Determinants of Household Air Pollution Exposure Among Pregnant Women in Zaria Metropolis, Kaduna State, Nigeria

Abstract Background : Household air pollution (HAP) from solid fuel combustion disproportionately affects pregnant women in low- and middle-income countries, yet data on their knowledge, perception, and exposure in Northern Nigeria remain scarce. Aim: To assess knowledge and perception of HAP, determine the prevalence of household smoke exposure, and identify independent predictors of high exposure among pregnant women in Zaria Metropolis, Kaduna State. Methodology : A descriptive cross-sectional study was conducted among 351 pregnant women attending antenatal care at eight selected primary health centres using multistage sampling. Data were collected with a structured interviewer-administered questionnaire and analysed using SPSS v25.0. Chi-square tests and binary logistic regression identified independent predictors of high HAP exposure at p < 0.05. Results : Most respondents demonstrated good knowledge (82.1%) and positive perception (78.1%) of HAP health risks. Despite this, 68.1% experienced high exposure, predominantly from charcoal use (45.6%) and near-universal indoor cooking (92.9%). Knowledge was not associated with exposure (p = 0.361). Independent predictors of high exposure included lower respondent education (AOR up to 47.21; p < 0.001), lower spousal education (AOR = 3.020; 95% CI: 1.605–5.681; p < 0.001), household size ≥11 members (AOR = 13.503; 95% CI: 4.358–41.835; p < 0.001), and negative HAP perception (AOR = 1.960; 95% CI: 1.015–3.785; p = 0.045). Conclusion : A significant knowledge-action gap exists, where awareness of HAP risks does not translate into reduced exposure. Structural determinants, particularly educational deprivation and large household size, are the primary drivers. Targeted antenatal counselling, male partner engagement, and clean fuel access programmes are urgently needed.