RESEARCH BRIEF

 

Household air pollution and respiratory symptoms a month before and during the stringent COVID-19 lockdown levels 5 and 4 in South Africa

 

 

Caradee Y Wright^{I, II}; Thandi Kapwata^{III, IV}; Nada Abdelatif^V; Chiara Batini^VI; Bianca Wernecke^III; Zamantimande Kunene^III; Danielle A Millar^{I, II}; Angela Mathee^{III, IV, VII}; Renée Street^VIII; Rikesh Panchal^IX; Anna Hansell^VI; Rebecca Cordell^IX; Joshua Vande Hey^IX

^IEnvironment and Health Research Unit, South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
^IIDepartment of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
^IIIEnvironment and Health Research Unit, South African Medical Research Council, 1 Soutpansberg Road, Johannesburg, South Africa
^IVDepartment of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
^VBiostatistics Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge Road, Overport, Durban, South Africa
^VIDepartment of Health Sciences, University of Leicester, Leicester, United Kingdom
^VIIFaculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
^VIIIEnvironment and Health Research Unit, South African Medical Research Council, 491 Peter Mokaba Ridge Road, Overport, Durban, South Africa
^IXCentre for Environmental Health and Sustainability, University of Leicester, University Road, Leicester, UK

 

 

In March 2020, the South African government declared a National State of Emergency as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also known as coronavirus disease (COVID-19) pandemic threatened the lives of South Africans. A National Lockdown comprising five Levels was developed and implemented starting with Level 5 for 'high COVID-19 spread with low health system readiness'. Level 5 meant employees working in non-essential services and schoolchildren stayed in their dwellings with limited movement (essential supplies only).

With people spending majority of their time in their dwellings, their exposure to household air pollution (HAP) became reason for concern; especially among people who rely on so-called 'dirty fuels' as their main source of energy for cooking and / or heating. A recently published study by Wright et al. (2022) conducted a retrospective online / telephonic survey to investigate fuel use behaviours / patterns of use affecting HAP exposure and associated HAP-related respiratory health outcomes a month before and during Lockdown Levels 5 and 4, i.e., the two most stringent levels. Participants were drawn from an existing market research company panel (since field campaigns were not possible) from Gauteng, Western Cape, KwaZulu-Natal and Eastern Cape where COVID-19 cases were highest at the time of study planning.

Among 2 505 participants (72% Black African, 12% Coloured, 4% Indian/Asian and 12% White) electricity was the main energy source for heating and cooking before and during Lockdown Levels 5 and 4. Some households used less electricity and a few switched to 'dirty fuels' during Lockdown Levels 5 and 4. Unfortunately, due to the reliance on online survey questionnaires, majority of participants were from middle-to-high income groups. Fewer participants (n=250) from lower socio-economic groups were contacted by telephone to complete the questionnaire due to cost.

The prevalence of HAP-related respiratory health outcomes like wheeze, wet cough, hay fever, and shortness of breath was similar and relatively low (< 10%) before and during Lockdown Levels 5 and 4, except for dry cough (16% before; 12% after). Recall bias may have influenced these results. Most participants reported that they were cleaning more, cooking more and spending more time indoors during Lockdown Levels 5 and 4. Our most concerning finding was that one-third of participants reported presence of environmental tobacco smoke (ETS, including smoke/vape) in the dwelling (Figure 1). ETS is a form of HAP and is associated with adverse health effects, especially among children under 5 years of age. It can contribute to middle ear disease, asthma, bronchiolitis and impaired pulmonary function among others (Hwang et al., 2012).

 

 

These are important findings for public health should South Africa return to Lockdown Levels that restrict movement and keep people and children at home indoors the majority of the time. Recommendations are needed to raise awareness about HAP, especially ETS, including how to avoid or reduce HAP to prevent associated human health impacts.

 

References

Hwang SH, Hwang JH, Moon JS, Lee DH. Environmental tobacco smoke and children's health. Korean J Pediatr. 2012;55(2):35-41. https://doi.org/10.3345/kjp.2012.55.235        [ Links ]

Wright CY, Kapwata T, Abdelatif N, Batini C, Wernecke B, Kunene Z, Millar DA, Mathee A, Street R, Panchal R, Hansell A, Cordell R, Vande Hey J. Household Air Pollution and Respiratory Symptoms a Month Before and During the Stringent COVID-19 Lockdown Levels 5 and 4 in South Africa. Annals of Global Health. 2022; 88(1): 3, 1-12. https://doi.org/10.5334/aogh.3465        [ Links ]