Association between household fuel use and cardiometabolic risk factors in sub-Saharan Africa: A systematic review

Abstract

The dependence on solid fuels for cooking is high in sub-Saharan Africa, as very few of the population (17%) have access to clean energy. Household air pollution resulting from the use of solid cooking fuels has been increasingly linked to cardiometabolic risk factors, though literature on the topic in the region remains scarce. This systematic review aimed to synthesize available evidence on the link between household fuel use and cardiometabolic risk factors in sub-Saharan Africa. We conducted bibliographic searches in PubMed, Scopus, Embase, Web of Science, African Index Medicus, and Global Health databases for studies published between 2005 and June 2025. We included studies on the association between household fuel use and cardiometabolic risk factors.The search yielded 2174 documents, out of which 8 were included. Six studies reported on hypertension, while one each reported on diabetes and metabolic syndrome. All studies employed a cross-sectional design. Hypertension prevalence ranged from 1.0% [95% CI = 0.9, 1.2] to 63.7% [95% CI = 61.7, 65.7] across study settings, and the single prevalence of metabolic syndrome was 30% [95% CI = 23, 38]. While one study found an overall association between using unclean cooking fuel and hypertension [AOR = 1.21, 95% CI = 1.11, 1.31], most studies of hypertension reported positive, yet non-significant findings (e.g. an AOR of 1.07 [95% CI = 0.99, 1.16]. The single study on diabetes reported no association [AOR = 0.99, 95% CI = 0.41, 2.40], while the single metabolic syndrome study reported increased odds [AOR = 2.18, 95% CI = 1.01, 4.68]. Overall, limited evidence was found exploring associations between household fuel use and cardiometabolic risk factors, reflecting an overall paucity in data across the SSA region. These findings warrant further longitudinal research to better clarify the link between household fuel use and cardiometabolic risk factors in the region.