Environmental health literacy and household air pollution-associated symptoms in Kenya: a cross-sectional study

Jill Raufman,Deanna Blansky,Qing Lan,Esther Wairimu Mwangi,David W. Lounsbury,H. Dean Hosgood,Jordi Olloquequi

doi:10.1186/s12940-020-00643-5

Abstract

BackgroundHousehold air pollution (HAP) is a significant source of the global burden of disease. Our objective was to evaluate the association between environmental health literacy (EHL), a domain of health literacy (HL) that describes the ability to use environmental health information to reduce health risks, and symptoms associated with HAP.MethodsWe performed a cross-sectional population-based study of 353 households in Kasarani, Kenya. One individual from each household was surveyed using our novel EHL survey tool. Baseline characteristics were compared between individuals who were symptomatic (i.e., experiencing cough, shortness of breath, phlegm production, wheeze, chest tightness, headache, eye irritation, or burns from cooking at least 5 times per month) versus individuals who were asymptomatic (i.e., experiencing none or symptoms no more than once per month). Multivariate logistic regression was used to determine the odds ratios (OR) of self-reported symptoms associated with HL, stratified by median EHL, adjusting for education, self-perceived health and solid fuel use.ResultsA total of 100 individuals (28%) reported experiencing one or more symptoms at least 5 times per month, including 31.2% of solid fuel users and 30.3% of non-solid fuel users. Among individuals with high EHL, higher HL was associated with lower risk of experiencing symptoms (OR = 0.26; 95% CI 0.10–0.67), however, there was no association among individuals with low EHL (OR = 0.85; 95% CI 0.34–2.13). Among solid fuel users, the association between HL and risk of experiencing symptoms was driven by individuals with high EHL (OR = 0.30; 95% CI 0.05–1.84), rather than those with low EHL (OR = 1.22; 95% CI 0.36–4.16).ConclusionsTo the best of our knowledge, this was the first study to assess the association between EHL, HL, and HAP-associated symptoms. Our findings highlight the potential importance of EHL in promoting sustainable interventions to reduce symptoms associated with HAP from solid fuel use among communities in Kenya.

Highlights

Household air pollution (HAP) is a significant source of the global burden of disease
We found that higher health literacy (HL) was associated with lower risk of experiencing symptoms among those with high environmental health literacy (EHL)
After adjusting for education, EHL, and self-reported health we found that higher HL was associated with lower risk of experiencing symptoms (OR = 0.46; 95% CI 0.25–0.86; Table 2)

Summary

Introduction

Household air pollution (HAP) is a significant source of the global burden of disease. Household air pollution (HAP) attributed to the burning of solid fuels, such as coal, wood, and dung for heating and cooking is a key contributor to ambient air pollution, morbidity, and mortality [1, 2]. In Kenya, use of solid fuels for cooking account for 95% of the rural population, 51% of the urban population, and 84% of the national total population, leading to approximately 44,000 deaths per year [4]. There have been interventions to reduce exposure via safer cooking practices, build community awareness of HAP danger, alter fuel availability, reduce the cost of cleaner cookstoves, improve the actual environment of the household and villages, and modify patterns of daily living, access to affordable non-solid fuel cookstoves has remained a major barrier to reducing solid fuel use [11]

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