Background Globally, anaemia affects 0.5 billion reproductive-aged women and 42% of children under 5-year-olds. Over three billion people use polluting fuel daily mostly in low and low-middle-income countries. Most of these countries have severe public health significance of anaemia. Previous studies examined grouped effect of household fuel and health outcomes. We examined the associated risk of anaemia in women and children in Sub-Saharan Africa from exposure to individual cooking fuel types.

Methods This study explored the most recent data from Demographic and Health Survey (2013–2018) program. It involves nationally representative samples of women, children and household data in Ghana, Malawi, Rwanda, Tanzania, Uganda, and Zimbabwe. Anaemia, the outcome variable in women of reproductive age (15–49 years) and children aged 6–59 months, was ascertained from haemoglobin testing results carried out by trained field staff. The exposure variable was fuel used primarily in the households asked from the questionnaire. Descriptive analysis and multivariate Poisson regression analyses were done to estimate the risk of anaemia in both sample populations from exposure to cooking fuels after adjusting for several social determinants of health variables.

Results Overall, 93% of the total sampled population (55,742) were exposed to polluting cooking fuel, with 35% and 54% anaemia prevalence in women and children, respectively. In women, higher risk of anaemia was associated with exposure to liquid-petroleum-gas, adjusted risk ratios 1.29 [95% CI 1.03–1.63], p=0.03; charcoal 1.23 [1.05–1.44], p=0.01. Higher risk in children includes LPG 1.19 [1.01–1.41) p=0.04; coal/lignite 1.21 [1.11–1.36] p<0.00; and natural-gas 1.73 [1.18–2.53], p=0.01. The highest risk of anaemia (89%) was found in children aged 6–11 months.

Conclusion The study adds to the body of evidence of the risk to health of women and children from the specific fuel used for cooking. It is urgent for policymakers to prioritise funding for clean, affordable, equitable fuel in these low-middle-income countries and for implementation research to establish the best suited for each community based on resources available to them. The increase in global migration calls for healthcare professionals to enhance socio-demographic history taking to include detailed information about fuel use for the accurate diagnosis of anaemia.