Niger J Paed 2015; 42 (4): 309 - 313
ORIGINAL
Sadoh AE
Traders’ perception of cooking
Nwaneri DU
smoke as a risk factor for childhood
Famuyiwa O
Ogboghodo BC
pneumonia
Eregie CO
Oviawe O
DOI:http://dx.doi.org/10.4314/njp.v42i4.5
Accepted: 24th February 2015
Abstract :
Background: Child-
pneumonia while 99(7.2%) consid-
hood pneumonia is the foremost
ered avoidance of smoke as a
Sadoh AE
(
)
killer of under-fives. Indoor air
method for preventing pneumonia.
Nwaneri DU, Famuyiwa O
pollution by smoke from cooking
Firewood (biomass fuel) was util-
Ogboghodo BC, Eregie CO
Oviawe O
fuel is a major risk factor for
ized by 272(19.8%) respondents.
Institute of Child Health,
childhood pneumonia. The knowl-
Respondents with no education
University of Benin, Benin City,
edge of caregivers about risk fac-
were significantly more likely to
Nigeria.
tors can facilitate the practice of
use firewood (p<0.000).
Email: ayebosadoh@yahoo.com
appropriate preventive measures.
All respondents with under-fives
This study set out to evaluate the
reported having them in the cook-
perception of traders about cook-
ing area. Having a child who had
ing smoke as a risk factor for
suffered pneumonia in the past was
childhood pneumonia.
not significantly associated with
Methodology: A researcher ad-
knowing that smoke was a risk
ministered, questionnaire based,
factor for childhood pneumonia
cross-sectional study was carried
p>0.05.
out at a major market in Benin
Conclusion: There is poor aware-
City prior to a market rally to
ness of smoke as a risk factor for
celebrate World Pneumonia Day
childhood pneumonia while the
2014. The respondents were trad-
use of unclean fuel is significant.
ers. Information on biodata, place
As part of health education on
of cooking, fuel for cooking and
childhood pneumonia, smoke as a
presence of under-fives in the
risk factor should be emphasized.
cooking area of homes of respon-
Government should make cleaner
dents was sought.
fuels more available, accessible
Results: There were 1374 respon-
and affordable.
dents of which 1192(88.5%) were
females. Only 67(4.9%) respon-
Keywords :
traders,
cooking
dents considered smoke from
smoke, risk factor, childhood
cooking fuel a risk factor for
pneumonia
Introduction
ments. The incomplete combustion of these fuels leads
to air pollution and for this reason they are considered
unclean fuels . Smoke from the burning of biomass
3,4
Pneumonia is a major killer of under-fives, being re-
sponsible for up to 15% of under-five mortality . In Ni-
1
fuels contains large amounts of particulate matter and
geria, pneumonia resulted in over 121,000 deaths in
gaseous pollutants, the inhalation of which have health
2013 making her one of the high burden countries for
consequences. Health consequences of indoor air pollu-
childhood pneumonia . Many risk factors contribute to
1
tion include low birth weight, acute respiratory infec-
childhood pneumonia. These include young age
tions, cataracts, chronic obstructive pulmonary disease
and cancer .
5
(<5years), malnutrition, lack of immunization against
measles , pre-existing disease such as Human immuno-
deficiency virus infection, overcrowding, parental smok-
Biomass fuels include wood, animal dung, crop residues
and sawdust . In rural areas of Nigeria, biomass fuels are
3
ing and indoor air pollution .
1,2
the primary means of energy with about 80million
Indoor air is the air within an indoor environment . In-
3
metres of fuel wood used annually for cooking and other
domestic activities . In homes where biomass fuels are
3
door air pollution can result when biomass fuels are
burnt in open fires and in poorly ventilated environ-
burnt for household energy use, the air pollution levels
310
are often higher than the World Health Organisation
married traders was determined using the level of educa-
guideline values for 24 hour indoor levels set at 25µg/
tion of the female and occupation of the male partners as
described by Olusanya et al .
12
m . They also have higher mean annual levels of par-
33
ticulate matter (PM 2.5 ), carbon monoxide levels, and
The instruments were administered by research assis-
sulphur dioxide levels . In a study among rural dwellers
3
tants who were trained on how to administer the ques-
in Nigeria, it was found that the mean values of given
tionnaire. Data was entered into SPSS spreadsheet. As-
pollutants were all higher than the recommended Na-
sociation of variables was determined using chi square,
tional ambient air standards . Elevated levels of particu-
6
significance level was set at <0.05
late pollution have been associated with increased inci-
dence of respiratory symptoms and diseases including
acute lower respiratory infections in children.
7
Results
Women are the primary caregivers for children in most
developing countries. It is, thus, important that pro-
There were 1374 respondents of whom 1192(88.5%)
grammes targeting reduction in child morbidity and
were females. Of the 1316 who responded to the ques-
mortality must necessarily include them. Also women
tion on marital status, 1096 (79.8%) were married. The
and children are more disproportionately affected by
age range of the respondents was 18 to 82 years. More
indoor air pollution as they tend to spend more hours
than half 785(60.1%) of those who responded to the
indoor and women are directly involved in preparation
question on level of education had secondary education
of meals . Health education is known to be important in
4
while 85(6.5%) had no formal education. Table 1: Ma-
improving knowledge and reinforcing desired behavior .
8
jority of the respondents 601(54.8%) were in the middle
Thus, health education could be an important strategy in
socioeconomic class.
limiting indoor air pollution. Health education should be
predicated on the knowledge and practices of the target
Table 1: Demographic characteristics of the study population
population. This study targeted traders because many
Characteristic
n
%
women are involved in trading and the market place can
Gender
be an important arena for the dissemination of informa-
Male
155
11.5
tion.
Female
1192
88.5
Studies evaluating the perception of caregivers about
Level of Education
pneumonia have often focused on identification of signs
None
85
6.5
and symptoms and care seeking behavior
9-11
. In studies
Primary
243
18.6
which examined knowledge of cause of pneumonia,
Secondary
785
60.1
smoke as a risk factor was not evaluated
10,11
. As part of a
Tertiary
194
14.8
larger study on pneumonia the perception and knowl-
Socioenomic class
edge of traders about smoke and pneumonia was evalu-
Upper
192
17.5
Middle
601
54.8
ated. The larger study was conducted as part of an
Low
303
27.7
assessment to determine the areas of knowledge deficit
Have a child
prior to a market rally to celebrate world pneumonia day
Yes
708
53.1
2014.
No
626
46.9
Any Under-five
Yes
301
22.6
No
1033
77.4
Methodology
Some of the totals do not add up to total number of respon-
The study was carried out at Edaiken market in Benin
dents because of missing data
City. Respondents were traders who were aged 18 years
and above. Verbal consent was obtained after the pur-
About half of the respondents 708(53.1%) had children
pose of the study was explained to them. The interviews
and of these 301(22.6%) had at least an under-five. Of
were conducted in Pidgin English. Ethical consent for
these 301, 285(94.7%) had one under five while 15
the study was sought from the University of Benin ethi-
(5.0%) and 1(0.3%) had two and three under-fives re-
cal review committee. The instrument was developed
spectively. Only 67(4.9%) respondents considered
and validated in the ICH after extensive literature re-
smoke as a factor in childhood pneumonia. Of the 70
view. Thereafter it was pretested among mothers attend-
respondents with no education only 1(1.4%) knew that
ing the ICH child welfare clinic for childhood immuni-
smoke was a risk factor for pneumonia compared to 18
zation.
(8.7%), 32(4.5%) and 12(6.5%) of those with primary,
The instrument was interviewer administered and sought
secondary and tertiary education respectively. This dif-
information on the biodata of the respondents, place of
ference was statistically significant p=0.04 Table 2.
cooking, fuel for cooking and the presence of under-
Avoidance of smoke in the home was considered a pre-
fives in the cooking area. Respondents were also asked
vention method for pneumonia by only 99(7.2%) re-
about their perception of smoke as a risk factor for pneu-
spondents. The proportions of respondents with differ-
monia and control of smoke as a method of prevention
ent levels of education (11.1% no education, 9.5% pri-
of childhood pneumonia. Socioeconomic status for
mary, 7.3% secondary and 10.2% tertiary) who consid-
ered avoidance of smoke as a method of prevention of
311
other low income countries. The lack of emphasis on
sion indicated otherwise. Education was an independent
smoke as a potential risk factor may suggest that au-
predictor for the use of firewood while socioeconomic
thors do not consider smoke an important risk factor.
class was not. This highlights the importance of educa-
This is very important giving the fact that 50% of pre-
tion. Female education is an important strategy to im-
mature death in under-fives is due to pneumonia caused
prove standard of living. With more than 75% of the
by particulate matter (soot) inhaled from indoor air Pol-
respondents also using kerosene stoves there is a poten-
lution .
5
tial for encouraging them to use kerosene which is a
cleaner fuel. It should however be pointed out that the
The poor knowledge about smoke as a risk factor for
World Health Organization discourages the use of kero-
pneumonia documented in this study is, however, in
sene because it has been shown to produce high levels of
contrast to that of a study from Zaria, in which close to
pollutants exceeding recommended levels especially
70% of those studied knew that cooking fuels were
when used with simple unvented combustion technolo-
sources of indoor air pollution.
14
In that study, respon-
gies like wick cookstoves, in addition to the risks for
dents were also aware that air pollution was detrimental
fires, burns and poisoning associated with its use in low
and middle income countries. The low use of clean
15
to health. The better knowledge may be due to methodo-
logical differences, in that this study did not ask about
fuels( gas and electricity ) may be due to these fuels
general health consequences of smoke but as a specific
being more expensive and the erratic supply of electric-
risk factor for childhood pneumonia.
ity. This is supported by the finding of socioeconomic
class being an independent predictor for the use of gas
The role of formal education in health information is
and electricity for cooking.
exemplified by the fact that respondents with any educa-
tion were more likely than those with no education to
Respondents whose children had suffered pneumonia in
know that smoke is a risk factor in childhood pneumo-
the past were not significantly different in terms of their
nia. Health information on the risks of smoke and bio-
knowledge of smoke as a risk factor or its avoidance as a
mass fuel is one of the strategies that could be used in
method of prevention. This may be because many health
getting people to start using cleaner fuels. Almost a fifth
workers do not provide health information concerning
children’s ailment to the caregivers.
16
of the study population use biomass fuel for cooking.
In a study on
This is much lower than the proportion reported for rural
Bangladeshi mothers whose children had recently been
communities in Sub Saharan Africa, where up to 80% of
hospitalized for pneumonia, it was found that they
lacked appropriate knowledge about pneumonia. They
11
the population use biomass fuel for cooking and heating
purposes. The difference may be because rural areas
attributed the pneumonia to such factors as dust, un-
have more access to biomass fuel and it is more afford-
healthy household condition, cold allergy and heavy
able. The proportion of respondents using biomass fuel
sweating during the hot summer months. The lack of
in this study was thus more comparable to that from an
knowledge of risk factors and methods of prevention
urban city in northern Nigeria. Although this study did
14
mean that the same child or siblings will continue to be
not evaluate ventilation in the homes of the respondents
at risk as their caregivers will not take appropriate pre-
some studies have shown that poor ventilation increases
ventive steps due to ignorance.
the risk of indoor air pollution.
It is concluded that the low level of knowledge of smoke
Majority of the respondents carried out their cooking in
as a risk factor for childhood pneumonia and the signifi-
the kitchen. This is similar to findings from the Zaria
cant proportion of respondents using unclean fuels
study. The use of biomass fuel in confined spaces such
14
means that the children of the studied respondents are at
as the kitchen presupposes that the indoor air pollution
risk for pneumonia. We recommend that as part of creat-
in such a space will be high. Thus the presence in this
ing awareness on childhood pneumonia smoke as a risk
study of under-fives in the kitchen places them at risk
factor should be emphasized. The government should
for acute respiratory infections including pneumonia.
also make cleaner fuels more available, accessible and
Even when biomass fuels are used outdoors, studies
affordable. This is needed to effect a change in the type
have shown that indoor air becomes polluted because of
of fuel communities use for domestic purposes.
the way houses are constructed and the layout of the
houses. Also the fact that majority of the respondents
3
Limitation of study
do not consider smoke a risk factor, and its avoidance a
method of prevention, further increases the risk of their
This study did not explore respondents’ perception of
children for acute respiratory infections including pneu-
smoking and other forms of smoke (such as lantern
monia as they would be unlikely to undertake specific
smoke) as potential risk factors for childhood pneumo-
acts of prevention directed at reduction of exposure to
nia. The population studied is highly selective although
smoke.
they may not be significantly different from the general
population with regards to the subject under study. The
Respondents with no formal education were more likely
study also did not evaluate ventilation or the proximity
to use biomass fuel for cooking. Although bivariate
of the cooking area to the living and bedroom.
analysis indicated that this may be associated with eco-
nomic power as those from upper and middle class were
significantly less likely to use fire wood logistic regres-
312
pneumonia were not significantly different p=0.42.
ent variables for cooking fuel showed that socioeco-
All those with under-fives usually have them in the
nomic status was an independent predictor for the use of
cooking area while cooking. Of those responding, 188
gas and electricity while level of education was an inde-
(16%) had had a child who suffered pneumonia in the
pendent predictor of use of firewood. Table 4
past. Having a child who had suffered pneumonia was
not significantly associated with knowing that smoke
Table 3: Distribution of respondents by socioeconomic status
was a risk factor for pneumonia and that avoidance of
and cooking fuel
smoke could prevent pneumonia in children p>0.05.
Cooking Fuel
Socioeconomic class
Table 2.
Upper
Middle
Low
pvalue
n
%
n
%
n
%
Table 2: Relationship between level of education, previous
Firewood
experience of pneumonia in child and perception of smoke as a
Yes
26 13.6 101 17.0 77
26.8
risk factor and avoidance of smoke as a preventive action
No
165 86.4 492 83.0 210
73.2
0.000
Variable
Knows smoke
Pvalue Knows avoidance of Pvalue
Kerosene
Is a risk factor
smoke is preventive
Yes
123 65.4 454 76.2 200
67.6
Yes
No
Yes
No
No
65 34.6 142 23.8 96
32.4
0.002
n
%
n
%
n
%
n
%
Sawdust
Level of Education
Yes
11
5.8
24
4.1
6
2.1
None
1
1.4
70
98.6
8
11.1
64 88.9
No
180 94.1 568 95.9 276
97.9
0.112
Primary
18
8.7 187
91.3 0.04 19
9.5
182 90.5
0.42
Gas
Secondary 32
4.5 681
95.5
53
7.3
668 92.7
Yes
105 55.3 173 29.2 38
13.3
Tertiary
12
6.5 172
93.5
19
10.2 167 89.8
No
85 44.7 419 70.8 247
86.7
0.000
Child had pneumonia
Electricity
Yes
6
3.2 182 96.8
11
5.6
177 94.4
Yes
33 17.3 10
1.7
6
2.1
No
61
6.3
902 93.7 0.12 86
9.0
868 91.0
0.20
No
158 82.7 582 98.3 276
97.9
0.000
Some of the totals do not add up to total number of respon-
Some of the totals do not add up to total number of
dents because of missing data
respondents because of missing data
Majority of the respondents 1146(83.4%) do their cook-
Table 4: Logistic regression on predictors of cooking fuel
ing in the kitchen. Outside the house 8.3%, in the pas-
choices
sage 3.7% and in the bedroom 0.3% were other cooking
Cooking fuel
Socioeconomic class
Level of Education
areas mentioned by respondents. Biomass fuel is utilized
Β
Exp β
CI
pvalue
β
Exp β
CI
pvalue
Firewood
-0.22
0.80 0.51,1.27
0.45
-0.66 0.52
0.36,0.75 0.00
by 272(19.8%) – firewood and 54(3.9%) sawdust.
Kerosene
0.11 1.12
0.75,1.68
0.59
0.12 1.12
0.79,1.59 0.52
Gas
-0.94
0.39 0.25,0.60
0.00
0.11 1.11
0.75,1.66 0.60
Electricity
-1.20 0.30
0.12,0.79
0.01
0.58 1.78
0.701,4.53 0.23
Figure 1 shows the distribution of respondents by their
level of education and the type of cooking fuel they use.
Significantly more respondents with no formal educa-
tion use firewood 28(34.1%) compared to respondents
Fig 1: Distribution
of respondents by
with primary 66(28%), secondary 142(18.3%) and terti-
level of education
ary 30(15.8%) education p<0.000. The use of Gas and
and their type of
Electricity was significantly higher among those with
cooking fuel
any education( primary-9.6% and 4.0%, secondary
28.5% and 1.8%, tertiary 39.4% and 18.5% for gas and
electricity respectively) compared to 17.3% and 0% for
gas and electricity respectively among those with no
education P<0.000.
Table 3 shows the distribution of respondents by their
Discussion
socioeconomic status and their cooking fuel. Respon-
dents from low socioeconomic class 77(26.8%) were
This study has demonstrated that majority of the re-
statistically significantly more likely to use firewood
spondents do not consider smoke as a risk factor in
compared to those from middle 101(17.0%) and upper
pneumonia and accordingly did not think that avoiding
26(13.0%) socioeconomic classes p=0.000. Respondents
smoke in their homes could prevent pneumonia in their
from middle socioeconomic class 454(95.9%) were
children. The poor knowledge of smoke as a risk factor
more likely than those from upper123 (65.4%) and
for pneumonia (only 4.9% of respondents) is in keeping
lower 200(67.6%) socioeconomic classes to use kero-
with findings in a Nigerian study which found that
mothers knowledge about pneumonia was poor. In that
13
sene p=0.002. The use of sawdust was not significantly
associated with socioeconomic class. Those from upper
study it was suggested that the focus of health education
socioeconomic class were statistically significantly more
campaign should be on germs as the cause of pneumo-
likely to use gas and electricity than those from low and
nia, immunizations, hand washing and exclusive breast-
middle socioeconomic classes p <0.0001.
feeding as potent preventive measures. While these are
unarguably important areas of focus, the authors failed
The logistic regression with level of education and
to mention smoke as a contributing factor giving the
socioeconomic class entered into the model as independ-
context of the high use of biomass fuel in Nigeria and
313
Author’s contribution
Acknowledgement
This study is part of an institutional research by the
Institute of Child Health, University of Benin.
We acknowledge with thanks the non academic staff of
Conflict of interest : None
the Institute of Child Health, University of Benin who
Funding: Cipla Evans Nigeria limited provided finan-
participated in data collection and in the provision of
cial support for the
health information at the market rally held in celebration
of World pneumonia day 2014
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