Abstract
Solid fuel use is a major contributor to indoor air pollution and poses significant public health risks in low-income countries. However, regional variation and its determinants in East Africa remain poorly understood. This study aimed to assess the spatial distribution and key predictors of solid fuel utilization among households in East Africa. We analyzed data from 218,282 households across 12 East African countries using Demographic and Health Survey (2012-2023) data. Spatial analyses were conducted using ArcGIS V.10.7.1 and SaTScan™ 10.0.2, while multilevel logistic regression was applied to identify significant individual- and community-level factors. The AIC, BIC, and Deviance were used to assess the model's fitness. Solid fuel use was highly prevalent at 88.5% (95% CI: 88.4-88.7%), with hotspots identified in Uganda, Burundi, Rwanda, and Malawi; some parts of Mozambique and Ethiopia. Significant predictors were female household head, 30-40 age of household head, large family size, education level, marital status, no mobile phone, wealth index, no electricity access, rural residence, and no media exposure. Solid fuel dependence remains widespread in East Africa, with marked regional disparities. Expanding access to affordable clean energy and targeted public health policies are urgently needed to reduce reliance on solid fuels and achieve equitable energy access.