Population In Malawi Research Articles

Agricultural Policy, Employment Opportunities and Social Mobility in Rural Malawi

Despite the youth accounting for more than half of the population of Malawi, they have been marginalized and pushed to the periphery of several development policy interventions. This article interrogates the question of how the youth and policy-makers view agricultural development as a means of social mobility for youth in Malawi. The paper argues that even though agricultural production is the main occupation in Malawi, young people do not value agriculture as a means of upward social mobility. Furthermore, youth and agriculture policy frameworks provide little support to youth in terms of access to affordable farm inputs, land, extension services, value addition initiatives, and markets. It is argued that Malawi is missing the strategic policy direction by not implementing non-traditional agriculture interventions that would engage the youth in a bid to reduce massive youth unemployment.

Chemically Enhanced Primary Treatment-Trickling Filter with <i>Moringa oleifera</i> Seeds for Improved Energy Recovery from Wastewater Treatment Plants in Malawi

Only 10% of the population in Malawi has access to electricity and there is increasing surface water pollution especially in urban areas. This research was conducted with the objectives of improving electricity generation and reducing water pollution in Malawi. A chemically enhanced primary treatment-trickling filter (CEPT-TF) system with Moringa oleifera (MO) seeds as a coagulant is proposed for municipal wastewater (WW) treatment to achieve both objectives. CEPT improves energy recovery by increasing the proportion of captured raw COD whose anaerobic digestion gives higher CH4 yield than secondary COD. The COD removal efficiency of MO was investigated by conducting jar tests and COD tests using WW samples from three different WWTPs in Suzhou New District, China. The amount of energy recoverable was estimated using an equation derived from COD removal efficiencies and the stoichiometric relationships between COD and CH4. The results showed a COD removal efficiency of 74% with MO concentration of 50mg/l for 880mg/l COD which is an average COD for municipal WW in Malawi. It is found that the WWTPs in Malawi’s two big cities of Blantyre and Lilongwe have the potential of producing 9,781.86kWh/d of electricity. CEPT-TF will offer sustainable solutions in Malawi, MO can be planted on sites creating closed loop systems as it provides the coagulant and gets watered and nourished with the effluent from the WWTP.

Community prevalence of chronic respiratory symptoms in rural Malawi: Implications for policy.

BackgroundNo community prevalence studies have been done on chronic respiratory symptoms of cough, wheezing and shortness of breath in adult rural populations in Malawi. Case detection rates of tuberculosis (TB) and chronic airways disease are low in resource-poor primary health care facilities.ObjectiveTo understand the prevalence of chronic respiratory symptoms and recorded diagnoses of TB in rural Malawian adults in order to improve case detection and management of these diseases.MethodsA population proportional, cross-sectional study was conducted to determine the proportion of the population with chronic respiratory symptoms that had a diagnosis of tuberculosis or chronic airways disease in two rural communities in Malawi. Households were randomly selected using Google Earth Pro software. Smart phones loaded with Open Data Kit Essential software were used for data collection. Interviews were conducted with 15795 people aged 15 years and above to enquire about symptoms of chronic cough, wheeze and shortness of breath.ResultsOverall 3554 (22.5%) participants reported at least one of these respiratory symptoms. Cough was reported by 2933, of whom 1623 (55.3%) reported cough only and 1310 (44.7%) combined with wheeze and/or shortness of breath. Only 4.6% (164/3554) of participants with chronic respiratory symptoms had one or more of the following diagnoses in their health passports (patient held medical records): TB, asthma, bronchitis and chronic obstructive pulmonary disease)ConclusionsThe high prevalence of chronic respiratory symptoms coupled with limited recorded diagnoses in patient-held medical records in these rural communities suggests a high chronic respiratory disease burden and unmet health need.

Setting up a Newborn Hearing Screening Programme in a Low-Income Country: Initial Findings from Malawi

Establishing a newborn hearing screening programme in a low-income country with poor communication infrastructure has unique challenges. Data from 195 infants in three different patient populations in Malawi who underwent hearing screening using transient evoked otoacoustic emissions (TEOAE) testing were analysed to investigate the feasibility of a long-term screening programme. There were 65 infants in each group: infants from Group A were born in a private maternity unit, Group B attended a free community vaccination clinic, and Group C were receiving special care at a government hospital. 75% of infants requiring follow-up from the special-care baby unit were uncontactable following hospital discharge, and screening was discontinued there. Lost to follow-up rates after the first screen were lower from the private maternity unit (14%) and the community vaccination clinic (36%), and these screening programmes continue. A successful hearing screening programme requires extensive support services to manage infants requiring further testing and habilitation, this is not currently possible on a large scale in Malawi due to the small number of Audiology departments and trained staff.

Associations of maternal nutrition during pregnancy and post-partum with maternal cognition and caregiving.

Pregnant and post‐partum women require increased nutrient intake and optimal cognition, which depends on adequate nutrition, to enable reasoning and learning for caregiving. We aimed to assess (a) differences in maternal cognition and caregiving between women in Malawi who received different nutritional supplements, (b) 14 effect modifiers, and (c) associations of cognition and caregiving with biomarkers of iron, Vitamin A, B‐vitamin, and fatty acid status. In a randomized controlled trial (n = 869), pregnant women daily received either multiple micronutrients (MMN), 20 g/day lipid‐based nutrient supplements (LNS), or a control iron/folic acid (IFA) tablet. After delivery, supplementation continued in the MMN and LNS arms, and the IFA control group received placebo until 6 months post‐partum, when cognition (n = 712), caregiving behaviour (n = 669), and biomarkers of nutritional status (n = 283) were assessed. In the full group, only one difference was significant: the IFA arm scored 0.22 SD (95% CI [0.01, 0.39], p = .03) higher than the LNS arm in mental rotation. Among subgroups of women with baseline low hemoglobin, poor iron status, or malaria, those who received LNS scored 0.4 to 0.7 SD higher than the IFA arm in verbal fluency. Breastmilk docosahexaenoic acid and Vitamin B12 concentrations were positively associated with verbal fluency and digit span forward (adjusting for covariates ps < .05). In this population in Malawi, maternal supplementation with MMN or LNS did not positively affect maternal cognition or caregiving. Maternal docosahexaenoic acid and B12 status may be important for post‐partum attention and executive function.

Risk factors and reasons for treatment abandonment among children with lymphoma in Malawi.

Lymphoma is the commonest pediatric cancer in sub-Saharan Africa (SSA). Frequent treatment abandonment contributes to suboptimal outcomes. We examined risk factors and reasons for treatment abandonment for this population in Malawi. We conducted a mixed methods study among children <18years old with newly diagnosed lymphoma, prospectively enrolled during 2013-2016. All children received standardized diagnosis and treatment, and were followed for up to 2years. Treatment abandonment was defined as failure to attend prescribed chemotherapy within 4weeks, or post-treatment visit within 3months. Child, guardian, and household characteristics associated with treatment abandonment were assessed. Semi-structured interviews were conducted with primary caregivers of children experiencing treatment abandonment. Of 121 children with newly diagnosed lymphoma, 72 (60%) had complete information regarding child, guardian, and household characteristics. Of these, 56 (78%) had Burkitt's and 16 (22%) Hodgkin's lymphoma. Forty-nine (68%) were male, median age was 10.6years (interquartile range [IQR] 7.9-13.0), and 26 (36%) experienced treatment abandonment. Lack of guardian education and travel time ≥4h to clinic were independently associated with treatment abandonment, with adjusted hazard ratio (aHR) 3.8 [95% confidence interval (CI) 1.5-8.9, p=0.005] and aHR 2.9 (95% CI 1.2-6.9, p=0.019), respectively. Commonest reasons for treatment abandonment endorsed by 15 guardians were community influence, suboptimal clinic environment, logistical challenges, transport costs, treatment toxicities, loss of hope, alternative healers, and beliefs about cure. These findings highlight families at risk for treatment abandonment, underlying reasons, and opportunities to improve retention in care for pediatric cancer patients in SSA.

Prevalence of hepatitis D virus infection in sub-Saharan Africa: a systematic review and meta-analysis.

SummaryBackgroundHepatitis D virus (also known as hepatitis delta virus) can establish a persistent infection in people with chronic hepatitis B, leading to accelerated progression of liver disease. In sub-Saharan Africa, where HBsAg prevalence is higher than 8%, hepatitis D virus might represent an important additive cause of chronic liver disease. We aimed to establish the prevalence of hepatitis D virus among HBsAg-positive populations in sub-Saharan Africa.MethodsWe systematically reviewed studies of hepatitis D virus prevalence among HBsAg-positive populations in sub-Saharan Africa. We searched PubMed, Embase, and Scopus for papers published between Jan 1, 1995, and Aug 30, 2016, in which patient selection criteria and geographical setting were described. Search strings included sub-Saharan Africa, the countries therein, and permutations of hepatitis D virus. Cohort data were also added from HIV-positive populations in Malawi and Ghana. Populations undergoing assessment in liver disease clinics and those sampled from other populations (defined as general populations) were analysed. We did a meta-analysis with a DerSimonian-Laird random-effects model to calculate a pooled estimate of hepatitis D virus seroprevalence.FindingsOf 374 studies identified by our search, 30 were included in our study, only eight of which included detection of hepatitis D virus RNA among anti-hepatitis D virus seropositive participants. In west Africa, the pooled seroprevalence of hepatitis D virus was 7·33% (95% CI 3·55–12·20) in general populations and 9·57% (2·31–20·43) in liver-disease populations. In central Africa, seroprevalence was 25·64% (12·09–42·00) in general populations and 37·77% (12·13–67·54) in liver-disease populations. In east and southern Africa, seroprevalence was 0·05% (0·00–1·78) in general populations. The odds ratio for anti-hepatitis D virus detection among HBsAg-positive patients with liver fibrosis or hepatocellular carcinoma was 5·24 (95% CI 2·74–10·01; p<0·0001) relative to asymptomatic controls.InterpretationFindings suggest localised clusters of hepatitis D virus endemicity across sub-Saharan Africa. Epidemiological data are needed from southern and east Africa, and from patients with established liver disease. Further studies should aim to define the reliability of hepatitis D virus testing methods, identify risk factors for transmission, and characterise the natural history of the infection in the region.FundingWellcome Trust, Royal Society.

Reframing noncommunicable diseases and injuries for the poorest Malawians: the Malawi National NCDI Poverty Commission.

Noncommunicable diseases and injuries (NCDIs) account for nearly 70% of deaths worldwide, with an estimated 75% of these deaths occurring in low- and middle-income countries. Globally, the burden of disease from noncommunicable diseases (NCDs) is most often caused by the "big 4," namely: diabetes, cardiovascular diseases, cancer, and chronic lung diseases. However, in Malawi, these 4 conditions account for only 29% of the NCDI disease burden. The Malawi National NCDI Poverty Commission was launched in November 2016 and will describe and evaluate the current NCDI situation in Malawi, with a focus on the poorest populations. The National Commission will investigate which NCDIs cause the biggest burden, which are more present in the young, and which interventions are available to avert death and disability from NCDIs in Malawi, particularly among the poorest segments of the population. The evidence gained through the work of this Commission will help inform research, policy, and programme interventions, all through an advocacy lens, as we strive to address the impact of NCDIs among all populations in Malawi.

Quality of Life Impacts Related to the Time to Access Drinking Water in Malawi

Background Universal and equitable access to safe and affordable drinking water for all by 2030 is one target stipulated in the Sustainable Development Goals (SDGs). As of 2015, 92% of the population in Malawi did not have access to water on premises and needed to fetch it. Thus, the issue of water accessibility warrants further research, particularly since the time/energy expenditure needed can impact the affordability of water and thus the quality of life and health of the population. This is perhaps the inverse problem of wealthy developed nations where greater active travel is required for improved health. Methods Malaria Indicator Survey (MIS) 2014 Household survey datasets from Health Surveys program was analysed in STATA MP 14 for the aim of this study (n=3405). Time to fetch water was applied as a proxy of the distance to estimate energy expenditure. Results Two models were created to show the quality of life impacts of the distance to access water. First, by using the indicator initially apply by JMP to monitor the MDG target (i.e. proportion of the population with access to an improved water source irrespective of the time), the proportion of the population with access would be 86%. However, by adding a 30 minutes round-trip distance as a key threshold to the proportion of the population using an improved water source the proportion of the population with access would decrease to 72% (p Conclusions In order to develop appropriate interventions to improve drinking water access and overall quality of life, the distance between the source and the point of use must be quantified to determine where thresholds and limits may exist.

Sexual Activity of the Youth Population in Malawi: The Emerging Health Care Scenario

The sexual behaviour of youths in Malawi is believed to play an important role in the spread of sexually transmitted infections (STIs). Relevant data from the Malawi Demographic and Health Survey 2010 and a sample of 16,217 youths aged 15–24 have been studied and subjected to bivariate and logistic regression analysis. The results show that married youths were not interested in using condoms (94.2%, p &lt; 0.05) and that those who were living together were 69 times (OR = 1.69, 95% CI, 1.26–2.26) more likely to be involved in early sexual activity than those who were not living together. It is argued that the results should help other researchers, policy makers and planners to create strategies to encourage these youths make use of contraception.

Vision Impairment and Ocular Morbidity in a Refugee Population in Malawi.

To provide screening services and obtain information on the eye health status and distribution of visual impairments in a refugee population of the sole refugee camp in Malawi. A general eye screening at Dzaleka refugee settlement camp was organized in November 2012. Final-year optometry students conducted detailed optometry examinations, including visual acuity (VA) assessment for near and distance, retinoscopy, and subjective refraction in cases with distance VA less than 6/12 or near VA less than N8, anterior and posterior segment evaluation. Their findings were then verified by an optometrist. The World Health Organization definition of vision impairment was followed, and the cause of vision impairment was determined at the end of each examination. Where possible, participants requiring refractive correction were provided spectacles free of cost. Of a total 635 participants examined, around one-half were male with 61% in the 16 to 49 years age group. The overall prevalence of presenting blindness, severe vision impairment, and vision impairment were 1.3% (95% confidence interval [95% CI], 0.5 to 2.4), 0.5% (95% CI, 0.0 to 1.1), and 3.6% (95% CI, 2.3 to 5.2), respectively. Overall vision impairment (VA <6/18) was present in 5.4% (95% CI, 3.6 to 7.1) of the participants. The principal causes of blindness, severe vision impairment, and vision impairment were cataracts, refractive errors, and corneal opacities, respectively; and more than 90% of the overall vision impairment was avoidable. Refractive errors and presbyopia were the most common morbidity, present in more than two-thirds of the participants examined. Only 5% of all the participants ever had a previous eye examination. The prevalence and causes of blindness and vision impairment in a refugee population are comparable with those of the general population. Lack of basic eye care services in the health center for refugees is a major concern. The health care facility in the settlement camp needs to be upgraded to provide comprehensive eye care including refractive care services.

Three genetic groups of the Eucalyptus stem canker pathogen Teratosphaeria zuluensis introduced into Africa from an unknown source.

The Eucalyptus stem canker pathogen Teratosphaeria zuluensis was discovered in South Africa in 1988 and it has subsequently been found in several other African countries as well as globally. In this study, the population structure, genetic diversity and evolutionary history of T. z uluensis were analysed using microsatellite markers to gain an enhanced understanding of its movement in Africa. Isolates were collected from several sites in Malawi, Mozambique, Uganda and Zambia. Data obtained were compared with those previously published for a South African population. The data obtained from 334 isolates, amplified across eight microsatellite loci, were used for assignment, differentiation and genetic diversity tests. STRUCTURE analyses, θ st and genetic distances revealed the existence of two clusters, one dominated by isolates from South Africa and the other by isolates from the Zambezi basin including Malawi, Mozambique and Zambia. High levels of admixture were found within and among populations, dominated by the Mulanje population in Malawi. Moderate to low genetic diversity of the populations supports the previously held view that the pathogen was introduced into Africa. The clonal nature of the Ugandan population suggests a very recent introduction, most likely from southern Africa.

P16.29 Prevalence of metabolic risk factors in hiv-infected population under antiretroviral therapy in northern malawi

Introduction With increased availability of antiretroviral therapy (ART), the life expectancy of people with human immunodeficiency virus (HIV) infection is expected to improve substantially. On the other hand, life-long ART may be associated with increased obesity, diabetes, and hypertension. The situation of obesity, diabetes, and hypertension in HIV-infected population in Malawi is unclear. Methods We conducted a cross-sectional study including adult HIV-infected patients under ART treatment in a teaching hospital from northern Malawi. Trained field workers performed anthropometric measurements, blood pressure exam, and finger prick test for blood glucose. We followed the WHO and International Diabetes Federation (IDF) criteria to define obesity, hypertension, and diabetes. We compared the prevalence of metabolic risk factors in our study population to that in the 2009 STEPwise approach to Surveillance (STEPS) survey in Malawi. Results The study included 410 participants (20.97% males). The prevalence of overweight (25≤BMI Conclusion Our study provides an initial assessment of the burden of metabolic risk factors among HIV-infected population under long-term ART treatment in Malawi. The high prevalence of metabolic risk factors in this population is concerning. Long-term impact on the burden of noncommunicable diseases warrants further investigation. Disclosure of interest statement This study was funded by Luke international belongs Pingtung Christian hospital. And that was leaded by National Taiwan University for academic research.

A Pilot Study of a Picture- and Audio-assisted Self-interviewing Method (PIASI) for the Study of Sensitive Questions on HIV in the Field

Self-interview methods such as audio computer-assisted self-interviewing (ACASI) are used to improve the accuracy of interview data on sensitive topics in large trials. Small field studies on sensitive topics would benefit from methodological alternatives. In a study on male involvement in antenatal HIV testing in a largely illiterate population in Malawi, we piloted picture- and audio-assisted self-interviewing (PIASI). Out of 388 participants, 96 were randomized to answer six sensitive questions using PIASI after the face-to-face interview (FTF). Participants who responded by PIASI were more likely to express accepting attitudes toward childbearing by HIV-positive women than were FTF respondents. Most considered PIASI easy to use, and one in five preferred it to FTF. PIASI may offer a feasible, low-cost alternative to ACASI for small and simple studies on sensitive topics and in illiterate populations.

Excessive bird collecting in Malawi: a new threat

SummaryMalawi is under heavy pressure for land by an increasing human population, and there is little natural habitat left outside gazetted wildlife and forest reserves. Widespread collecting of birds in Malawi’s small protected rain forests by the National Museum of Malawi in conjunction with Western academic institutions has been taking place almost yearly since 2001 and has continued until at least 2011. The collection of specimens, although often a contentious issue, does have scientific value but should be undertaken in a limited way with careful evaluation of the populations from which birds are being taken. We consider that the numbers collected are likely to pose a threat to some bird populations in view of their isolation and the slow turn-over rates of breeding individuals. Collecting has been carried out in some of the same reserves two or three times within a few years. Examples are given of very small populations in Malawi and adjacent Mozambique where the slightest off-take would be very dangerous. Many species have been collected during their breeding season, which we find both wasteful and unethical. Several of the species collected occur in no more than one or two reserves today in Malawi and in such instances we recommend their complete protection. We are also concerned about the example presented to the local communities, reserve wardens and young conservation biologists by the off-take of hundreds of birds in official reserves which were primarily set up for the protection of wildlife.

Determination of a Viral Load Threshold To Distinguish Symptomatic versus Asymptomatic Rotavirus Infection in a High-Disease-Burden African Population.

We evaluated quantitative real-time PCR to establish the diagnosis of rotavirus gastroenteritis in a high-disease-burden population in Malawi using enzyme immunoassay as the gold standard diagnostic test. In 146 children with acute gastroenteritis and 65 asymptomatic children, we defined a cutoff point in the threshold cycle value (26.7) that predicts rotavirus-attributable gastroenteritis in this population. These data will inform the evaluation of direct and indirect rotavirus vaccine effects in Africa.

Refractive errors, visual impairment, and the use of low-vision devices in albinism in Malawi.

This study focuses on the refractive implications of albinism in Malawi, which is mostly associated with the burden of visual impairment. The main goal was to describe the refractive errors and to analyze whether patients with albinism in Malawi, Sub-Saharan Africa, benefit from refraction. Age, sex, refractive data, uncorrected and best-corrected visual acuity (UCVA, BCVA), colour vision, contrast sensitivity, and the prescription of sunglasses and low vision devices were collected for a group of 120 albino individuals with oculocutaneous albinism (OCA). Refractive errors were evaluated objectively and subjectively by retinoscopy, and followed by cycloplegic refraction to reconfirm the results. Best-corrected visual acuity (BCVA) was also assessed binocularly. One hundred and twenty albino subjects were examined, ranging in age from 4 to 25 years (median 12 years), 71 (59 %) boys and 49 (41 %) girls. All exhibited horizontal pendular nystagmus. Mean visual acuity improved from 0.98 (0.33) logMAR to 0.77 (0.15) logMAR after refraction (p < 0.001). The best improvement of VA was achieved in patients with mild to moderate myopia. Patients with albinism who were hyperopic more than +1.5 D hardly improved from refraction. With the rule (WTR) astigmatism was more present (37.5 %) than against the rule (ATR) astigmatism (3.8 %). Patients with astigmatism less than 1.5 D improved in 15/32 of cases (47 %) by 2 lines or more. Patients with astigmatism equal to or more than 1.5 D in any axis improved in 26/54 of cases (48 %) by 2 lines or more. Refraction improves visual acuity of children with oculocutaneous albinism in a Sub-Saharan African population in Malawi. The mean improvement was 2 logMAR units.

Prevalence of hepatitis C virus in mothers and their children in Malawi.

ObjectivesHepatitis C virus (HCV) prevalence is poorly mapped in the East African region; with the advent of novel HCV therapies, better epidemiological data are required to target the infection. We sought to estimate HCV prevalence in healthy Malawian mothers and assess mother-to-child transmission (MTCT); context is provided by reviewing previously published HCV prevalence data from the region.MethodsUsing ELISA screening and confirmatory blot, serological testing of 418 healthy Malawian mothers for HCV was performed. To examine MTCT, the children of any positive women were also tested for HCV; all children had malignant disease unrelated to hepatocellular carcinoma. We compared our results to published literature on HCV prevalence in Malawi and its neighbouring countries.ResultsThree of 418 women were HCV reactive by ELISA; two were confirmed positive by immunoblot (0.5%). One child of an HCV-infected mother was HCV seropositive. The literature review revealed HCV prevalence ranging from 0 to 7.2% in the region, being highest in Tanzania and specifically for cohorts of inpatients and HIV-co-infected people. The overall estimated prevalence of HCV in Malawi was 1.0% (95%CI 0.7–1.4) when all studies were included (including this one), but lower in healthy cohorts alone at 0.3% (95%CI 0.1–1.2).ConclusionsThis is the first study using confirmatory tests to examine HCV prevalence in healthy Malawian mothers; the prevalence was low. Future studies need to address the source of infection in healthy women.

HIV-related stigma: implications for symptoms of anxiety and depression among Malawian women

An estimated 11% of the adult population in Malawi, Africa, is living with HIV/AIDS. The disease has taken a toll on communities, resulting in high morbidity and mortality. Malawian women carry the burden of being caretakers for individuals infected with HIV while also worrying about their own health. However, little is known about how HIV/ AIDS affects psychological functioning among Malawian women in areas hit hardest by the epidemic. To that end, this paper examined the influence of HIV-related stigma on symptoms of anxiety and depression among 59 women 17–46 years old who were recruited from the Namitete area of Malawi. Women who reported greater worry about being infected with HIV and greater HIV-related stigma were significantly more likely to report greater symptoms of anxiety and depression. These findings suggest that interventions that reduce HIV-related stigma are likely to enhance psychological functioning among Malawian women, which in turn will improve the women's quality of life and well-being.

A cross-sectional study of household biomass fuel use among a periurban population in Malawi.

The Global Burden of Disease Study suggests almost 3.5 million people die as a consequence of household air pollution every year. Respiratory diseases including chronic obstructive pulmonary disease and pneumonia in children are strongly associated with exposure to household air pollution. Smoke from burning biomass fuels for cooking, heating, and lighting is the main contributor to high household air pollution levels in low-income countries like Malawi. A greater understanding of biomass fuel use in Malawi should enable us to address household air pollution-associated communicable and noncommunicable diseases more effectively. To conduct a cross-sectional analysis of biomass fuel use and population demographics among adults in Blantyre, Malawi. We used global positioning system-enabled personal digital assistants to collect data on location, age, sex, marital status, education, occupation, and fuel use. We describe these data and explore associations between demographics and reported fuel type. A total of 16,079 adults participated (nine households refused); median age was 30 years, there was a similar distribution of men and women, 60% were married, and 62% received secondary school education. The most commonly reported occupation for men and women was "salaried employment" (40.7%) and "petty trader and marketing" (23.5%), respectively. Charcoal (81.5% of households), wood (36.5%), and electricity (29.1%) were the main fuels used at home. Only 3.9% of households used electricity exclusively. Lower educational and occupational attainment was associated with greater use of wood. This large cross-sectional study has identified extensive use of biomass fuels in a typical sub-Saharan Africa periurban population in which women and people of lower socioeconomic status are disproportionately affected. Biomass fuel use is likely to be a major driver of existing communicable respiratory disease and the emerging noncommunicable disease (especially respiratory and cardiovascular) epidemic in this region. Our data will help inform the rationale for specific intervention studies and the development of appropriately targeted public health strategies to tackle this important and poverty-related global health problem.