Cooking energy sources and the lived experience of health: Evidence from Sub-Saharan Africa

Background: Despite global commitments under Sustainable Development Goal 7, almost one billion people in Sub-Saharan Africa still rely on polluting cooking fuels. Although biomedical research has established the health risks of household air pollution, less is known about how cooking energy sources relate to adults' everyday experiences of health and safety across countries. Methods: Using harmonised survey data from 10,637 adults in Kenya, Nigeria, South Africa and Uganda from the gEneSys survey, conducted 2024-2025, this study compares self-rated health, perceived harm and chronic illness across eight primary cooking energy sources. Multivariate regression models used multiple imputation and adjusted for socioeconomic, demographic, health-related and contextual factors. Results: Cooking sources did not form a simple health hierarchy. Solar-based electricity was associated with the most favourable self-rated health and perceived safety, although this group was small and potentially selective. Direct comparisons among other modern sources revealed only a few outcome-specific differences and no consistent ranking. Traditional and open-fire cooking sources showed the clearest disadvantages in perceived harm and more moderate differences in self-rated health, but no consistent pattern for chronic illness. These associations remained visible after adjustment. Conclusions: Cooking source was most clearly associated with lived health experience rather than reported chronic illness. Clean-cooking research and monitoring should therefore complement exposure and morbidity indicators with measures of self-rated health and perceived safety. Policies should address not only fuel replacement, but also affordability, reliability, safety and the social conditions under which energy is used.