Regional disparities and household determinants of smoke exposure risk in Ghana

Household air pollution remains a major climate-related health concern in sub-Saharan Africa, driven by persistent reliance on unclean biomass fuels and inadequate ventilation despite ongoing clean energy expansion. In Ghana, disparities in cooking environments and fuel use contribute to unequal smoke exposure across regions and household characteristics. This study assessed regional disparities and household determinants of smoke exposure risk (SER) using nationally representative data. Data from 17,305 households in the 2022 Ghana Demographic and Health Survey (GDHS) were analyzed. SER was operationalized as an ordinal indicator by combining cooking fuel type and cooking location into four exposure categories. Weighted descriptive analyses, spatial visualisation, and multivariable ordinal logistic regression were used to estimate national and regional prevalence and identify household-level determinants. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported at p < 0.05. Nationally, 14% of households were classified as having high SER, 56% medium, 19% low, and 11% very low exposure risk. Pronounced regional disparities were observed, with the highest prevalence of high SER in the North East (61.1%), Upper East (43.8%), and Bono (24.5%) regions, compared with Western (4.7%) and Greater Accra (8.6%). Male-headed households were more likely to fall within lower exposure categories compared with female-headed households (aOR = 1.18; 95% CI: 1.09–1.29; p < 0.001). Education showed a non-linear association: households headed by individuals with primary education were more likely to experience higher exposure risk, whereas higher education was associated with reduced exposure risk. A strong wealth gradient was evident, with households in the richest quintile much more likely to experience lower SER (aOR = 13.87; 95% CI: 11.59–16.59; p < 0.001). Larger household size and older household head age were modestly associated with lower exposure risk. Spatial patterns revealed a marked north–south gradient reflecting socioeconomic and infrastructural inequalities. Substantial regional and household-level disparities in smoke exposure risk persist in Ghana. Integrating standardized exposure indicators into national surveys can strengthen climate–health monitoring, support geographically targeted clean energy interventions, and inform progress toward Sustainable Development Goals (SDGs) 3 and 7.