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 PM(2‧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 PM(2‧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 PM(2‧5) levels. Approximately 9% of participants exhibited signs of obstructive airway disease, and 25% had positive results for allergen sensitisation. Although the associations between PM(2‧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.