Indoor Air Pollution and Health in Ghana: Self-Reported Exposure to Unprocessed Solid Fuel Smoke.

Most countries in Sub-Saharan Africa including Ghana still depend extensively on unprocessed solid cooking fuels with many people exposed on a daily basis to harmful emissions and other health risks. In this study, using complementary log-log multivariate models, we estimated the health effects of exposure to smoke from unprocessed wood in four regions of Ghana while controlling for socio-environmental and socio-demographic factors. The results show that the distribution of self-reported exposure to smoke was highest among participants in the Northern region, rural dwellers, the 25-49 age groups, individuals with no education, and married women. As expected, exposure to smoke was higher in crowded households and in communities without basic social amenities. Region, residential locality, housing quality (type of roofing, floor and exterior materials), self-reported housing condition, and access to toilet facilities were associated with self-reported exposure to solid fuel smoke. Participants living in urban areas were less likely (OR = 0.82, ρ ≤ 0.01) to be exposed to solid fuel smoke compared to their rural counterparts. An inverse relationship between self-reported housing condition and exposure to solid fuel smoke was observed and persisted even after adjustments were made for confounding variables in the demographic model. In Ghana, the cost and intermittent shortages of liquefied petroleum gas and other alternative fuel sources hold implications for the willingness of the poor to shift to their use. Thus, the poorest rural populations with nearly no cash income and electricity, but with access to wood and/or agricultural waste, are unlikely to move to clean fuels or use significantly improved stoves without large subsidies, which are usually not sustainable. However, there appears to be large populations between these extremes that can be targeted by efforts to introduce improved stoves.