Impact of Indoor Air Pollution on Health in Low-to-Middle Income Countries

OBJECTIVES: The objective of this study was to conduct an updated review of the literature on the impact of indoor/household air pollution (IHAP) on health and quality of life (QoL) among residents in Low-to-Middle Income Countries (LMICs).

METHODS: We conducted a systematic review of peer-reviewed articles published between January 2015 and March 2024 through manual searches from PubMed and Google. Abstracts and non-English articles were excluded from our search. Keywords included: indoor air pollution, health, QoL, and Low-to-Middle-Income Countries. Preferred Reporting Items for Systematic Review and Meta-Analyzes (PRISMA) guidelines were followed.

RESULTS: Indoor air pollution was found to negatively impact health and QoL in LMICs. The final number of studies included in this review was 118. Low income, lower education status, residence type (rural vs urban), traditional use of cooking devices (biomass, solid fuels), poor ventilation, and indoor smoking were factors contributing to increased IHAP in LMICs (n=23). Of the 118 included articles, 55 reported a negative impact of IHAP on residents’ health. Most of these studies (n=29) showed associations with respiratory-related conditions, such as lung disease, pneumonia, COPD, asthma, and respiratory infections. Other conditions included general health (n=9), cardiovascular (n=8), depression, anxiety, and cognitive impairment (n=4), diabetes (n=2), cervical neoplasia (n=1), cancer (n=1), and arthritis (n=1). Several studies (n=21) showed impact of IHAP on maternal health and child-birth defects, stunting, and mortality. Lower perceptions on QoL due to IHAP was reported in one article. Potential IHAP interventions include use of liquefied petroleum gas, improved cookstove use, outdoor cooking, and wearable technologies (n=18).

CONCLUSIONS: Residents in LMICs lack the education, medical infrastructure, and financial resources to implement interventions to mitigate the negative impact of IHAP. Further research to identify perceptions and risk factors of IHAP as well as implementation of interventions to improve indoor air quality, health, and QoL in LMICs is warranted.