SciELO - Scientific Electronic Library Online

vol.20 issue1The potential impact of small-scale flywheel energy storage technology on Uganda's energy sector author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand



Related links

  • On index processCited by Google
  • On index processSimilars in Google


Journal of Energy in Southern Africa

On-line version ISSN 2413-3051
Print version ISSN 1021-447X

J. energy South. Afr. vol.20 n.1 Cape Town  2009


Household energy, indoor air pollution and child respiratory health in South Africa



Brendon BarnesI; Angela MatheeII; Elizabeth ThomasIII; Nigel BruceIV

ISchool of Human and Community Development, University of the Witwatersrand; and Environment and Health Research Unit, Medical Research Council of South Africa
IIEnvironment and Health Research Unit, Medical Research Council of South Africa
IIICentre for Health Policy, School of Public Health, University of the Witwatersrand; and Medical Research Council of South Africa
IVDepartment of Public Health, University of Liverpool, England




Indoor air pollution due to the indoor burning of polluting fuels has been associated with Acute Lower Respiratory Infections (ALRI) amongst children less than five years old. This paper reviews evidence of the association between household energy, indoor air pollution and child ALRI in South Africa. Studies show evidence consistent with the international literature with the likelihood of ALRI between 2 and 4 amongst children living in households using polluting fuels compared to households using electricity. Indoor air pollution is responsible for the deaths of up to 1 400 children annually. Interventions have demonstrated 46 - 97% lower pollution concentrations compared to open fires. However, the sustainability of selected interventions has been questioned in certain contexts. The paper discusses the strengths and weaknesses of the evidence and highlights opportunities for further research.

Keywords: household energy, indoor air pollution, child ARI, interventions



Full text available only in PDF format.




Bailie, R.S., Pilotto, L.S., Ehrlic, R.I., Mbuli, S., Truter, R. and Terblanche, P (1999) Poor urban environments: use of paraffin and other fuels as sources of indoor air pollution. Journal of Epidemiology and Community Health 53, 585-586.         [ Links ]

Ballard-Tremeer, G. and Jawurek, H.H. (1996) Comparison of Five Rural, Wood -Burning Cooking Devices: Efficiencies and Emission. Biomass and Bioenergy 11, 419-430.         [ Links ]

Ballard-Tremmer, G. and Mathee, A. (2000) Review of interventions to reduce exposure of women and young children to indoor air pollution in developing countries. Washington D.C.: WHO/ USAID Global Consultation.         [ Links ]

Barnes, B., Mathee, A., Bruce, N. and Thomas, L. (2006) Protecting children from indoor burning through outdoor burning in rural South Africa. Boiling Point 52, 11-13.         [ Links ]

Barnes, B.R. (2005) Interventions to reduce child indoor air pollution exposure in developing countries: behavioural opportunities and research needs. Children, Youths and the Environment 15, 67-82.         [ Links ]

Barnes, B.R., Mathee, A. and Moiloa, K. (2005) Assessing child time-activity patterns in relation to indoor cooking fires in developing countries: a methodological comparison. International Journal of Hygiene and Environmental Health 208, 219-225.         [ Links ]

Barnes, B.R., Mathee, A., Shafritz, L.B., Krieger, L., Favin, M. and Sherburne, L. (2004a) Testing selected behaviours to reduce indoor air pollution exposure in young children. Health Education Research 19, 543-50.         [ Links ]

Barnes, B.R., Mathee, A., Shafritz, L.B., Krieger, L. and Zimicki, S. (2004b) A behavioural intervention to reduce child exposure to indoor air pollution: identifying possible target behaviours. Health Education and Behavior 31, 306-317.         [ Links ]

Barnes, D.F, Openshaw, K., Smith, R.K. and Van der Plas, R. (1994) What makes people cook with improved cookstoves?        [ Links ]

Bradshaw, D., Bourne, D. and Nannan, N. (2003) What are the leading causes of death among South African children? MRC Policy Brief        [ Links ]

Bruce, N., Bates, E., Nguti, R., Gitonga, S., Kithinji, J. and Doig, A. (2002) Reducing indoor air pollution through participatory development in rural Kenya. Indoor Air 12, 590-595.         [ Links ]

Bruce, N., Neufeld, L., Boy, E. and West, C. (1998) Indoor biofuel air pollution and respiratory health: the role of confounding factors among women in highland Guatemala. International Journal of Epidemiology 27, 454-8.         [ Links ]

Bruce, N., Perez-Padilla, R. and Albalak, R. (2000) Indoor air pollution in developing countries: a major environmental and public health challenge. Bulletin of the World Health Organization 78, 1078-92.         [ Links ]

Budds, J., Biran, A. and Rouse, J. (2001) What's Cooking: A review of the health impacts of indoor air pollution and technical interventions for its reduction. WELL: Loughborough University.         [ Links ]

Davis, M. (1998) Rural household energy consumption: the effects of access to electricity - evidence from South Africa. Energy Policy 26, 207-17.         [ Links ]

De Wet, T., Mathee, A. and Barnes, B. (2001) Anthropology and epidemiology: a case study of health and environment in Alexandra, Johannesburg. Africanus 31, 75-106.         [ Links ]

Department of Minerals and Energy (2001) National electrification programme (NEP) 1994-1999 summary evaluation report. Pretoria: DME.         [ Links ]

Department of Minerals and Energy (2004) Integrated Household Clean Energy Strategy. Pretoria: DME.         [ Links ]

Department of Minerals and Energy (2006) Digest of South African Energy Statistics. Pretoria: DME.         [ Links ]

Dherani, M., Pope, D., Mascanheras, M., Smith, K. R., Weber, M., Bruce, N. G. (2008) Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis. Bulletin of the World Health Organization 86, 390-398        [ Links ]

Dudley, L., Hussey, G., Huskissen, J. and Kessow, G. (1997) Vitamin A status, other risk factors and acute respiratory infection morbidity in children. SAMJ 87, 65-70.         [ Links ]

Engelbrecht, J.P, Swanepoel, L., Chow, J.C., Watson, J.G. and Egami, R.T. (2001) PM25 and PM10 concentrations from the Qalabotjha low-smoke fuels macro-scale experiment in South Africa. Environmental Monitoring and Assessment 69, 1-15.         [ Links ]

Ezzati, M., Bailis, R., Kammen, D., Holloway, T., Price, L., Cifuentes, L., Barnes, B.R., Chaurey, A. and Dhanapala, K. (2004) Energy management and global health. Annual Review of Environment and Resources 29, 383-419.         [ Links ]

Ezzati, M. and Kammen, D. (2002) The health impacts of exposure to indoor air pollution from solid fuels in developing countries: knowledge, gaps, and data needs. Environmental health perspectives 110, 1057-1068.         [ Links ]

Ezzati, M., Mbinda, B.M. and Kammen, D.M. (2000) Comparison of emissions and residential exposure from traditional and improved cookstoves in Kenya. Environ. Sc. Technol. 34, 578-583.         [ Links ]

Goldemberg, J. (2004) Rural energy in developing countries. New York: UNDP, UNESCA & WEC.         [ Links ]

Kirkwood, B., Gove, S., Rogers, S., Lob-Levyt, P, Arthur, P and Campbell, H. (1995) Potential interventions for the prevention of childhood pneumonia in developing countries: a systematic review. Bulletin of the World Health Organization 73, 793-8.         [ Links ]

Kossove, D. (1982) Smoke filled rooms and lower respiratory disease in infants. South African Medical Journal April, 622-24.         [ Links ]

Mathee, A., Röllin, H. and Bruce, N. (2000) Electricity and health. Johannesburg: MRC.         [ Links ]

Matzopoulos, R., Jordaan, E. and Carolissen, G. (2006) Safety issues relating to paraffin usage in Eshane, Kwazulu- Natal. Journal of Energy in Southern Africa 17, 4-9.         [ Links ]

Mehta, S. and Shahpar, C. (2004) The health benefits of interventions to reduce indoor air pollution from solid fuel use: a cost-effectiveness analysis. Energy for sustainable development 8, 53-59.         [ Links ]

Moya, J., Bearer, C.F and Etzel, R.A. (2004) Children's behaviour and physiology and how it affects exposure to environmental contaminants. Paediatrics 113, 996-1006.         [ Links ]

Mtango, F.D.E., Neuvians, D., Broome, C.V., Hightower, A.W. and Pio, A. (1992) Risk factors for deaths in children under 5 years old in Bagamoyo District, Tanzania. Trop. Med. Parasitol. 43, 229-233.         [ Links ]

Muller, E., Diab, R.D., Binedall, M. and Hounsome, R. (2003) Health risk assessment of kerosene usage in an informal settlement in Durban, South Africa. Atmospheric Environment 37, 2015-2022.         [ Links ]

Murray, C.J.L. and Lopez, A.D. (1997) Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The Lancet 349, 1436-42.         [ Links ]

Nel, R., Terblanche, P., Danford, I., Opperman, L.B.P. and Pols, A. (2003) Domestic fuel exposure as a risk factors fro development of upper respiratory illnesses and lower respiratory illnesses in rural and urban communities. Clean Air Challenges 1993 (conference proceedings) paper 7, 1-5.         [ Links ]

NEM (2004) National Environment Management: Air Quality Act, no. 39 of 2004. Cape Town: Republic of South Africa.         [ Links ]

Norman, R., Barnes, B., Mathee, A., Debbie Bradshaw and the South African Comparative Risk Assessment Collaborating Group. (2007) Estimating the burden of disease attributable to indoor air pollution from household use of solid fuels in South Africa in 2000, South African Medical Journal 97, 773-780.         [ Links ]

Pande, J.N. (2000) Respiratory medicine in the tropics, Oxford: Oxford University Press.         [ Links ]

Roberts, E. and Wentzel, M (2006) Household paraffin consumption in four areas: Benoni, Galashewe, Gugulethu and Lady Grey. Journal of Energy in Southern Africa 17, 23-26.         [ Links ]

Röllin, H.B., Mathee, A., Bruce, N., Levin, J. and von Schirnding (2004) Comparison of indoor air quality in electrified and un-electrified dwellings in rural South African villages. Indoor Air 14, 208-216.         [ Links ]

Sanyal, D.K. and Maduna, M.E. (2000) Possible relationship between indoor air pollution and respiratory illness in an Eastern Cape community. South African Journal of Science 96, 94-96.         [ Links ]

Shackleton, C.M., Gambiza, J. and Jones, R. (2007) Household fuelwood use in small electrified towns of the Makana District, Eastern Cape, South Africa. Journal of Energy in Southern Africa 18, 4-9.         [ Links ]

Schwartz, J. (2004) Air pollution and children's health. Paediatrics 113, 1037-1043.         [ Links ]

Smith, K.R. (1987) Biofuels, air pollution and health, New York: Plenum Press.         [ Links ]

Smith, K.R. (2002) Indoor air pollution in developing countries: recommendations for research. Indoor Air 12, 198-207.         [ Links ]

Smith, K.R., Apte, G.M., Yuqing, M., Wongsekiarttirat, W. and Kulkarni, A. (1994) Air pollution and the energy ladder in Asian cities. Energy 19, 587-600.         [ Links ]

Smith, K.R., Samet, J.M., Romieu, I. and Bruce, N. (2000) Indoor air pollution in developing countries and acute lower respiratory infection in children. Thorax 55, 518-532.         [ Links ]

Statistics South Africa (2003) Census in Brief 2001, 2edn. Pretoria: South African government.         [ Links ]

Statistics South Africa (2004) Census 2001: Primary Tables 1996-2001 Compared. Pretoria: Statistics South Africa.         [ Links ]

Surridge, A.D., Kgobane, K.B. and Chauke, G.R. (2005) Strategy to combat the negative impacts of domestic coal combustion: Basa Njengo Magogo. Clean Air Journal 14, 13-16.         [ Links ]

Terblanche, A.P., Opperman, L., Nel, C.M. and Nyikos, H. (1993) Exposure to air pollution from transitional household fuels in a South African population. J Expo Anal Environ Epidemiol 3, 15-22.         [ Links ]

Terblanche, A.P, Opperman, L., Nel, C.M., Reinach, S.G., Tosen, G. and Cadman, A. (1992) Preliminary results of exposure measurements and health effects of the Vaal Triangle Air Pollution Health Study. South African Medical Journal 81, 550-6.         [ Links ]

Terblanche, P. (1998) Vaal Triangle air pollution and health study. Pretoria: MRC.         [ Links ]

The World Resources Institute (1998) World resources: a guide to the global environment 1998-99.         [ Links ]

Thomas, E.P, Seager, J.R., Viljoen, E., Potgieter, FF, Rossouw, A., Tokota, B., McGranahan, G. and Kjellen, M. (1999) Household Environment and Health in Port Elizabeth. Cape Town: MRC        [ Links ]

Victora, C.G., Kirkwood, B.R., Ashworth, A., Black, R.E., Rogers, S., Sazawal, S., Campbell, H. and Gove, S. (1999) Potential interventions for the prevention of child hood pneumonia in developing countries: improving nutrition. American Journal of Clinical Nutrition 70, 309-20.         [ Links ]

Victora, C.S., Fuchs, S.C., Flores, J.A.C., Fonseca, W. and Kirkwood, B. (1994) Risk factors for pneumonia among children in a Brazilian metropolitan area. Paediatrics 93, 977-985.         [ Links ]

von Schirnding, Y, Bruce, N., Smith, K.R., Ballard-Tremmer, G., Ezzati, M. and Lvovsky, K. (2002) Addressing the impact of household energy and indoor air pollution on the health of the poor. Geneva: World Health Organisation.         [ Links ]

von Schirnding, Y.E.R., Yach, D., Blignaut, R. and Mathews, C. (1991a) Environmental determinants of acute respiratory symptoms and diarrhoea in young coloured children living in urban and peri-urban areas of South Africa. SAMJ 79, 457461        [ Links ]

von Schirnding, Y.E.R., Yach, D. and Klein, M. (1991b) Acute respiratory infections as an important cause of deaths in South Africa. South African Medical Journal 80, 79-82.         [ Links ]

WEC & FAO (1999) The challenge of rural energy in developing countries. London: World Energy Council.         [ Links ]

Wesley, A.G. and Loening, W.E.K. (1996) Assessment and 2-year follow-up of some factors associated with severity of respiratory infections in early childhood. SAMJ 86, 365-368.         [ Links ]

Wichmann, J. and Voyi, K.V.V. (2005) Air pollution epidemiological studies in South Africa - need for freshening up. Reviews on Environmental Health 20, 265-301.         [ Links ]

Wichmann, J. and Voyi, K.VV (2006a) Impact of cooking and heating fuel use on acute respiratory health of preschool children in South Africa. The Southern African Journal of Epidemiology and Infection 21, 48-54.         [ Links ]

Wichmann, J. and Voyi, K.VV (2006b) Influence of cooking and heating fuel use on 1-59 month old mortality in South Africa. Maternal Child Health 10, 553-561.         [ Links ]

World Health organization (2007) Indoor air pollution: national burden of disease estimates. Geneva: WHO.         [ Links ]

Zwi, S., Davies, J.C.A., Becklake, M.R., Goldman, H.I., Reinach, S.G. and Kallenbach, J.M. (1990) Respiratory health status of children in the eastern Transvaal highveld. SAMJ 78, 647-653.         [ Links ]



Received: 15 June 2008

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License