Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000–18: a geospatial modelling study
Joseph Frostad, QuynhAnh P Nguyen, Mathew M Baumann, Brigette F. Blacker, Laurie B. Marczak, Aniruddha Deshpande, Kirsten E. Wiens, Kate E LeGrand, Kimberly B. Johnson, Mohsen Abbasi‐Kangevari, Amir Abdoli, Hassan Abolhassani, Lucas Guimarães Abreu, Michael R.M. Abrigo, Niveen ME Abu-Rmeileh, Victor Adekanmbi, Anurag Agrawal, Muktar Beshir Ahmed, Ziyad Al‐Aly, Fahad Alanezi, Jacqueline Elizabeth Alcalde‐Rabanal, Vahid Alipour, Khalid A Altirkawi, Nelson Alvis‐Guzmán, Nelson J Alvis-Zakzuk, A. Kofi Amegah, Saeed Amini, Fatemeh Amiri, Dickson A Amugsi, Robert Ancuceanu, Cătălina Liliana Andrei, Tudorel Andrei, Ernoiz Antriyandarti, Davood Anvari, Jalal Arabloo, Morteza Arab‐Zozani, Seyyed Shamsadin Athari, Marcel Ausloos, Getinet Ayano, Yared Asmare Aynalem, Samad Azari, Ashish Badiye, Atif Amin Baig, Kalpana Balakrishnan, Maciej Banach, Sanjay Basu, Neeraj Bedi, Michelle L Bell, Derrick Bennett, Krittika Bhattacharyya, Zulfiqar A Bhutta, Sadia Bibi, Somayeh Bohlouli, Soufiane Boufous, Nicola Luigi Bragazzi, Dejana Braithwaite, Sharath Burugina Nagaraja, Zahid A Butt, Florentino Luciano Caetano dos Santos, Josip Car, Rosario Cárdenas, Félix Carvalho, João Maurício Castaldelli-Maia, Carlos A Castañeda-Orjuela, Ester Cerin, Soosanna Kumary Chattu, Vijay Kumar Chattu, Pankaj Chaturvedi, Sarika Chaturvedi, Simiao Chen, Dinh‐Toi Chu, Sheng‐Chia Chung, Saad M A Dahlawi, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Aso Mohammad Darwesh, Jai K Das, Aditya Prasad Dash, Claudio Alberto Dávila-Cervantes, Diego De Leo, Jan‐Walter De Neve, Getu Debalkie Demissie, Edgar Denova‐Gutiérrez, Sagnik Dey, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Govinda Prasad Dhungana, Daniel Díaz, Isaac Oluwafemi Dipeolu, Fariba Dorostkar, Leila Doshmangir, André Rodrigues Durães, Hisham Atan Edinur, Ferry Efendi, Maha El Tantawi, Sharareh Eskandarieh, Ibtihal Fadhil, Nazir Fattahi, Nelsensius Klau Fauk
Abstract
BACKGROUND: More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. METHODS: We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. FINDINGS: Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000-257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. INTERPRETATION: Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. FUNDING: Bill & Melinda Gates Foundation.