Air pollution and health in Rwandan and Kenyan schools cooking with polluting fuels: a cross-sectional impact study.

School meals across Sub-Saharan Africa are typically prepared using biomass on inefficient stoves, resulting in high air pollution levels that might affect learners and staff. However, there is a paucity of air pollution health-related research in African schools. This study, conducted in seven schools in Rwanda and four schools in Kenya, assessed 1) levels of carbon monoxide (CO) and fine particulate matter (PM) in school kitchens, classrooms (three, at different distances from the kitchen), playgrounds and personal among learners and catering staff; and 2) the prevalence of acute air pollution health-related symptoms and knowledge and perceptions of air pollution among learners and staff. For Rwanda and Kenya respectively, median 24-h PM levels were 263 and 1480 μg/m for kitchens and 63 and 68 μg/m for classrooms. In Rwanda, median personal PM exposure levels were 354 μg/m for cooks and 86 μg/m for leaners. In Kenya, median personal PM exposures were 1280 μg/m for cooks and 99 μg/m for leaners. Median CO levels in the kitchens were 1.8 and 23 and for cooks 3 and 14.8 mg/m for Rwanda and Kenya respectively. Surveys with learners (n = 526 and n = 302), catering staff (n = 45 and n = 28), and teachers (n = 21 and n = 12) for Rwanda and Kenya, respectively, demonstrated a high prevalence of self-reported air pollution-related headaches, eye irritation, and cough. The elevated air pollution levels and associated prevalence of health issues underscore the urgent need to accelerate transition to clean energy in African schools.