When Traditions Take a Toll Duke students research the health & environmental impact of open-fire cooking in Mandena, Madagascar

In summer 2016, a Duke-led student research team traveled to a small village in northeast Madagascar to investigate the effect of traditional cooking practices on human respiratory health, air quality, biodiversity and agriculture.

Their goal? To work with the local community to produce sustainable data-driven solutions to foster the health of the people of Mandena and their natural environment.

Mandena is a small rural village in the SAVA region in northeastern Madagascar.

This Bass Connections project included undergraduate, graduate and medical students and faculty from a range of academic disciplines from evolutionary anthropology to environmental sciences to medicine. Through the Bass Connections program, students apply their knowledge and skills and engage with community partners to explore big questions about major societal challenges.

We’re not just collecting data. We’re really formulating new questions and identifying ways to tackle them. We’re immersed in this village. We’re getting to know the people. Ultimately, our goal is really to improve the health of this village.

—Charles Nunn, project leader & professor of evolutionary anthropology & global health

Mandena, a village of about 2,500 people, is located on the outskirts of Marojejy National Park.

Mandena is an ideal location for this project because it’s a village that is transitioning from a traditional, agriculture-based system to more of a market economy. This transition has brought many changes, including:

  • Increased exposure to a Western diet (high fat and sugar and less fiber) and more sedentary jobs
  • Increased exposure to electricity/light pollution, which is detrimental to sleep
  • Increase in population, resulting in more competition for resources like clean water and building materials

These types of transitions often lead to a shift from infectious disease to non-communicable disease.

Watch the Team in Action

The brief video below highlights the team’s efforts to collect health and air quality data from community members to discern the effects of open-fire cooking on their respiratory and cardiovascular health. Video by DDC International.

The brief video below showcases how the team is exploring key questions related to community members’ use of wood and what effect their practices are having on the local forests, including tree and animal species. Video by DDC International.

Exploring Health Hazards

The team established an outpost in the center of the village where students administered surveys and performed basic health assessments, including taking blood pressure, temperature, height and weight, and using a spirometry instrument to test lung health. Henri Lahady, a Malagasy nurse (top photo, center), assisted with the health assessments.

Want to get a closer look? Click on the photos for a slide show!

Open-fire cooking increases exposure to carbon monoxide and particulate matter, which can lead to serious long-term health consequences. These health effects are often exacerbated for women—who typically do the family cooking—and children.

The World Health Organization estimates that more than two million people die annually from the effects of indoor air pollution originating from household fires—more deaths than are attributed to malaria.

Students Laura Guidera (left) and Erin Litzow observe and take notes on the cooking area in a home in the village.

Families in Mandena typically cook in an area separate from their main living space, with simple ventilation such as a window, door or small space between the wall and the roof. Many families also cook in a designated area outside of their home.

Students Njara Raharinoro (left, from the University of Antananarivo in Madagascar) and Brittany Carson (from North Carolina Central University) prepare to place air quality monitors in a villager’s home—one in the cooking area and one in the sleeping area.

Exploring Environmental Costs

A typical family using traditional cooking practices uses about two tons of firewood per year.

Student Lydia Greene weighs the wood cut by Desiré Razafimatratra (center), Mandena local and team research assistant, as team leader Charles Nunn, professor of evolutionary anthropology and global health, looks on.

In addition to their negative effects on human health, traditional cooking practices endanger biodiversity and contribute to global warming. Loss of trees represents lost habitats for various animal species, many of which are found only in Madagascar.

A villager prepares bundles of wood to sell.

The loss of ground cover also impacts the water cycle and other processes, leading to drying of the microclimate. As a result, traditional cooking practices can impact agricultural output in rural communities, while contributing to greenhouse gases and pollutants involved in global climate change.

With the assistance of Prisca Raharimalala, a Malagasy translator (center, in white), the team interviews a family about their use of wood and their thoughts about the local forest.
The project is looking at, from a whole community perspective, how can this community move forward, but in a way that helps preserve the local environment and the natural capital for future generations.

—Erin Litzow, Master of Environmental Management candidate

What We’ve Learned

This project is part of an ongoing series of research studies in Mandena that began in 2015 and will continue into the foreseeable future. Between 2015 and 2016, more than 300 villagers participated in these studies.

In fall 2016, Charles Nunn, project leader and professor of evolutionary anthropology and global health, presented some of the team’s research findings at the Duke Lemur Center’s 50th Anniversary Scientific Symposium. Watch the video below.

Key Findings:

  • 93% of participants had lung capacity below healthy values.
  • 26% of participants’ lung capacity is was below the “lower limit of normal.” Women comprise 65% of this group.
  • Based on its data, the team estimates that one in five community members have impaired lung function.
  • The sleeping areas of homes had very high levels of particulate matter throughout the day. These particles can be kicked up and tossed around as people come in and out, sweep their homes, shake out blankets, and engage in other daily activities.
  • The cooking areas of homes had extremely high levels of carbon monoxide around meal times (see graph below).
The team presented this research poster at the Duke Global Health Institute Research Showcase in fall 2016. The poster highlights some of the same findings Dr. Nunn described in his presentation.

Can we attribute these health problems to open-fire cooking? The team found strong indications that traditional cooking practices are a culprit:

  • The study participants with impaired lung function were more likely to cook inside than participants with healthy lung function.
  • The individuals who cook inside had a higher systolic blood pressure than those who cook outside.

What’s Next

As the project continues, the team will continue their research and explore a number of possible ways to address the health and environmental tolls of traditional cooking practices in this village, including:

  • Developing strategies to improve ventilation and reduce smoke from cooking
  • Increasing awareness of health effects of indoor air polution
  • Encouraging families to cook outside when possible
  • Assessing the effects of different cooking practices on air quality and human health
  • Encouraging more sustainable use of local forests

Teamwork: A Key to Success

We’re using different perspectives and students from different levels to address this global health issue. This is a very important component of global health—using teamwork to solve a problem.

—Melissa Manus, project coordinator & 2016 Master of Science in Global Health graduate

The team takes a break for a group photo.

Team leaders Melissa Manus, a 2016 Master of Science in Global Health graduate, and Charles Nunn, professor of evolutionary anthropology and global health, take advantage of a quiet moment to discuss the project.

The team met periodically every day—both formally and informally—to check in on various aspects of the project, explore questions as they arose, share new discoveries and identify ways to enhance the research process.

Group meals at the team’s camp site were a highlight of the team’s experience in Madagascar. Throughout the day, the team dispersed across the village for different research activities. Meals—usually traditional Malagasy food prepared by a local cook—were a time to reconnect.

Henri Lahady (left) and Desiré Razafimatratra were instrumental to the project.

Lahady, a Malagasy state nurse, assisted with health assessments. Des, a Mandena local, assisted with a variety of research tasks and facilitated connections with community members. Des has partnered with Duke faculty and staff on several projects, including the Duke Lemur Center’s SAVA Conservation initiative.

I think the combination of our different experiences and what we bring to the table is going to create a really meaningful product in the end, and it will really have a true impact on the community.

—Anna-Karin Hess, Duke sophomore

Learn more:

The Duke Global Health Institute and Bass Connections would like to thank DDC International for their thoughtful documentation of these research projects through videos and photographs.


Duke Global Health Institute and DDC International

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