Abstract:
Background Relatively clean cooking fuels such as liquefied petroleum gas (LPG) emit less fine particulate matter
(PM2·5) and carbon monoxide (CO) than polluting fuels (eg, wood, charcoal). Yet, some clean cooking interventions
have not achieved substantial exposure reductions. This study evaluates determinants of between-community
variability in exposures to household air pollution (HAP) across sub-Saharan Africa.
Methods In this measurement study, we recruited households cooking primarily with LPG or exclusively with wood
or charcoal in peri-urban Cameroon, Ghana, and Kenya from previously surveyed households. In 2019–20, we
conducted monitoring of 24 h PM2·5 and CO kitchen concentrations (n=256) and female cook (n=248) and child
(n=124) exposures. PM2·5 measurements used gravimetric and light scattering methods. Stove use monitoring and
surveys on cooking characteristics and ambient air pollution exposure (eg, walking time to main road) were also
administered.
Findings The mean PM2·5 kitchen concentration was five times higher among households cooking with charcoal than
those using LPG in the Kenyan community (297 μg/m³, 95% CI 216–406, vs 61 μg/m³, 49–76), but only 4 μg/m³
higher in the Ghanaian community (56 μg/m³, 45–70, vs 52 μg/m³, 40–68). The mean CO kitchen concentration in
charcoal-using households was double the WHO guideline (6·11 parts per million [ppm]) in the Kenyan community
(15·81 ppm, 95% CI 8·71–28·72), but below the guideline in the Ghanaian setting (1·77 ppm, 1·04–2·99). In all
communities, mean PM2·5 cook exposures only met the WHO interim-1 target (35 μg/m³) among LPG users staying
indoors and living more than 10 min walk from a road.
Interpretation Community-level variation in the relative difference in HAP exposures between LPG and polluting
cooking fuel users in peri-urban sub-Saharan Africa might be attributed to differences in ambient air pollution levels.
Thus, mitigation of indoor and outdoor PM2·5 sources will probably be critical for obtaining significant exposure
reductions in rapidly urbanising settings of sub-Saharan Africa.