“We threw away the stones”: a mixed method evaluation of a simple cookstove intervention in Malawi

Background: Air pollution exposure is responsible for a substantial burden of respiratory disease globally. Household air from cooking using biomass major contributor to overall in rural low-income settings. Previous research Malawi has revealed how precarity and food insecurity shape individuals' daily experiences, contributing perceptions health. Aiming avoid mismatch between intervention local context, we introduced simple cookstove Malawi, analysing change fine particulate matter (PM 2.5) exposures, community perceptions. Methods: Following period baseline ethnographic research, distributed 'chitetezo mbaula', locally-made cookstoves, all households (n=300) Malawian village. Evaluation incorporated village-wide participant observation concurrent monitoring portable PM 2.5 monitors at follow-up (three months post-intervention). Qualitative data were thematically analysed. Quantitative analysis included pre-post comparisons, with datapoints divided into periods combustion activity (almost exclusively cooking) non-combustion periods. Findings integrated the interpretation stage, convergent design mode synthesis. Results: Individual pre- post-cookstove involved sample 18 participants (15 female; mean age 43). Post-intervention exposures (median 9.9μg/m 3 [interquartile range: 2.2-46.5]) not significantly different pre-intervention (11.8μg/m [3.8-44.4]); p=0.71. On by activity, background found be reduced post-intervention (from 8.2μg/m [2.5-22.0] 4.6μg/m [1.0-12.6]; p=0.01). Stoves well-liked widely used residents as substitutes previous methods (mainly three-stone fires). Commonly cited benefits related fuel saving shorter times. Conclusions: The had no impact on cooking-related exposures. A significant reduction may relate smouldering emissions. Uptake continued use stoves was high amongst members, who preferred over open fires.