Abstract
Introduction: Household air pollution from domestic solid fuel use remains a global public
health concern, particularly in low-income communities. This study assessed associations
between household fuel use, indoor air pollution, and respiratory health outcomes in two
Mpumalanga communities in South Africa.
Methods: A cross-sectional study was conducted in KwaZamokuhle and eMzinoni
between July 2019 and February 2020. Indoor PM₂.₅ concentrations were measured
using Airmetrics MiniVol samplers and TSI DustTrak II monitors. We carried out household
surveys, lung function tests and allergen sensitivity testing and performed multivariable
logistic regression to assess associations between indoor pollutant exposure and
respiratory health outcomes.
Results: Indoor and ambient PM₂.₅ concentrations in KwaZamokuhle were more than twice
as high as those in eMzinoni, exceeding both national standards and WHO Air Quality
Guidelines. Coal use for heating was more prevalent in KwaZamokuhle and appeared
directly related to elevated PM₂.₅ levels. Approximately 9% of participants exhibited signs
of obstructive airway disease, and 25% had positive results for allergen sensitisation.
Although the associations between PM₂.₅ levels, solid fuel use and measured respiratory
outcomes did not reach statistical significance, consistent trends in the expected direction
were observed, suggesting a potential relationship that warrants longitudinal studies with
larger sample sizes.
Conclusion: These findings suggest complex, possibly nonlinear relationships between
indoor air pollution and respiratory health effects. The study underscores the urgent need
for a greater use of clean energy alternatives and increased public awareness about the
risks of household air pollution in low-income South African communities.