Household air pollution impacts on mortality and disease burden in East Africa and Nile Basin African countries

Background: Clean household energy access is a major public health challenge across East Africa and the Nile Basin African countries. Objectives: This is to quantify exposure and health impacts of household air pollution from using solid fuels for cooking from 1990 to 2019 to inform policy and practice.Methods: In all 18 countries across East Africa and the Nile Basin Africa region, we estimated exposure to household air pollution from solid fuels (defined as the percentage of households using solid cooking fuels and the corresponding exposure to particulate matter 2.5 (PM2.5). We applied the methods of the Global Burden of Diseases, Injuries, and Risk Factor Study 2019 to estimate deaths, premature mortality, and disability-adjusted life years attributable to household air pollution from solid fuels with 95% Uncertainty Intervals (UI).Results: There was a high prevalence of household air pollution from using solid fuels for cooking, ranging from 78% in Somalia to 0.02% in Egypt in 2019. In total, there were 346,600 deaths attributable to household air pollution from using solid fuels for cooking in ENB countries in 2019. The highest number of all-cause household air pollution -attributable deaths was in Ethiopia, 67,830 (95% UI: 52,710-82,420), DR. Congo, 58,040 (95% UI: 41,170-77,460), Tanzania 39,170 (95% UI: 29,180-49,860) and Somalia 27,550 (95%% UI: 19,570-38,960), and the lowest deaths were in Comoros 550 (95% UI: 410-710), Djibouti 20 (95% UI: 90-360) and Egypt 70 (95% UI: 30-170). Almost all deaths were due to respiratory infection, neonatal diseases and conditions, cardiovascular diseases, chronic respiratory disease, and diabetes across all countries. Premature mortality and disability attributable to household air pollution from solid fuels were highly prevalent in Somalia, DR. Congo, Ethiopia, Tanzania, and Uganda compared to Egypt. Though the trend of death rate per 100,000 populations attributable to household air pollution showed a decline in Ethiopia and all countries between 1990 and 2019, it was unacceptably high in Somalia (272 deaths), Burundi (186 deaths), DR. Congo (157 deaths), Eritrea (140 deaths), South Sudan (133 deaths) and Ethiopia (130 deaths) compared to Egypt (0 deaths).Conclusion: Household air pollution is highly prevalent and a major public health concern across East Africa and the Nile Basin Africa countries except Egypt. The prevalence and impact vary between countries. Governments need to address Household air pollution in their disease prevention and control strategies for lower respiratory infection, neonatal, diabetes, chronic respiratory diseases, and cardiovascular diseases. To provide affordable and clean energy for their population and achieve Sustainable Development Goal 7, partnership on different energy sources, including building dams for electrification, such as the Grand Ethiopian Renaissance Dam, could be important. [Ethiop. J. Health Dev. 2023;37 (SI-2)]