Abstract:
ntroduction: Liquefied petroleum gas (LPG) is a clean cooking fuel that emits less household air pollution (HAP)
than polluting cooking fuels (e.g. charcoal, wood). While switching from polluting fuels to LPG can reduce HAP
and improve health, the impact of ‘stacking’ (concurrent use of polluting fuels and LPG) on adverse health
symptoms (e.g. headaches, eye irritation, cough) among female cooks is uncertain.
Methods: Survey data from the CLEAN-Air(Africa) study was collected on cooking patterns and health symptoms
over the last 12 months (cough, wheezing, chest tightness, shortness of breath, eye irritation, headaches) from
approximately 400 female primary cooks in each of three peri‑urban communities in sub-Saharan Africa:
Mbalmayo, Cameroon; Obuasi, Ghana; and Eldoret, Kenya. Random effects Poisson regression, adjusted for
socioeconomic and health-related covariates, assessed the relationship between primary and secondary cooking
fuel type and self-reported health symptoms.
Results: Among 1,147 participants, 10 % (n = 118) exclusively cooked with LPG, 45 % (n = 509) stacked LPG and
polluting fuels and 45 % (n = 520) exclusively cooked with polluting fuels. Female cooks stacking LPG and
polluting fuels had significantly higher odds of shortness of breath (OR 2.16, 95 %CI:1.04–4.48) compared with
those exclusively using LPG. In two communities, headache prevalence was 30 % higher among women stacking
LPG with polluting fuels (Mbalmayo:82 %; Eldoret:65 %) compared with those exclusively using LPG (Mbal-
mayo:53 %; Eldoret:33 %). Women stacking LPG and polluting fuels (OR 2.45, 95 %CI:1.29–4.67) had signifi-
cantly higher odds of eye irritation than women cooking exclusively with LPG. Second-hand smoke exposure was
significantly associated with higher odds of chest tightness (OR 1.92, 95 % CI:1.19–3.11), wheezing (OR 1.76, 95
% CI:1.06–2.91) and cough (OR 1.78, 95 %CI:1.13–2.80).
Conclusions: In peri‑urban sub-Saharan Africa, women exclusively cooking with LPG had lower odds of several
health symptoms than those stacking LPG and polluting fuels. Promoting a complete transition to LPG in these
communities may likely generate short-term health benefits for primary cooks.