By Vera van Rijn Although the media frequently reports on African children dying from malaria or HIV, it is actually pneumonia that is the biggest killer in children under five. With nearly 1 million annual deaths, pneumonia kills more children than HIV, diarrhea and malaria combined. Pneumonia is called ‘the silent killer’ because even today little attention is paid to this disease. In 2015 I joined a research team in the slums of Kampala, Uganda, in search of a way to stop children from dying of this disease.
It may not surprise you that children living in the slums are highly susceptible to pneumonia (and a lot of other diseases). Sanitation is poor, people hardly make enough money to properly feed their children and families with up to 9 children have to live in 6 m2 mud houses. However, the main reason why slum children get pneumonia is because their mothers cook inside their houses on leaky stoves in poorly ventilated houses. Young children constantly inhale the toxic fumes produced by the stoves because they spend most of their time indoors: eating, sleeping and playing. This continuous exposure severely damages their lungs, making them very susceptible to lung conditions.
To find out why women cook inside their houses we spent our days talking to numerous mothers living in Kampala’s slums. Most women we spoke to actually preferred to cook outside, because the smoke blackens their interior. However, they felt that cooking outside is challenging, because of the cramped space between houses and rainy seasons. They said that heavy rains make it impossible to cook outside without getting the food spoiled. Heavy rains also flood the entire slum, turning mud paths between the houses into small rivers. Outdoor cooking stoves would wash away or would be destroyed.
Only some of the women knew that cooking indoors is related to pneumonia. In fact, most women didn’t know what pneumonia was or how to recognize it. Signs of severe coughing and difficulty breathing were most likely treated with cough syrup or herbal potions. None of the women would take her child to a health clinic with these symptoms and we soon learned why: pneumonia antibiotics and other medication are often not available in these facilities. Doctors explained to us that medication is freely provided by the Ugandan government, but the amount of medication they receive in their clinics is insufficient to treat all patients. Pharmacies and private clinics do sell antibiotics for a prize equivalent to 8 dollars which is unaffordable for most people living in the slums.
After collecting all this information it was time for some action. We gathered all the women who participated in our research and we played them a video that clearly explained the signs and symptoms of pneumonia and the risks of cooking indoors. At that very moment the women realized that they had continuously exposed their children to toxic air without knowing it. This first led to complete chaos and frustration, but soon turned into a determined willingness to change their situation. In a following focus group session we made these women aware that they themselves are capable of improving their children’s health. This group of women became a wind of change in their slum.
Together with a carpenter they designed a cooking shelter that kept the food safe from the rain. This structure is made of wood, a tin foil and some nails, but it’s strong enough to hold even during heavy rains. The women place these shelters outside their house on small dams made from sand-filled water bottles. Now when it rains, the water flows around their cooking place.
These simple adjustments have turned out to be extremely effective. None of the women have reported a sick child since they started cooking outside. And it has had another unexpected major advantage. The shelter prevents a lot of skin burns, because the structure stops children from falling into boiling water. The cooking shelters attract a lot of attention from curious by passers and the women are eager to share their success stories with others. We started this program two years ago with six motivated mothers and today we are proud to see numerous shelters are being used in four different slum areas around Kampala.
Vera van Rijn is lecturer at the department of Health Sciences and founder of Clean Cooking, Healthy Lungs: an organization that fights childhood pneumonia in the slums by introducing sustainable low-cost solutions to slum communities. To learn more about the projects visit Clean Cooking, Healthy Lungs.