Eleven health areas were selected – 2/4 in urban and 9/18 in rural setting - leading to a final sample of 848 households (98% response rate) within 85 villages/quarters. The study sample included 257 urban and 591 rural household. Approximately 80% of respondents were females. The mean age of respondents was 38 ( 18.8) years, median age was 33 [range: 15 – 97] years. Average household size was 5 (Table 2). Nearly 15% of female respondents had never been to school and 60% of female participants reported peasant farming as their main occupation.
Table 1: Distribution of households reached in targeted health areas with population in 2018 by cluster and setting.
Targeted Health Areas of the study
|
Urban or Rural
|
Population size in 2018 (inhabitants)
|
Clusters
(Reached/Expected)
|
Households reached
|
Fiala-Foreke (1)
|
Urban
|
34,760
|
20/20
|
197
|
Balevouni (2)
|
Rural
|
1,856
|
1/1
|
12
|
Nkeuli (3)
|
Rural
|
2,691
|
2/2
|
19
|
Fotetsa (4)
|
Rural
|
5,128
|
3/3
|
28
|
Maka (5)
|
Urban
|
10,804
|
6/6
|
60
|
Fonakeukeu (6)
|
Rural
|
5,149
|
3/3
|
30
|
Lepoh (7)
|
Rural
|
10,472
|
6/6
|
60
|
Ndoh-Djuttitsa (8)
|
Rural
|
13,663
|
9/9
|
93
|
Baleveng (9)
|
Rural
|
20,658
|
12/12
|
118
|
Doumbouo (10)
|
Rural
|
16,908
|
10/10
|
99
|
Mbeng (11)
|
Rural
|
20,508
|
13/13
|
132
|
TOTAL
|
/
|
142,597
|
85/85
|
848
|
Table 2: Socio-demographic presentation of the study sample.
Characteristics
|
Modalities
|
Urban
|
Rural
|
Total
|
P value
|
Reached households (n)
|
/
|
257
|
591
|
848
|
|
Response rate (%)
|
/
|
99.2
|
100
|
99.8
|
|
Gender
[n (%)]
|
Female
|
187 (72.8)
|
481 (81.4)
|
668 (78.8)
|
0.005
|
Male
|
70 (27.2)
|
110 (18.6)
|
180 (21.2)
|
Age of respondent
(µ ± SD)
|
/
|
31.1 ± 12.9
|
41.5 ± 20.0
|
38.3± 18.8
|
< 0.0005
|
Average household size
(µ ± SD)
|
/
|
5.4 ± 2.8
|
4.7 ± 2.4
|
4.9 ± 2.6
|
< 0.0005
|
Mother’s level of education [n (%)]
|
No school
|
13 (5.5)
|
96 (16.3)
|
109 (13.2)
|
< 0.0005
|
Primary
|
63 (26.7)
|
307 (52.0)
|
370 (44.8)
|
Secondary
|
112 (47.5)
|
181 (30.7)
|
293 (35.5)
|
Higher
|
48 (20.3)
|
6 (1.0)
|
54 (6.5)
|
Father’s level of education [n (%)]
|
No school
|
10 (4.4)
|
103 (18.0)
|
113 (14.1)
|
< 0.0005
|
Primary
|
70 (30.6)
|
275 (48.2)
|
345 (43.1)
|
Secondary
|
92 (40.2)
|
168 (29.4)
|
181 (32.5)
|
Higher
|
57 (24.9)
|
25 (4.4)
|
6 (10.2)
|
Mother’s occupation
[n (%)]
|
Housewife
|
47 (20.0)
|
29 (4.9)
|
76 (9.3)
|
< 0.0005
|
Farming
|
55 (23.4)
|
452 (77.4)
|
507 (61.9)
|
Self-employment
|
69 (29.4)
|
73 (12.5)
|
142 (17.3)
|
Civil servant
|
29 (12.3)
|
23 (3.9)
|
52 (6.3)
|
Student
|
35 (14.9)
|
7 (1.2)
|
42 (5.1)
|
Main sources of Household air pollution in the DHD
From this study, 90% of households used firewood and about 75% (630 households) of them exclusively used wood. Almost all households (98%) used wood to meet at least some of their cooking needs in rural HAs. Our results also reveal that 25% household have access to domestic gas for cooking, with a higher proportion in urban areas (55.6%) (Table 3). Figure 1 & 2 show the pictures of a charcoal and firewood fuel source, snapped in two separate households enrolled in the study. P-value less than 0.0005 as presented in table 3 means the difference in proportion between urban and rural settings is statistically significant. It is important to note that no one was found to use an electric cooker or a micro wave.
Table 3: Distribution of cooking fuel types in the households of the Dschang Health District
Cooking instruments
|
Urban [n (%)]
|
Rural [n (%)]
|
Total [n (%)]
|
P value
|
Firewood only*
|
97 (37.7)
|
533 (74.3)
|
630 (74.3)
|
< 0.0005
|
Firewood
|
191 (74.3)
|
577 (97.8)
|
768 (90.6)
|
< 0.0005
|
Gas only*
|
38 (14.8)
|
10 (1.7)
|
48 (5.7)
|
< 0.0005
|
Gas
|
143 (55.6)
|
69 (11.7)
|
212 (25.0)
|
< 0.0005
|
Kerosene stove
|
14 (5.5)
|
12 (2.0)
|
26 (3.1)
|
0.008
|
Charcoal
|
33 (12.8)
|
6 (1.0)
|
39 (4.6)
|
< 0.0005
|
Saw dust
|
26 (10.1)
|
6 (1.0)
|
32 (3.0)
|
< 0.0005
|
* Exclusive use of the fuel type
Among the interviewed households, approximately 75% use more than one cooking fuel type (Table 4).
Table 4: Distribution of multiple cooking fuel type utilization in the Dschang Health District
Number of cooking fuel sources
|
Urban [n (%)]
|
Rural [n (%)]
|
Total [n (%)]
|
P value
|
More than one source of cooking fuel
|
114 (44.4)
|
67 (11.3)
|
181 (21.3)
|
< 0.0005
|
More than two sources of cooking fuel
|
29 (11.3)
|
4 (0.7)
|
33 (3.9)
|
< 0.0005
|
More than three sources of cooking fuel
|
8 (3.1)
|
0 (0.0)
|
8 (0.9)
|
< 0.0005
|
Factors influencing the choice of cooking fuel type
Nearly 60% of households choose their fuel type based on affordability and only 18% based on availability (Tables 5 and 6). Availability meant the presence of the fuel type in the surroundings of the household.
Table 5: Distribution of reasons influencing choice of cooking fuel type in the Dschang Health District.
Reasons
|
Urban [n (%)]
|
Rural [n (%)]
|
Total [n (%)]
|
P value
|
Affordability
|
130 (50.6)
|
375 (63.4)
|
505 (59.5)
|
< 0.0005
|
Availability
|
27 (10.5)
|
122 (20.6)
|
149 (17.6)
|
Rapidity
|
44 (17.1)
|
31 (5.2)
|
75 (8.8)
|
Culture
|
8 (3.1)
|
40 (6.8)
|
48 (5.7)
|
Easy to use
|
33 (12.8)
|
17 (2.9)
|
50 (5.9)
|
Cleanliness
|
10 (3.9)
|
5 (0.8)
|
15 (1.8)
|
Other reason
|
5 (1.9)
|
1 (0.2)
|
6 (0.7)
|
Table 6: Distribution of main reasons of choice per main cooking fuel types in the Dschang Health District.
|
Firewood [n (%)]
|
Gas [n (%)]
|
Charcoal [n (%)]
|
Reasons
|
U
|
R
|
T
|
P value
|
U
|
R
|
T
|
P value
|
U
|
R
|
T
|
P value
|
Affordability
|
118 (61.8)
|
373 (64.5)
|
491 (63.9)
|
<0.0005
|
52 (36.4)
|
37 (53.6)
|
89 (42.0)
|
0.08
|
16 (48.5)
|
4 (66.7)
|
20 (51.3)
|
0.05
|
Culture
|
8 (4.2)
|
40 (6.9)
|
48 (6.2)
|
4 (2.8)
|
3 (4.4)
|
7 (3.3)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
Rapidity
|
22 (11.5)
|
28 (4.8)
|
50 (6.5)
|
36 (25.2)
|
9 (13.0)
|
45 (21.2)
|
5 (15.2)
|
0 (0.0)
|
5 (12.8)
|
Cleanliness
|
5 (2.6)
|
3(0.5)
|
8 (1.0)
|
8 (5.6)
|
2 (2.9)
|
10 (4.7)
|
4 (12.1)
|
0 (0.0)
|
4 (10.3)
|
Easy to use
|
12 (6.3)
|
13 (2.2)
|
25 (3.2)
|
25 (17.5)
|
6 (8.7)
|
31 (14.6)
|
7 (21.2)
|
0 (0.0)
|
7 (17.9)
|
Availability
|
24 (12.6)
|
120 (20.8)
|
144 (18.7)
|
15 (10.5)
|
11 (15.9)
|
26 (12.3)
|
1 (3.0)
|
2 (33.3)
|
3 (7.7)
|
Other reason
|
2 (1.1)
|
1 (0.2)
|
3 (0.4)
|
3 (2.1)
|
1 (1.4)
|
4 (1.9)
|
0 (0.0)
|
0 (0.0)
|
0 (0.0)
|
U= Urban; R=Rural; T=Total
Burden of exposure to sources household of air pollution.
Figure 3 shows the frequency of both lone and multiple cooks in households. In 9 out of 10 households interviewed, women were reported to be the main cook. Children were involved in cooking in more than 60% of the households and men in only 7% of the households. It is to be emphasised that only the mothers in 270 (31.84%) and the children in 42(4.95%) were in charge of the cooking.
Food was cooked an average of one time (1.3± 0.5) per day in study households, with no variation between rural and urban areas. More than ¾ of households have been using their primary fuel type for more than five years (Table 7). Firewood has been used for the entire lifespan in almost all the households.
Table 7: Duration of usage of principal fuel type
Fuel types
|
Duration
|
Urban
|
Rural
|
Total
|
P value
|
n (%)
|
(95% CI)
|
n (%)
|
(95% CI)
|
n (%)
|
(95% CI)
|
Firewood
|
<= 5 yrs
|
14 (7.3)
|
(4.1 – 12.0)
|
9 (1.6)
|
(0.8 – 2.9)
|
23 (3.0)
|
(2.0 – 4.5)
|
<0.0005
|
> 5 yrs
|
177 (92.7)
|
(88.0 – 95.9)
|
569 (98.4)
|
(97.1 – 99.2)
|
746 (97.0)
|
(95.5 – 98.0)
|
Gas
|
<= 5 yrs
|
40 (28.0)
|
(20.8 – 36.1)
|
10 (14.5)
|
(7.2 – 25.0)
|
50 (23.6)
|
(18.0 – 29.9)
|
0.03
|
> 5 yrs
|
103 (72.0)
|
(63.9 – 79.1)
|
59 (85.5)
|
(75.0 – 92.8)
|
162 (76.4)
|
(70.1 – 82.0)
|
Charcoal
|
<= 5 yrs
|
6 (18.2)
|
(7.0 – 35.5)
|
1 (16.7)
|
(0.4 – 64.1)
|
7 (17.5)
|
(7.5 – 33.5)
|
0.93
|
> 5 yrs
|
27 (81.8)
|
(64.5 – 93.0)
|
5 (83.3)
|
(35.9 – 99.6)
|
32 (82.0)
|
(66.5 – 92.5)
|
Kerosene
|
<= 5 yrs
|
4 (28.6)
|
(8.4 – 58.1)
|
1 (8.3)
|
(0.2– 38.5)
|
5 (19.2)
|
(6.5 – 39.3)
|
0.19
|
> 5 yrs
|
10 (71.4)
|
(41.9 – 91.6)
|
11 (91.7)
|
(61.5 – 99.8)
|
21 (80.8)
|
(60.6 – 93.4)
|
Saw dust
|
<= 5 yrs
|
4 (15.4)
|
(4.4 – 34.9)
|
1 (16.7)
|
(0.4 – 64.1)
|
5 (15.6)
|
(5.3– 32.8)
|
0.94
|
> 5 yrs
|
22 (84.6)
|
(65.1 – 95.6)
|
5 (83.3)
|
(35.9 – 99.6)
|
27 (84.4)
|
(67.2 – 94.7)
|