Trends in Household Air Pollution Contributed by the Type of Cooking Fuel Used in Ugandan Households from 2000 to 2016 and Associated Household Factors: An Analysis of Demographic and Health Surveys

Background The type of cooking fuel used in households can expose the members to polluted air which has been shown to have multiple health effects. We describe the trend in household air pollution (HAP) caused by the type of cooking fuel used in Ugandan households from 2001 to 2016 and explore the household factors associated with it. Methods This was a retrospective analysis of four datasets of Ugandan demographic and health surveys (DHS) conducted from 2000/2001 to 2016 with the household as the unit of analysis. We included variables that described the households, the type of cooking fuel, and where the food was cooked. A household was considered to have exposure to HAP if they used cooking fuels like coal, charcoal, wood, straw/shrubs/grass, crops, or animal dung for cooking. Bivariate and multivariate logistic regression was used to determine the association between household characteristics and exposure to household air pollution (HAP) from the most recent DHS of 2016. Results A total of 45,376 households were included in the study. In all the surveys, the majority of the households were rural (74.33–85.11%), were headed by a male (68.98–72.46%), and with their highest educational attainment as incomplete primary education (37.21–42.44%). In all the surveys, the majority of the households used wood as a cooking fuel (71.69–82.08%). Most of the households were exposed to HAP (96.69–99.80%). From the multivariate logistic regression analysis, households with a household head having attained either complete secondary education [Adjusted Odd ratio: 0.13, 95% Confidence interval (0.03–0.58), p-value = 0.008] or higher education [Adjusted Odd ratio: 0.11, 95% Confidence interval (0.03–0.48), p-value = 0.003] were less likely to be exposed to HAP when compared with households with a household head having no education. Conclusions This study revealed that most households in Uganda have exposure to household air pollution caused by the type of cooking fuel used in the household. This underscores the need for innovations in cooking fuels like clean energy stoves that are cost-effective and cause less exposure to household air pollution.

Preventive behaviours and family inequalities during the COVID-19 pandemic: a cross-sectional study in China

Background The coronavirus disease 2019 (COVID-19) pandemic is an international public health threat, and people's participation in disease-related preventive behaviours is the key to controlling infectious diseases. This study aimed to assess the differences in adopting preventive behaviours among populations to explore potential individual and household factors and inequalities within families. Methods This online survey was conducted in April 2020. The directional stratified convenient sampling method was used to select 4704 participants from eight provinces in eastern, central, and western China. The questionnaire included demographic information, household variables, and five target prevention behaviours. The chi-squared test, binary multilevel model, and Mantel–Haenszel hierarchical analysis were used for data analysis in the study. Results Approximately 71.2% of the participants had appropriate outdoor prevention, and 32.9% of the participants had indoor protection in place. Sharing behaviours (P < 0.001) and education level (P < 0.001) were positively associated with adopting preventive measures. The inhibiting effect of household crowding and stimulating effect of high household income on preventive behaviours were determined in this study. Household size was negatively associated with living area (β = -0.057, P < 0.05) and living style (β = -0.077, P < 0.05). Household income was positively associated with age (β = 0.023, P < 0.05), and relationship with friends (β = 0.053, P < 0.05). Vulnerable groups, such as older adults or women, are more likely to have inadequate preventive behaviours. Older adults (OR = 1.53, 95% CI 1.09–2.15), women (OR = 1.37, 95% CI 1.15–1.64), and those with more than 2 suspected symptoms (OR = 1.85, 95% CI 1.07–3.19) were more likely to be affected by the inhibiting effect of household crowding, while the stimulating effect of high household income was limited in these groups. Conclusions Inequalities in COVID-19 prevention behaviours exist between families and inadequate adoption of prevention by vulnerable groups are noteworthy. This study expands the research perspective by emphasizing the role of household factors in preventive behaviours and by focusing on family inequalities. The government should use traditional media as a platform to enhance residents’ public health knowledge. Targeted additional wage subsidies, investments in affordable housing, financial support for multigenerational households, and temporary relocation policies may deserve more attention. Communities could play a critical role in COVID-19 prevention. Graphical abstract

In-Home Observations Are a Useful Tool to Assess the Household Enabling Environment for Child Nutrition in Burkina Faso and Sierra Leone

Objectives Two field studies assessed the effectiveness and cost-effectiveness of specialized nutritious foods (SNF) to prevent and treat malnutrition among children 6–24 months old in Burkina Faso and 6–59 months old in Sierra Leone. In-home observations (IHO) were conducted to understand household use of SNFs. The IHO data are unique, as local enumerators directly observed caregiver behaviors that would otherwise be provided by self-report. In this study, we examined household factors that may influence child nutrition, including child feeding, care, and hygiene practices among caregivers, and sanitary conditions of the home environment. Methods Local enumerators conducted 3–5-day IHO among a subset of 321 and 176 beneficiary households in Sierra Leone and Burkina Faso, respectively. Using time-stamped checklists and detailed observation notes, they recorded household activities, focused on feeding and care of beneficiary children. Detailed enumerator notes were analyzed using qualitative content analysis. Results Similar trends emerged in both countries. Poor hand-washing and food hygiene practices were common among caregivers; children consumed poor quality, starchy diets; children were most often cared for by their mothers and other adult, female relatives. Child feeding during illness was poor, and child mouthing of unsanitary household objects was common. In Burkina Faso, domestic animals were frequently present in the courtyard and near children during meals. Conclusions Future nutrition interventions may consider approaches that address multiple household factors that contribute to an enabling environment for child nutrition. Further, considering the feasibility of field application, the IHO method may be used in future nutrition programs to provide information beyond what could be obtained accurately from caregiver self report, and thus help inform nutrition behavior change strategies. Funding Sources Support for this research was provided by the USAID Bureau for Humanitarian Assistance.

Estimating the Dog Population, Responsible Pet Ownership, and Intestinal Parasitism in Dogs in Quito, Ecuador

In 2011, authorities of Quito, the capital city of Ecuador, approved an ordinance to promote public health and animal welfare through responsible pet ownership promotion. The population of dogs was not known, and the relationships between dog abundance, socio-economic factors, prevalence of zoonotic gastrointestinal parasites, and pet ownership responsibility had not been investigated. The objectives of this study were (i) to estimate the human:dog (HD) ratio, (ii) to examine the relationship between household factors and responsible pet ownership and (iii) to estimate the prevalence of households with one or more dogs infected with intestinal parasites in Quito, Ecuador. Space-based random sampling procedures were used for estimation of HD ratios in stray dogs and confined owned dogs. The relationship between household factors and a responsible pet ownership index was examined using logistic regression. Dog fecal samples were tested for intestinal parasites. Among stray dogs, the observed HD ratio was 58:1. Among dogs kept indoors, the observed HD ratio was 3,5:1. A positive interaction effect between number of dogs in study households and household living conditions (a proxy for household wealth) on responsible pet ownership was observed, which we discuss in this report. Prevalence of households with dogs infected with intestinal parasites was 28% (95% CI = 21-37). Ancylostoma spp. was the most frequent intestinal parasite in study dogs kept indoors. This study provides new information that can be used by policy makers to formulate, implement, and evaluate public policies and education programs aimed at enhancing pet ownership responsibility in Ecuador.