Abstract:
BACKGROUND. Household air pollution (HAP) due to the use of solid fuels for cooking is a global problem with significant impacts on human
health, especially in low- and middle-income countries. HAP remains problematic in South Africa (SA). While electrification rates have
improved over the past two decades, many people still use solid fuels for cooking owing to energy poverty.
OBJECTIVES. To estimate the disease burden attributable to HAP for cooking in SA over three time points: 2000, 2006 and 2012.
METHODS. Comparative risk assessment methodology was used. The proportion of South Africans exposed to HAP was assessed and assigned
the estimated concentration of particulate matter with a diameter <2.5 μg/m3 (PM2.5) associated with HAP exposure. Health outcomes and
relative risks associated with HAP exposure were identified. Population-attributable fractions and the attributable burden of disease due
to HAP exposure (deaths, years of life lost, years lived with disability and disability-adjusted life years (DALYs)) for SA were calculated.
Attributable burden was estimated for 2000, 2006 and 2012. For the year 2012, we estimated the attributable burden at provincial level.
RESULTS. An estimated 17.6% of the SA population was exposed to HAP in 2012. In 2012, HAP exposure was estimated to have caused 8 862
deaths (95% uncertainty interval (UI) 8 413 - 9 251) and 1.7% (95% UI 1.6% - 1.8%) of all deaths in SA, respectively. Loss of healthy life
years comprised 208 816 DALYs (95% UI 195 648 - 221 007) and 1.0% of all DALYs (95% UI 0.95% - 1.0%) in 2012, respectively. Lower
respiratory infections and cardiovascular disease contributed to the largest proportion of deaths and DALYs. HAP exposure due to cooking
varied across provinces, and was highest in Limpopo (50.0%), Mpumalanga (27.4%) and KwaZulu-Natal (26.4%) Provinces in 2012. Agestandardised
burden measures showed that these three provinces had the highest rates of death and DALY burden attributable to HAP.
CONCLUSION. The burden of disease from HAP due to cooking in SA is of significant concern. Effective interventions supported by
legislation and policy, together with awareness campaigns, are needed to ensure access to clean household fuels and improved cook stoves.
Continued and enhanced efforts in this regard are required to ensure the burden of disease from HAP is curbed in SA.
