A Qualitative Exploration of Household Biomass Fuel Use and Low Birth Weight Incidence among Pregnant Women in the Lake Victoria Region, Uganda

**Abstract** Household air pollution from biomass fuel use remains a significant public health issue in sub-Saharan Africa. Pregnant women are particularly vulnerable, with emerging evidence suggesting a link to adverse birth outcomes such as low birth weight. The specific perceptions and lived experiences within the Lake Victoria region of Uganda are poorly documented. This qualitative study explored the perceived association between household biomass fuel use and low birth weight among pregnant women in this region, aiming to understand community perspectives and local explanatory models. An exploratory design was employed, using semi-structured interviews and focus group discussions. Participants (n=35) were purposively sampled and included pregnant women, mothers of low birth weight infants, community health workers, and traditional birth attendants. Data were analysed using reflexive thematic analysis. Four primary themes were constructed: 1) *Ubiquitous exposure*, describing constant smoke inhalation during cooking; 2) *Direct attribution of harm*, with many participants linking smoke exposure to foetal 'weakness' and impaired growth; 3) *Compounded vulnerability*, where smoke exposure intersected with poverty and food insecurity; and 4) *Constrained agency*, highlighting limited capacity to adopt cleaner cooking methods due to economic and cultural barriers. The findings demonstrate a strong, community-held perception of a causal link between biomass smoke and low birth weight, situated within a context of socio-economic constraint. This underscores the need for community-engaged, low-cost, and culturally acceptable interventions to reduce exposure during pregnancy. Integrating this concern into antenatal education is advised, alongside further quantitative research to establish the exposure-response relationship locally. **Keywords:** household air pollution, biomass fuel, pregnancy, low birth weight, qualitative research, Uganda, sub-Saharan Africa