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WELL FACTSHEET - Regional Annex for East Africa

Indoor air pollution

Author:  Gerald Rukunga, AMREF, Kenya

Quality Assurance: Adam Biran


Globally, almost 3 billion people rely on biomass fuels (wood, charcoal, crop residues and dung) and coal as their primary source of domestic energy. Biomass fuels have been associated with Indoor Air Pollution (IAP),  which is a major risk factor accounting for 4% of the global burden of disease measured by Disability Adjusted Life Years (DALYs) lost.

In developing countries 28% of deaths in children under 5 years of age are associated with Acute Respiratory Infections (ARI). The sources of fumes and particulates are either outdoor or indoor.  Indoor exposures are of greater concern because concentrations are often much higher and greater time is spent indoors by vulnerable population sub-groups, including young children (USAID 1997).

In Sub Saharan Africa, around 80% of the rural communities depend on biomass fuels for their domestic energy. In all the Countries of East Africa, the majority of the populations live in the rural and peri-urban areas where poverty is rampant leading to extensive use of biomass as source of energy. Exposure to IAP  from the combustion of solid fuels is a predisposing factor contributing to morbidity and mortality in developing countries and the worst levels of exposure are closely associated with the poorest households.

Indoor Air Pollution is an emerging area of focus in the health sector due to its increasing risks to Acute Respiratory Infections particularly among children under five years of age. In the East African region, there are policy guidelines for the implementation of interventions on the control of childhood diseases. However, there are no specific policies targeting IAP and the existing ARI policy focuses mainly on curative rather than both curative and preventive interventions. In Kenya for example, ARI policy does not include control measures targeting environmental factors linked to child health and by extension IAP . Consequently, ARI diseases are addressed mainly through case management and seeking prompt treatment,  totally ignoring the role of IAP and other environmental factors in transmission of ARI and its appropriate interventions.

Experiences and lessons learned from past and current interventions have been documented but these are yet to be replicated or incorporated into existing policies. One of the Government of Kenya strategic objectives is to reduce underfives morbidity and mortality attributed to measles, pneumonia, diarrhoea, malaria and malnutrition from 70% to 40% in the period 1999 2004. This is achieved through replacement of vertical programmes such as those for Acute Respiratory Infections  with Integrated Management of Childhood Illnesses (IMCI)

The importance of interventions to reduce exposure to IAP is reflected in the Millennium Development Goals (MDGs) in many ways. With less time spent on fuel collection, people will have more time available for education for children and Income Generation Activities (IGAs) for women that are likely to contribute to eradicating extreme poverty. As most of the disease burden due to IAP falls on children under five years of age, interventions will help achieve a significant reduction in child mortality and consequently contribute to the fourth MDG.

The World Bank has identified three key considerations in the successful implementation of IAP interventions. These include the policy and regulatory context; making sure that all relevant sectors / perspectives are considered and local community involvement in technology design and application.

In East Africa various interventions are ongoing with the aim of reducing the risks and mitigating the health effects of IAP. The interventions focus on improving ventilation in houses, extraction of smoke and improving combustion of fuels. In improving house ventilation, the main activities include provision of windows and eaves spaces in the existing houses. The pilot work on this aspect has focused on Manyattas (igloo like structures) and other traditional houses in the rural areas. With regard to smoke extraction, a number of appropriate technologies have been employed. These include construction of smoke hoods, chimneys and flues. Introduction of improved cooking stoves has been the main intervention in improving the combustion of fuels but the experiences need to be disseminated widely for replication.

Although IAP has been a problem mainly in rural areas, lately it has become a source of concern in the informal settlements where the slum houses are constructed back-to-back inhibiting proper ventilation. In most cases these houses are often overcrowded and low socio-economic status forces occupants to use low cost incombustible fuels. The net effect of these problems is high prevalence of acute respiratory infections among children and eye problems resulting from constant contact with a smoky environment.

The following are benefits from the current IAP interventions:

  • improved health

  • increased income for households

  • empowerment

  • prestige through increased social capital

  • gender mainstreaming

As work on IAP evolves there remain several challenges to be addressed:

  • how to diversify types of fuels among the communities living in abject poverty in rural and slum areas

  • ensuring the sustainability of interventions given the dynamic nature of the technologies

  • developing simple and affordable technologies that meet cultural diversity and contexts

  • quantification of the effects of IAP with respect to emerging diseases such as tuberculosis and HIV/Aids

To effectively address issues related to IAP, there is a need for policies that recognize the linkage between environmental causes of IAP and related interventions. Similarly, sector coordination involving key stakeholders whose activities contribute to, or would influence, Indoor Air Pollution interventions should be enhanced.



Rukunga G K (2002): Towards Environmental Health Justice for Children in Kenya.I 12th Eastern Africa Environmental Network Conference Proceedings:  Nairobi, Kenya 

GoK, Ministry of Health (2000): Integrated Management if Childhood Illness (IMCI), National technical guidelines on the acute respiratory infections. Government Press. Nairobi, Kenya.

Government of Kenya (1999): The National Health Sector Strategic Plan (NHSSP) 1999-2004, Ministry of Health. Government Printers, Nairobi, Kenya

World Health Organization: Indoor Air Pollution and the Millennium Development Goals, available at accessed 29th April 2004.

World Bank (2003): Indoor Air Pollution - at a glance, available at:

$FILE/IAP%20AAG%209-03.pdf accessed 30th April 2004

Intermediate Technology Development Group



This Regional Annex was developed by Gerald Rukunga, AMREF Kenya (2004) under the WELL Partnership.  For further information contact:  



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