Killer in the kitchen

Women coughing in their sleep is hardly new in Bangladesh, particularly in rural areas, where women spend more than half their working day in the kitchen cooking food with solid fuels such as wood, dung and agricultural waste, say health experts.

Typically, the cramped rooms where the cooking is done have little or no ventilation, and the women wear no mask to protect their lungs from the resulting smoke and soot.

Smoke from the burning wood, dung and crop waste or rubbish (often including plastic or rubber) contains significant quantities of pollutants, generating carbon monoxide, airborne particles, hydrocarbons, and nitrogen oxides, and can be toxic or carcinogenic.

According to a recent report, the risk factors are worse for children.

Toddlers suffer more as they are often tied to their mothers while they work. As a result, they inhale the same pollutants that their mothers do, says a report entitled Causes and Consequences of Indoor Air Pollution: An Experimental Investigation in Bangladesh 2006-2008.

Children in fact absorb pollutants more readily than adults, and retain them in their system longer. Their tender lungs and growing bodies are more susceptible to harmful pollutants than adults, health experts say.

UNICEF report

The UN Children’s Fund (UNICEF) said in its 2008 State of the World Children Report that 30 percent of all under-five children in Bangladesh who had been taken to local health care facilities in 2006 were suspected pneumonia patients; 22 percent of them were treated with antibiotics.

The report went on to say that 69 in every 1,000 children in Bangladesh do not live to see their fifth birthday, with nearly one third of them dying as a result of some kind of respiratory tract infection - pneumonia claiming the largest share.

World Bank/donor report

An April 2008 report by the Energy Sector Management Assistance Programme of the World Bank and bilateral donors entitled Improving Indoor Air Quality for Poor Families: A Controlled Experiment in Bangladesh observed that exposure to particulates, particularly small ones, was strongly associated with respiratory illness and death.

Small particles are more dangerous since they can be inhaled more deeply into the lungs and settle in areas where natural clearance mechanisms, such as coughing, cannot remove them.

The current scientific consensus is that most respiratory health damage comes from the inhalation of respirable particles the diameter of which is less than 10 microns (PM10), with recent attention focusing on even finer particles (PM2.5), the report said.

Several studies have concluded that young children and poorly educated women in poor households face pollution exposure that is four times that of men in higher income households.

The poorest, least-educated households had twice the pollution levels of relatively high-income households with highly educated adults. (Who suffers from indoor air pollution? Evidence from Bangladesh 2006)

What could be done?

Yet simple measures can be taken to improve the situation.

In a typical Bangladeshi household, pollution exposure for children could be halved by doubling their outdoor time and concentrating outdoor time during peak cooking periods.

“For households whose young children are kept inside during peak cooking periods, simply moving the children outside when weather permits could yield a significant reduction in exposure,” said Reazuddin Ahmed, director of the Department of Environment.

A recent study showed that in rural Bangladesh an average under-five child spends only three to four hours outdoors. “Household members assigned to outside supervision would also benefit from reduced pollution,” Ahmed said.

Photo: Shamsuddin Ahmed/IRIN

A young girl collects dry tree leaves to use as cooking fuel

Education has a particularly strong effect on reducing indoor air pollution.

Results of the 2006 World Bank study indicated that when men's and women's education levels jointly increased from 0 (no primary schooling) to 4 (post-secondary education), the predicted PM10 in the cooking area decreases substantially.

 “Living eight hours in a smoke-filled rural and poor Bangladeshi kitchen is equal to smoking 20 cigarettes [a day],” Iftekhar Hossain of the Bangladesh Council of Scientific and Industrial Research (BCSIR) laboratories, said. He pointed out, however, that there was no immediate sign that the poor would be able to easily switch from wood, dung, tyres and crop residues to cleaner fuels like natural gas or kerosene any time soon.

“It seems our children and women are destined to suffer from indoor air pollution for many years to come,” he predicted.

The World Health Organization’s 2004 Global and Regional Burden of Disease Report estimates that acute respiratory infections from indoor air pollution (pollution from burning wood, animal dung, and other biofuels) kill a million children annually in developing countries, inflicting a particularly heavy toll on poor families in South Asia and Africa.

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