In November and December 2022, Commonwealth Alumnus Joshua Epuitai delivered two online awareness webinars on, ‘Empowering midwives to health educate women during routine antenatal care on the effects of household air pollution (HAP) from cooking fuels’, in Uganda. The activity promotes the 2022/23 ACEF theme, Clean energy, Air and Oceans.

The webinar was designed to raise awareness of the harmful effects of air polluting cooking fuels on women and child

Commonwealth Alumnus Joshua Epuitai headshot

Joshua Epuitai

health. The activity also aimed to introduce ways in which healthcare workers can promote the adoption of cleaner fuels, improved stoves, and improve ventilation in the cooking places to reduce HAP through antenatal health education.

The webinar was delivered twice to reach a greater audience and attended by over 120 healthcare workers and midwifery students from institutes across Uganda. This included Mbale Regional Referral Hospital, Kagote Health Centre 3, Lira University hospital, Soroti Regional Referral Hospital, Busitema University, Mountains of the Moon University, Lira University, and Mumi University-Arua.

Joshua Epuitai is a registered nurse and midwife and a Lecturer at Busitema University. His work includes midwifery clinical practice, training, research, and community outreach programmes on women’s health.

Awareness on adoption of clean cooking methods

The 2021 World Bank report estimates 95% of the population in Uganda predominantly use biomass energy, such as firewood, charcoal, and burning cow dung and crop residue, for cooking and other household purposes. Overreliance on biomass energy is a driver to deforestation, land degradation, and household air pollution (HAP). HAP contains a range of harmful pollutants and small particles that affect the respiratory system and can enter the bloodstream.

The World Health Organization (WHO) estimates 3.2 million people die each year from illnesses related to HAP. Women and children are more vulnerable to the effects of HAP due to gendered roles such as cooking and time spent indoors. Exposure to toxic levels of HAP during pregnancy can lead to increased risks in outcomes such as preterm birth, low birthweight, pre-eclampsia still birth, and neonatal mortality and morbidity.

97% of women attend antenatal care in Uganda, but health education is not provided on the effects of cooking fuels on maternal and child health. The corollary effect is that most women are not aware of the harmful effects of using solid biomass fuels. This has led to a lack of understanding of the long term effects of cooking fuels and measures to reduce exposure to HAP. This highlights the importance of creating awareness about clean energy for cooking and cooking methods.

There is a need for collaborative efforts to sensitise people about the combined risks of air pollutants and high-risk pregnancies. In Uganda, healthcare workers such as midwives and nurses are primarily involved in providing health education to pregnant women and are therefore well placed to communicate information about the risks associated with HAP.

Promoting awareness through a webinar

The awareness webinars aimed to equip healthcare workers on the harmful effects of toxic cooking fuels on pregnant women and the skills to disperse this information. The webinar included sessions on HAP and available health interventions.

Christine Limio, the Principal Nursing Officer in Mbale Regional Referral Hospital, opened the webinars with welcome remarks and urged midwives to embrace integrating HAP as one of the topical areas for health education during antenatal care. She was joined by guest speakers Dr Okia David, public health specialist and Lecturer in Busitema University, Joshua Epuitai, and Samson Udho, Specialist Midwife, PhD Scholar at the University of Capetown, and Lecturer at Lira University. The session was moderated by Dr Rose Chalo Nabirye, Midwife and Senior Lecturer, Busitema University.

Dr Okia David delivered the first session on HAP, which explained how cooking fuels produce high levels of pollutants toxic to public health. He then discussed the effects of polluting fuels on public health and the adverse effects on pregnancy and children’s health. Dr David emphasised the effects of HAP on environmental degradation, climate change and perpetuating gender inequalities.

Joshua expanded on this further by exploring measures to reduce HAP amongst pregnant women. He stressed the importance of utilising short-term interventions including use of dry wood, opening windows and doors to ensure ventilation, and keeping children away from the cooking place to reduce HAP. He highlighted the role of midwives in urging families to adopt improved stoves or cleaner fuels to reduce HAP.

The last session delivered by Samson Udho and considered the feasibility of ensuring that health education on effects of cooking fuels becomes a topic that is routinely discussed during antenatal care. He urged midwives to advocate for cleaner cooking practices and create demand for cleaner fuels amongst families.

Inadequate capacity to provide health education among healthcare workers

Pre and post-webinar, Joshua asked participants to complete questionnaires to assess the impact of the session content.

Prior to the webinar, 40% did not know about cleaner fuels, whilst 45% did not know about the effects of cooking fuels on maternal and child health. 83% of healthcare workers did not health educate pregnant women on the effects of cooking fuels.

Following the webinar, 71% reported that they were now aware of the ways to reduce the effects of HAP.

“I liked the examples of the alternatives of fuel such as briqquetes that were introduced. Many people including me were not aware of them.” Healthcare worker

After the webinar, healthcare workers shared that they intend to routinely inform pregnant women about the effects of using cooking fuels on maternal and child health. This indicates a positive move to incorporate HAP as topic area for health education during antenatal care.

“I liked the topic because [cooking fuels] is something we do [sic use] almost every day but we have not thought of the danger it incurs to the pregnant women. I think it’s feasible to integrate it in ANC health education topics.” Healthcare worker

“…I believe this can be integrated on the daily health education during antenatal. This should also be carried along in postnatal because some could have missed it during antenatal”: Healthcare worker

Following the success of the webinars and intentions from attendees to integrate information into ANC health education, Joshua intends to engage midwives at Mbale Regional Referral Hospital long-term to continue to raise awareness of HAP and build healthier homes for all.

Joshua is a 2020 Commonwealth Scholar from Uganda. He studied Public Health at the University of Birmingham.