Behavioural change, indoor air pollution and child respiratory health in developing countries: a review.

Indoor air pollution caused by the indoor burning of solid biomass fuels has been associated with Acute Respiratory Infections such as pneumonia amongst children of less than five years of age. Behavioural change interventions have been identified as a potential strategy to reduce child indoor air pollution exposure, yet very little is known about the impact of behavioural change interventions to reduce indoor air pollution. Even less is known about how behaviour change theory has been incorporated into indoor air pollution behaviour change interventions. A review of published studies spanning 1983-2013 suggests that behavioural change strategies have the potential to reduce indoor air pollution exposure by 20%-98% in laboratory settings and 31%-94% in field settings. However, the evidence is: (1) based on studies that are methodologically weak; and (2) have little or no underlying theory. The paper concludes with a call for more rigorous studies to evaluate the role of behavioural change strategies (with or without improved technologies) to reduce indoor air pollution exposure in developing countries as well as interventions that draw more strongly on existing behavioural change theory and practice.

A follow-up cross-sectional study of environmental lead exposure in early childhood in urban South Africa.

BACKGROUND: Lead exposure has significant detrimental effects on the health and wellbeing of children. In resource-poor countries, information on the extent of lead exposure is often inadequate owing to the lack of surveillance and screening programmes. OBJECTIVE: To determine the degree of lead exposure in children residing in South African urban areas. METHODS: A cross-sectional survey was conducted in schools in Johannesburg, Cape Town and Kimberley in 2007 - 2008. Blood lead levels were assessed in a total of 1 349 grade 1 children using the LeadCare Analyser system. Parents completed a structured questionnaire on sociodemographic profiles and risk factors to provide information about socioeconomic status and other risk factors for lead exposure. RESULTS: Blood lead levels ranged from 0.8 - 32.3 µg/dl. The mean blood lead level in the total sample was 7.97 µg/dl; 74% had blood lead levels ≥5 µg/dl. The highest proportion (84%) of children with blood lead levels ≥5 µg/dl was in Johannesburg. In the multivariate analysis, socioeconomic status was significantly associated with blood lead levels ≥5 µg/dl. CONCLUSION: Lead exposure in South African urban areas remains widespread. The risk of lead poisoning in some areas and certain groups of children may be increasing despite the phasing out of lead-containing petrol. Children living in poverty continue to be the most vulnerable.

Elevated mercury exposure in communities living alongside the Inanda Dam, South Africa.

Mercury is a persistent heavy metal that has been associated with damage to the central nervous system, including hearing and speech impairment, visual constriction and loss of muscle control. In aquatic environments mercury may be methylated to its most toxic form, methyl-mercury. In 1990 concerns were raised over mercury contamination in the vicinity of a mercury processing plant in KwaZulu-Natal, South Africa. Mercury waste was reported to have been discharged into the Mngceweni River, situated in close proximity to the plant. The Mngceweni River joins the uMgeni River, which in turn flows into the Inanda Dam, along the banks of which several villages are located. This study evaluated the mercury levels in river and dam sediments, fish from the Inanda Dam and hair samples collected from residents of three villages along the banks of the Inanda Dam. The study results showed that 50% of the fish samples and 17% of hair samples collected from villagers had mercury concentrations that exceeded guideline levels of the World Health Organization. Mercury concentrations in 62% of the river sediment samples collected in close proximity to the former mercury processing plant exceeded the level at which remedial action is required according to legislation in the Netherlands. These preliminary findings give reasons for concern and should be used as a baseline for further investigations.

The Prevalence and Health Implications of Violence in Impoverished Communities in Johannesburg

Abstract:The experience of violent crime can have a significant impact on the physical and psychological well-being of victims and their families. This paper looks at household experience of violence in five impoverished sites in the city of Johannesburg; South Africa. Five sites were purposefully selected to reflect the prevailing housing profiles in settings of relative impoverishment in Johannesburg. A structured questionnaire was used to obtain information on demographic profiles; socioeconomic data; environmental conditions and health status. Bivariate analyses were conducted to assess the relationship between household experience of violence; and potential risk factors and health/social outcomes. Overall; members of 28 of households had been a victim of violence in the year preceding the study. Across sites; experience of violence within households ranged from 21 to 36. Perceptions of drug abuse (p=0.01) and drug peddling (p=0.03) as being major problems in the neighbourhood; and living in a house of poor quality (p=0.01); were significantly associated with household experience of crime. In households with experience of violence; fear of crime (p=0.03) and depression (p 0.001) were elevated; and levels of exercise in men were decreased (p

Estimating the burden of disease attributable to indoor air pollution from household use of solid fuels in South Africa in 2000.

OBJECTIVES: To estimate the burden of respiratory ill health in South African children and adults in 2000 from exposure to indoor air pollution associated with household use of solid fuels. DESIGN: World Health Organization comparative risk assessment (CRA) methodology was followed. The South African Census 2001 was used to derive the proportion of households using solid fuels for cooking and heating by population group. Exposure estimates were adjusted by a ventilation factor taking into account the general level of ventilation in the households. Population-attributable fractions were calculated and applied to revised burden of disease estimates for each population group. Monte Carlo simulation-modelling techniques were used for uncertainty analysis. SETTING: South Africa. SUBJECTS: Black African, coloured, white and Indian children under 5 years of age and adults aged 30 years and older. OUTCOME MEASURES: Mortality and disability-adjusted life years (DALYs) from acute lower respiratory infections in children under 5 years, and chronic obstructive pulmonary disease and lung cancer in adults 30 years and older. RESULTS: An estimated 20% of South African households were exposed to indoor smoke from solid fuels, with marked variation by population group. This exposure was estimated to have caused 2,489 deaths (95% uncertainty interval 1,672 - 3,324) or 0.5% (95% uncertainty interval 0.3 - 0.6%) of all deaths in South Africa in 2000. The loss of healthy life years comprised a slightly smaller proportion of the total: 60,934 DALYs (95% uncertainty interval 41,170 - 81,246) or 0.4% of all DALYs (95% uncertainty interval 0.3 - 0.5%) in South Africa in 2000. Almost 99% of this burden occurred in the black African population. CONCLUSIONS: The most important interventions to reduce this impact include access to cleaner household fuels, improved stoves, and better ventilation.

Estimating the burden of disease attributable to lead exposure in South Africa in 2000.

OBJECTIVES: To estimate the burden of disease attributable to lead exposure in South Africa in 2000. DESIGN: World Health Organization comparative risk assessment (CRA) methodology was followed. Recent community studies were used to derive mean blood lead concentrations in adults and children in urban and rural areas. Population-attributable fractions were calculated and applied to revised burden of disease estimates for the relevant disease categories for South Africa in the year 2000. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. SETTING: South Africa. SUBJECTS: Children under 5 and adults 30 years and older. OUTCOME MEASURES: Cardiovascular mortality and disability-adjusted life years (DALYs) in adults 30 years and older and mild mental disability DALYs in children under 5 years. RESULTS: Lead exposure was estimated to cause 1,428 deaths (95% uncertainty interval 1,086-1,772) or 0.27% (95% uncertainty interval: 0.21 - 0.34%) of all deaths in South Africa in 2000. Burden of disease attributed to lead exposure was dominated by mild mental disability in young children, accounting for 75% of the total 58,939 (95% uncertainty interval 55,413 - 62,500) attributable DALYs. Cardiovascular disease in adults accounted for the remainder of the burden. CONCLUSIONS: Even with the phasing out of leaded petrol, exposure to lead from its ongoing addition to paint, para-occupational exposure and its use in backyard 'cottage industries' will continue to be an important public health hazard in South Africa for decades. Young children, especially those from disadvantaged communities, remain particularly vulnerable to lead exposure and poisoning.

The politics of behavioural change for environmental health promotion in developing countries.

Behavioural change remains a popular intervention strategy for environmental health promotion in developing countries. This article explores the question of why behavioural change interventions continue to be widely used as an intervention strategy in developing countries and highlights the political implications of this approach. It suggests that framing interventions within a mainstream environmental health science paradigm serves to perpetuate a behavioural intervention approach while foreclosing other options. It also serves to perpetuate sexist representations of poor African women; absolves decision makers from addressing broader socio-political concerns (such as poverty and inequality) that are key to addressing environmental health concerns in developing countries; and sets up an expert model for environmental health and behavioural health scientists to thrive.

Assessing child time-activity patterns in relation to indoor cooking fires in developing countries: a methodological comparison.

Indoor air pollution, caused by the indoor burning of biomass fuels, has been associated with an increased risk of child acute respiratory infections in developing countries. The amount of time that children spend in proximity to fires is a crucial determinant of the health impact of indoor air pollution. Researchers are reliant on social scientific methods to assess exposure based on child location patterns in relation to indoor fires. The inappropriate use of methods could lead to misclassification of exposure. The aim of this paper is to compare two methods (observations and questionnaire interview) with video analysis (which is thought to offer a more accurate assessment of exposure) in rural South African villages. Compared to video analysis, results show that observations may underestimate the amount of time that children spend very close (within 1.5 m) to fires. This is possibly due to reactivity caused by the presence of an observer. The questionnaire interview offers a more accurate assessment of the amounts of time that children spend within 1.5 m of fires at the expense of a detailed behavioural analysis. By drawing on the strengths and weaknesses of each, this paper discusses the appropriateness of methods to different research contexts.

A behavioral intervention to reduce child exposure to indoor air pollution: identifying possible target behaviors.

Indoor air pollution has been causally linked to acute lower respiratory infections in children younger than 5. The aim of this study was to identify target behaviors for a behavioral intervention to reduce child exposure to indoor air pollution by attempting to answer two research questions: Which behaviors are protective of child respiratory health in the study context? and Which behaviors do mothers recommend to reduce their children's exposure to indoor air pollution? Observations and interviews were conducted with 67 mother-child combinations. The authors recommend that four behavioral clusters should be considered for the main intervention. These are to improve stove maintenance practices, to increase the duration that two ventilation sources are opened while a fire is burning, to reduce the time that children spend close to burning fires, and to reduce the duration of solid fuel burning.