Societal perceptions of household air pollution and how it impacts children’s respiratory health: a systematic review of qualitative studies

BACKGROUND: Household air pollution (HAP) represents a significant global health concern. Children are particularly vulnerable to HAP. Despite the known risks, there exists a "perception gap" between societal understanding and scientific evidence regarding HAP's impacts. This systematic review aims to explore societal perceptions regarding HAP and its impacts on children's respiratory health. METHODS: Following the PRISMA guidelines, a comprehensive search was conducted across relevant databases including Embase, PubMed, Web of Science, and Google Open Searches. The search strategy incorporated both Medical Subject Headings and search terms, focusing on "perception," "household air pollution," "children," and "respiratory health". Studies were included if they reported qualitative data on societal actors' perceptions of HAP's impact on children's (0-18 years) respiratory health. Titles, abstracts, and full texts were screened, followed by data extraction and quality assessment of included studies using CASP and AACODS tools. The findings across these publications were synthesized through thematic analysis. RESULTS: Ten studies met the inclusion criteria, revealing three key themes: (1) Perceived impact of HAP on children's respiratory health, (2) Perceived obstacles to implementation of solutions, and (3) Perceived drivers of change in behaviour to reduce exposure. The 'perceptions' highlight some important gaps in societal actors' view of HAP and awareness of its impact on children's respiratory health, particularly in rural areas. Financial constraints, low awareness, limited access to cleaner fuels and cultural practices are thought to be the key barrier amongst societal actors and stand as hurdles to change. Despite these, there is realization amongst societal actors of the need for practical solutions to mitigate HAP exposure. This points to the need for intervention strategies that not only targets HAP, but parallelly addressees' community's cultural norms, economic and educational realities. CONCLUSION: This review underscores the criticality of integrating societal insights with scientific evidence to tailor HAP mitigation strategies effectively. It reiterates the necessity for interventions to be culturally sensitive, economically feasible, and compatible with societal actors' expectations to improve children's respiratory health.