Household Smoke-Exposure Risks from Cooking Fuels and Cooking Places in Tanzania: A Cross-sectional Study

Abstract Background: Household s moke-exposure risk (SER) can be defined using cooking fuels (smoke and no smoke-producing) and cooking places (indoor and outdoor), which represents different levels of household air pollution. The study explored the prevalence and geographical variation of smoke-exposure risks (SERs) resulting from indoor and outdoor cooking practices using smoke-producing and no smoke-producing cooking fuels in Tanzania. We further investigated social and spatial factors associated with different levels of SER. Methods: We constructed an indicator variable, the household SER, using country-level cross-sectional data on cooking fuels and places from 2015–16 Tanzania Demographic and Health Survey, and estimated zone-level average SERs. An ordered logistic regression model was employed to assess the social and spatial characteristics associated with household SER. Results: Approximately 76.4% of total 12,425 households that practiced indoor cooking using smoke-producing fuels were at high SER. High-level SER was more prevalent in the Central, Southern highlights, and Southwest highlands zones. Overall, wealthier households, female-headed households, and having higher education levels among household members were more likely to be in very low SER category. However, older household heads and larger family sizes were less likely to be in very low SER category. Conclusions: The significant prevalence of high smoke-exposure risk is a major public health concern in Tanzania, which requires simultaneous adoption of improved cooking stoves and clean fuels to minimize the adverse effects attributed to household SER.