A nationwide comparative analysis of household air pollution and anemia among women of reproductive age in Ghana by rural and urban residence and pregnancy status

Household air pollution remains a major public health risk in low- and middle-income countries and may contribute to anemia among women of reproductive age. Exposure to pollutants generated from solid fuel combustion can induce systemic inflammation, oxidative stress, and impaired iron metabolism, potentially increasing the risk of anemia . However, evidence on this relationship remains limited in many sub-Saharan African settings, including Ghana. This study examined the association between cooking fuel type and anemia in Ghana, assessing differences by pregnancy status and place of residence. We analysed secondary data from the nationally representative Ghana Demographic and Health Survey using survey-weighted regression models. Anemia was defined using World Health Organization hemoglobin thresholds, and cooking fuel type was classified as clean or unclean. Multivariable logistic models estimated adjusted odds ratios. Statistical significance was set at 0.05. Among 7,657 women, 41.1% were anaemic and 74.0% used unclean cooking fuels. Anaemia prevalence was higher among pregnant women (51.2%) than non-pregnant women (40.4%) and among rural women (43.4%) than urban women (39.4%). Pregnant women using unclean fuels had a higher prevalence of anaemia than those using clean fuels (57.4% vs. 32.5%). In adjusted analyses, unclean fuel use was not associated with anemia in the overall population (AOR = 1.00, 95% CI: 0.82–1.23), but was associated with elevated odds among pregnant women (AOR = 2.12, 95% CI: 0.95–4.74), although not statistically significant. The relationship between household air pollution and anemia appears to be concentrated among pregnant women in crude analysis, though the adjusted association did not reach statistical significance. Integrating clean cooking interventions into antenatal care and addressing structural determinants may reduce anemia burden in Ghana. Further research should explore causal pathways and longitudinal exposure assessment.