# Educational attainment and self-reported environmental exposures of pregnant women living in Nairobi, Kenya

## TL;DR

This study examines environmental exposures among pregnant women in Nairobi, Kenya, and how these relate to their educational background.

## Contribution

The study provides new insights into environmental exposures among pregnant women in an urban African setting, linking them to educational attainment.

## Key findings

- Pregnant women in Nairobi frequently reported exposure to combustion-related air pollution sources like cooking emissions and vehicle exhaust.
- Women with lower educational attainment were more likely to use kerosene for cooking, a dirtier fuel compared to LPG.
- Work-related exposures to pollutants such as vehicle exhaust and rubbish burning were common among employed participants.

## Abstract

Environmental exposures experienced by pregnant women living in cities of low- and middle-income countries are poorly described. We collected information on housing characteristics, household and ambient air pollution, and work-related exposures through questionnaires in a cohort of 400 pregnant women in Nairobi, Kenya and examined exposures in relation to educational attainment, a proxy for socioeconomic status. Participants were median 26 years of age, mostly married (85%) and self-described homemakers (54%), with at least some secondary school education (74%). Housing generally consisted of one room (58%) with one window (57%), access to electricity (94%), and no piped water (88%). Participants commonly reported living near sewers (55%) and the Dandora dumpsite (34%). Liquified petroleum gas (LPG) was the primary domestic cooking fuel, followed by kerosene, with 65% and 32%, respectively, reporting use most days to daily. Most participants reported exposure to outdoor cooking smoke (73%) and vehicle exhaust (66%) most days to daily. Employed participants (N = 151) reported work-related exposure to vehicle exhaust (68%), cigarettes (37%), marijuana (33%), dusty/unpaved roads (32%), welding (30%), and the dumpsite (30%) most days to daily. Exposure to rubbish burning was reported by 4.5% of participants at home, by 24% outdoors, and by 25% related to work most days to daily. Relative to women with primary school education or lower, women with at least secondary school education were more likely to use LPG (p < 0.001) and less likely to use kerosene (p < 0.001). This study highlights a high prevalence of pregnant women in an urban African context experience multiple sources of combustion related air pollution sources. Exposure to cooking emissions, vehicle exhaust, and rubbish burning were frequent. Kerosene, the second most common and a dirty domestic fuel, was used more by women with lower educational attainment. These data may inform future studies of prenatal and early childhood environmental exposures and interventions.