Abstract
BACKGROUND: Household air pollution from solid fuel use poses a significant public health risk in low and middle-income countries. Somalia lacks national data on household smoke exposure risk (SER), a measure based on fuel type and cooking location. METHODS: We analyzed data from 15,823 households in the 2020 Somalia Health and Demographic Survey. SER was categorized as very low, low, medium, or high. Descriptive analysis and ordinal logistic regression identified associated factors, adjusting for sampling weights. RESULTS: High SER affected 60.3% of households; 36.3% had medium SER. Only 3.2% and 0.2% were in the low and very-low categories. Larger households had greater SER odds (AOR = 1.19). Surprisingly, middle- and high-income households had higher SER than the poorest. Media exposure reduced SER (AOR = 0.88), and nomadic households had significantly lower risk (AOR = 0.19) than urban ones. Regional differences remained significant. CONCLUSION: Most Somali households face high SER, shaped by household size, wealth, media access, and geography. Clean cooking programs should focus on high-density homes, promote awareness through media, and tailor approaches to local contexts. Expanding access to clean fuels and improving ventilation can reduce household air pollution in Somalia.