wood instead of kerosene or other gaseous fuels.  This can be split into two different categories.  This can be seen as an environmental determinant because they do not have access to better fuels (Legros et al, 2009).  In other words, the people in these developing countries may be using the best of what is around them.  If they have no access to fuels such as kerosene, then they cannot be expected to use them.  This determinant can also be seen as an economic one because better fuels are more expensive.  On an individual level, the families may not be able to afford the better fuel and so may just stick with the biomass because it is cheap and still gets the job done.  In fact approximately 3 billion people fall under this category (Duflo et al, 2008).  On a societal level, the country may not have the proper economic infrastructure to support the proper implementation of these new fuels.

A second determinant could be proper ventilation, which would fall under the category of environmental.  In many rural villages in developing countries, the homes have neither windows nor chimneys (Jamison et al, 2006).  This means that when cooking, the smoke enters the room and has no place to leave but the door.  Smoke builds up quickly in these homes and continues to persist for extended periods.  People living in the homes, especially women and children, are left exposed to this smoke for hours a day.

On a more sociocultural level, many behaviors exist in these developing countries related to cooking that increase the levels of inhalation.  First, women who cook tend to stand over the stove, where the concentration of airborne particulates is highest in the home.  They put themselves at a much higher risk of developing adverse health affects by doing this.  Additionally, they put their children at risk by holding them while cooking or keeping them in a carrier on their chest or back.  In this situation, they not only put themselves in the greatest density of smoke, but also the young ones.  Essentially, women and children are at highest risk because they spend the most time around the stove and in polluted rooms (Ezzati et al, 2001).

Duflo, E., Greenstone, M., Hanna, R. (2008) Indoor air pollution, health and economic well-being. S.A.P.I.EN.S. 1: 7-16.

Ezzati, M., Kammen, D.M. (2001) Indoor air pollution from biomass combustion and acute respiratory infections in Kenya: an exposure-response study. The Lancet 358: 619-624.

Jamison, D.T., et al. (2006) Disease control priorities in developing countries. New York, NY: Oxford University Press.

Legros, G., Havet, I., Bruce, N., Bonjour, S. (2009) The Energy Access Situation in Developing Countries. Geneva, Switzerland: WHO.