Knowledge and practices regarding household air pollution in communities of slum areas of Sonipat district in Haryana

INTRODUCTION

Household air pollution (HAP) from inefficient fuel combustion is one of the most important global environmental health risks today. A recent WHO report estimated that around 3 billion people still cook using solid fuels (such as wood, crop wastes, charcoal, coal and dung) and kerosene in open fires and inefficient stoves.

Most of these people are poor, and live in low and middle-income countries. Each year, 3.8 million people die prematurely from illness attributable to the household air pollution. Among these 3.8 million deaths, 27% are due to pneumonia, 18% from stroke, 27% from ischaemic heart disease, 20% from chronic obstructive pulmonary disease (COPD) and 8% from lung cancer.¹

It has been estimated that exposure to HAP caused over one million deaths per year in India in 2012 and the chronic cardiovascular and respiratory diseases and acute lung and respiratory infections in children were the main causes. The latest edition of the Global burden of disease showed that HAP was the fourth most important risk factor for mortality and morbidity in India.²

People spend the majority of their time in indoors, at home, work, or school, in public buildings, and therefore, indoor environments contribute significantly to the total daily exposure.³ The indoor environment has been explored much less extensively than the outdoor atmosphere.

As little information is available about community knowledge and practices regarding indoor pollution in slum areas in India. This study was conducted to assess the community knowledge and practices regarding household air pollution in slum areas of Sonepat district in Haryana.

METHODS

This community-based cross-sectional study was conducted over a period of five months from April to August 2018 in two slum areas of Sonipat district having a health center staffed with one health officer, a pharmacist, a coordinator and two community mobilizers who were frequently visiting the areas for catering health services. There was no government health facility and no Medical Officer in the study area.

A total of 104 households were included in the study. All houses were covered except which were found locked and there were refusal or non-availability of adult member in the house at the time of visit. Before data collection, every respondent was explained about the objectives of the study and informed consent was obtained from all participants.

The necessary prior written permission was obtained from the Non-Government Organization (NGO) officer to carry out the study. The data was collected by interview method using a pretested, semi-structured questionnaire included socio-demographic profile and questions for knowledge and practice regarding indoor pollution.

Both community mobilizers were trained before filling the designed formats. They used to visit between 10 am to 3 pm daily except Sundays and holidays. The data were coded and analysed using the software R, version 3.6.2 and were presented in form of frequency and proportion.

RESULTS

Table 1 shows the sociodemographic characteristics of the study subjects. A total of 104 household heads were interviewed. Slightly more than four fifth 86 (82.7%) were males and rest 18 (17.3%) were females. Most of them 72 (69.2%) were illiterates, while only 12 (11.5%) had high school level and above education.

More than half 56 (53.8%) of the respondents were laborers and rest 48 (46.2%) were engaged as factory workers. Majority, 67 (64.4%) were with monthly income ranging from 5000 to 10000 and only 24 subjects (23.1%) were with income above 10000 per month. Most of the houses were pucca (80%), whereas (20%) were kutcha. Majority of houses (88%) were having electricity supply and about (12%) were using kerosene oil lamps or candles for lighting purpose.

In Table 2, findings show the knowledge of respondents regarding indoor air pollution. Two third (75%) and more than two third (79.8%) of the household heads were aware that cooking fuel was harmful for the environment and smoke was harmful to the health respectively.

Maximum 61 (58.6%) responses reported by the respondents were for tuberculosis as health hazard of air pollution. Another health hazards mentioned by the participants were Asthma (21.1%), COPD (11.5%) and allergy (10.6%). Two third (75%) were not aware about Pradhan Mantri Ujjwala Yojana.

The preventive practices of the study subjects are presented in Table 3. Types of fuel used for cooking revealed that 74 (71.2%) and 22 (21.1%) of households used LPG and charcoal/firewood, respectively as the main cooking fuel while rest 7.7% used both. About two third (73.1%) of household cooked food inside the house. Common preventive practices for controlling indoor air pollution were using chimney (3.8%), opening doors (21.1%) and switching of fans (15.4%).

DISCUSSION

Presently, HAP has become a major public health concern in India and in the world. Among the study population of 104 household heads, more than four fifth (82.7%) were male. This might be because the male-headed household is the norm in India, a pattern consistent with traditional family structures and dominant roles of male gender in the society, and their perceived relative economic importance.

In the present study, among the study subjects, 69.2% were illiterates, 53.8% were laborers and 46.2% were factory workers and 64.4% were with monthly income ranging from 5000 to 10000. This might be due to the differences in education, occupation and economic aspects of slum and non-slum areas.In our study, we assessed the awareness of the study participants regarding indoor air pollution and found that 75% and 79.8% of the respondents aware that cooking fuel was harmful for the environment and smoke was harmful to the health respectively.

In a community based cross-sectional study conducted in rural Mangalore, it was found that most (80.8%) of the study population were aware of the health risks posed by the smoke from burning firewood.4 In a study conducted in rural Bangladesh, it was found that majority (85%) of the household women had good awareness regarding the harmful effects of burning firewood.⁵

In our study, we found that 58.6% responses reported by the participants were for tuberculosis as health hazard of air pollution and another health hazards mentioned by the participants were Asthma (21.1%), COPD (11.5%) and allergy (10.6%).

In contrast, in a study in slums of Kenya, cough/cold, difficulties in breathing, headache and eye problems were the most common health risks mentioned by the respondents related to air pollution.⁶ This difference in awareness of health risk could be explained by the difference in the education level and occupation of the participants.

In the present study, it was found that 71.2% and 21.1% of households used LPG and charcoal/firewood, respectively and 7.7% used both. In a study conducted in rural Mangalore, the study population using firewood and both firewood and LPG were comparatively more (34%) and (41.3%) respectively, while only 25% were using LPG for their cooking needs.⁴

In other study conducted in northeast India, firewood and charcoal users were (45%), LPG users were only 20% and people using both firewood and LPG were 35%.⁷ Some people are unable to procure the cylinder and prefer firewood for their cooking purposes. Two third of the study subjects were not aware about Pradhan Mantri Ujjwala Yojana and this could be the reason for using charcoal/firewood among the participants.About two third (73.1%) of household cooked food inside the house. Similar findings were seen in different studies conducted in India, where 67 to 73% of the study population cooked indoors.^8,9

Common preventive practices for controlling indoor air pollution were using opening doors (21.1%), switching of fans (15.4%) and using chimney (3.8%). Some studies study indicated that without adequate ventilation, installing a chimney may not necessarily solve air pollution problems.^10,11

Limitations

The present study was carried out in two slum areas only with small sample size so the results cannot be extrapolated to other areas. Practice of smoking for indoor air pollution was not assessed in our study.

CONCLUSION

The slum communities are aware of indoor air pollution and have knowledge regarding possible health effects. They are exposed to air pollution arising from cooking fuels. There is need for promoting awareness on exposure reductions in homes. The results of our study may help policymakers understand the need for strengthening supply of LPG under Pradhan Mantri Ujjwala Yojana.

ACKNOWLEDGEMENTS

Authors would like to thank Mr Zuber Khan, Project Director, Sakshi Center for Information, Education and Communication, New Delhi for his encouragement and support.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

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