Household Smoke-Exposure Risks Associated with Cooking Fuels and Cooking Places in Tanzania: A Cross-Sectional Analysis of Demographic and Health Survey Data.

Household smoke-exposure risk (SER) can be defined through the assessment of cooking fuels (smoke and no smoke-producing) and cooking places (indoor and outdoor) related information, which represent different levels of household air pollution. This study aimed to explore the prevalence and geographical variations in smoke-exposure risks (SERs) associated with indoor and outdoor cooking practices and use of smoke-producing and non-smoke-producing cooking fuels in Tanzania. We further investigated the social and spatial features associated with household SERs. We defined an indicator variable, the household SER, using country-level, cross-sectional data on cooking fuels and cooking places obtained from the 2015-2016 Tanzania Demographic and Health Survey and then estimated zone-level average SERs. We used an ordered logistic regression model to assess the social and spatial characteristics associated with household SER. We identified 76.4% of the 12,425 households that practiced indoor cooking using smoke-producing fuels as having a high SER. High-level SER was more prevalent in the Central, Southern highland, and Southwest highland zones. Overall, wealthier households, female-headed households, and households with higher education attainments were more likely to be categorized as households with very low SER. Meanwhile, households headed by older individuals and with larger family sizes were less likely to be in the very low SER category. The prevalence of high SER is a major public health concern in Tanzania. Improved cooking stoves and cleaner fuels should be adopted simultaneously to minimize the adverse effects associated with household SER.