Self-rated health among Mayan women participating in a randomised intervention trial reducing indoor air pollution in Guatemala

Esperanza Díaz, Nigel Bruce, Dan Pope, Anaité Díaz, Kirk R Smith, Tone Smith-Sivertsen, Esperanza Díaz, Nigel Bruce, Dan Pope, Anaité Díaz, Kirk R Smith, Tone Smith-Sivertsen

Abstract

Background: Indoor air pollution (IAP) from solid fuels is a serious health problem in low-income countries that can be alleviated using improved stoves. Although women are the principal users, few studies have investigated the self-assessed impact of the stoves on their health and lives.

Methods: This study was conducted in rural highland Guatemala, involving 89 intervention and 80 control Mayan Indian young women (mean 27.8 years, SD 7.2). Outcomes were assessed after approximately 18 months use of the new stove. Our objectives were to compare self-rated health and change in health among women participating in a randomised control trial comparing a chimney stove with an open fire, to describe impacts on women's daily lives and their perceptions of how reduced kitchen smoke affects their own and their children's health.

Results: On intention-to-treat analysis, 52.8% of intervention women reported improvement in health, compared to 23.8% of control women (p < 0.001). Among 84 intervention women who reported reduced kitchen smoke as an important change, 88% linked this to improvement in their own health, particularly for non-respiratory symptoms (for example eye discomfort, headache); 57% linked reduced smoke to improvement in their children's health, particularly sore eyes.

Conclusion: Women's perception of their health was improved, but although smoke reduction was valued, this was linked mainly with alleviation of non-respiratory symptoms like eye discomfort and headache. More focus on such symptoms may help in promoting demand for improved stoves and cleaner fuels, but education about more severe consequences of IAP exposure is also required.

Figures

Figure 1
Figure 1
Flowchart of RESPIRE study, and self-rated study.

References

    1. Smith KR, Metha S, Maeusezahl-Feuz M. Indoor air pollution from household use of solid fuels. In: Ezzati M, Rodgers A, Lopez AD, Murray CJL, editor. Comparative Quantification of Health Risks: Global and Regional Burden of Disease due to Selected major Risk Factors. Vol. 2. Geneva , WHO; 2004. pp. 1435–1493.
    1. Smith KR, Rogers J, Cowlin SC. World LP Gas Association and Intermediate Technology Development Group. Paris ; 2005. Household Fuels and Ill-Health in Developing Countries: What improvements can be brought by LP Gas? p. 59 pp.
    1. Chengappa C, Edwards R, Bajpai R, Shields KN, Smith KR. Impact of improved cookstoves on indoor air quality in the Bundelkhand region in India. Energy for Sustainable Development. 2007;11:33–44.
    1. Dutta K, Shields KN, Edwards R, Smith KR. Impact of improved biomass cookstoves on indoor air quality near Pune, India. Energy for Sustainable Development. 2007;11:19–32.
    1. Masera O, Edwards R, Arnez CA, Berrueta V, Johnson M, Bracho LR, Rojas-Rodríguez H, Smith KR. Impact of Patsari improved cookstoves on indoor air quality in Michoacán, Mexico. Energy for Sustainable Development. 2007;11:45–56.
    1. Mehta S, Shahpar C. The health benefits of interventions to reduce indoor air pollution from solid fuel use: a cost-effectiveness analysis. Energy for Sustainable Development. 2004;8:53–59.
    1. Hutton G, Rehfuess E, Tediosi F, Weiss S. In: Evaluation of the costs and benefits of household energy and health interventions at global and regional levels. Cataloguing WHOL, editor. Geneva ; 2006.
    1. Sinton JE, Smith KR, Peabody JW, Yaping L, Xiliang Z, Edwards R, Quan G. An assessment of programs to promote improved household stoves in China. Energy for Sustainable Development. 2004;8:33–52.
    1. Barnes DF, Openshaw K, Smith KR, van der Plas R. What makes people cook with improved biomass stoves?. A comparative international review of stove programs. World Bank Technical Paper Number 242; 1994.
    1. Bates E, Bruce N, Doig A, Gitonga S. Participatory approaches for alleviating indoor air pollution in rural Kenyan kitchens. Boiling point. 2002. pp. 12–15.
    1. Dutta S. Role of Women in Rural Energy Programmes: Issues, Problems and Opportunities. Energia International Network on Gender and Sustainable Energy. 1997.
    1. Khushk WA, Fatmi Z, White F, Kadir MM. Health and social impacts of improved stoves on rural women: a pilot intervention in Sindh, Pakistan. Indoor air. 2005;15:311–316. doi: 10.1111/j.1600-0668.2005.00367.x.
    1. Shaller DV. In: The sociology of a stove. Forestry , editor. FAO; 1979.
    1. Bruce N, Diaz A, Arana B, Jenny A, Thompsom L, Weber M, McCracken J, Dherani M, Juarez D, Ordonez S, Klein R, Smith KR. Pneumonia case-finding in the Guatemala indoor air pollution trial (RESPIRE): standardizing methods for resource-poor settings. WHO. 2007.
    1. Díaz E, Bruce NG, Pope D, Lie RT, Díaz A, Arana B, Smith K, Smith-Sivertsen T. Lung function and symptoms among Indigenous Mayan women exposed to high levels of indoor air pollution. International Journal for Tuberculosis and Lung Diseases. 2007;11:1372–1379.
    1. Díaz E, Smith-Sivertsen T, Pope D, Lie RT, Diaz A, McCracken J, Arana B, Smith KR, Bruce N. Eye Discomfort, Headache and Back Pain among Mayan Guatemalan Women taking part in a Randomised Stove Intervention. Journal of Epidemiology and Community Health. 2007;61:74–79. doi: 10.1136/jech.2006.043133.
    1. Idler E, Leventhal H, McLaughlin J, Leventhal E. In sickness but not in health: self-ratings, identity, and mortality. Journal of health & social behavior. 2004;45:336–356.
    1. Idler EL, Hudson SV, Leventhal H. The Meanings of Self-Ratings of Health. Research on Aging. 1999;21:458–476. doi: 10.1177/0164027599213006.
    1. Idler EL, Kasl S. Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol. 1991;46:S55–65.
    1. Segovia J, Bartlett RF, Edwards AC. An empirical analysis of the dimensions of health status measures. Social science & medicine. 1989;29:761–768. doi: 10.1016/0277-9536(89)90156-1.
    1. Smith-Sivertsen T, Díaz E, Bruce N, Díaz A, Khalakdina A, Schei MA, McCracken J, Arana B, Klein R, Thompson L, Smith KR. Reducing indoor air pollution with a randomised intervention design – A presentation of the Stove Intervention Study in the Guatemalan Highlands. Nor J Epidemiol. 2004;14:137–143.
    1. Albalak R, Bruce N, McCracken JP, Smith KR, de Gallardo T. Indoor Respirable Particulate Matter Concentrations from an Open Fire, Improved Cookstove, and LPG/Open Fire Combination in a Rural Guatemalan Community. Environmental Science and Technology. 2001;35:2650–2655. doi: 10.1021/es001940m.
    1. Bruce N, McCracken J, Albalak R, Schei MA, Smith KR, Lopez V, West C. Impact of improved stoves, house construction and child location on levels of indoor air pollution exposure in young Guatemalan children. J Expo Anal Environ Epidemiol. 2004;14 Suppl 1:26–33. doi: 10.1038/sj.jea.7500355.
    1. SPSS . SPSS Inc.,1989-2006. 13.0.0 2006.
    1. Wagner AK, Gandek B, Aaronson NK, Acquadro C, Alonso J, Apolone G, Bullinger M, Bjorner J. Cross-cultural comparisons of the content of SF-36. Translations across 10 countries: Results from the IQOLA project. Journal of clinical epidemiology. 1998;51:925–932. doi: 10.1016/S0895-4356(98)00083-3.
    1. Idler EL, Russell LB, Davis D. Survival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. First National Health and Nutrition Examination Survey. American Journal of Epidemiology. 2000;152:874–883. doi: 10.1093/aje/152.9.874.
    1. Schou MB, Krokstad S, Westin S. [How is self-rated health associated with mortality?] Tidsskrift for den Norske lÊgeforening. 2006;126:2644–2647.
    1. Shetterly SM, Baxter J, Mason LD, Hamman RF. Self-rated health among Hispanic vs non-Hispanic white adults: the San Luis Valley Health and Aging Study. American journal of public health. 1996;86:1798–1801.
    1. Leinonen R, Heikkinen E, Jylha M. Self-rated health and self-assessed change in health in elderly men and women--a five-year longitudinal study. Social science & medicine. 1998;46:591–597. doi: 10.1016/S0277-9536(97)00205-0.
    1. Patel KV, Eschbach K, Rudkin LL, Peek MK, Markides KS. Neighborhood context and self-rated health in older Mexican Americans. Annals of epidemiology. 2003;13:620–628. doi: 10.1016/S1047-2797(03)00060-7.
    1. Jylhä M, Guralnik JM, Ferrucci L, Jokela J, Hiekkinen E. Is Self-Rated Health Comparable Across Cultures and Genders? J Gerontol B Psychol Sci Soc Sci. 1998;53:S144–152.
    1. Haas JS, Jackson RA, Fuentes-Afflick E, Stewart AL, Dean ML, Brawarsky P. Changes in the health Status of Women During and After Pregnancy. J Gen Intern Med. 2004;20:45–51. doi: 10.1111/j.1525-1497.2004.40097.x.
    1. Murray SA, Manktelow K, Clifford C. The interplay between social and cultural context and perceptions of cardiovascular disease. Journal of advanced nursing. 2000;32:1224–1233. doi: 10.1046/j.1365-2648.2000.01593.x.
    1. Angel R, Thoits P. The impact of culture on the cognitive structure of illness. Culture, Medicine and Psychiatry. 1987;11:465–494. doi: 10.1007/BF00048494.
    1. Pebley A, Hurtado E, Goldman N. Beliefs about children's illness. Journal of biosocial science. 1999;31:195–219. doi: 10.1017/S0021932099001959.
    1. Barnes BR, Mathee A, Krieger L, Shafritz L, Favin M, Sherburne L. Testing selected behaviours to reduce indoor air pollution exposure in young children. Health Education Research. 2004;19:543–550. doi: 10.1093/her/cyg075.
    1. Larson BA, Rosen S. Understanding household demand for indoor air pollution control in developing countries. Social science & medicine. 2002;55:571–584. doi: 10.1016/S0277-9536(01)00188-5.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe