This paper aims to benchmark performance of combined solid waste management (SWM) and recycling systems in major cities of East Africa. The Wasteaware indicators are used to present a detailed systems analysis for Kigali in Rwanda, including a mass flow diagram; comparative data are taken from the Wasteaware database for Dar es Salaam, Tanzania, Kampala, Uganda, Nairobi, Kenya, and also for neighboring Maputo, Mozambique. The stand-out result is the relatively high collection coverage achieved, in Maputo with extensive international technical assistance, and in Kigali using its own local resources. In both cases, governance factors are key. Kigali uses a public–private partnership, with exclusive franchises in 35 sectors being tendered every three years; households pay an affordable fee depending on their ability to pay (the service is free to the poorest category); and 95% fee collection rates are achieved, partly through co-collection with charges for local security patrols, which is a service people value highly given the recent history of the country. Another key priority to improve SWM across East Africa is to eliminate open dumping – only Kampala currently has an engineered disposal site. Recycling rates also need to be increased – only Nairobi currently has a good baseline to build on (30%). Common weaknesses include a lack of segregation at source, of institutional capacity, and of available and reliable waste data.

Background: Household air pollution associated with biomass (wood, dung, charcoal, and crop residue) burning for cooking is estimated to contribute to approximately 4 million deaths each year worldwide, with the greatest burden seen in low and middle-income countries. We investigated the relationship between solid fuel type and respiratory symptoms in Uganda, where 96% of households use biomass as the primary domestic fuel. Materials and Methods: Cross-sectional study of 15,405 pre-school aged children living in charcoal or wood-burning households in Uganda, using data from the 2016 Demographic and Health Survey. Multivariable logistic regression analysis was used to identify the associations between occurrence of a cough, shortness of breath, fever, acute respiratory infection (ARI) and severe ARI with cooking fuel type (wood, charcoal); with additional sub-analyses by contextual status (urban, rural). Results: After adjustment for household and individual level confounding factors, wood fuel use was associated with increased risk of shortness of breath (AOR: 1.33 [1.10–1.60]), fever (AOR: 1.26 [1.08–1.48]), cough (AOR: 1.15 [1.00–1.33]), ARI (AOR: 1.36 [1.11–1.66] and severe ARI (AOR: 1.41 [1.09–1.85]), compared to charcoal fuel. In urban areas, Shortness of breath (AOR: 1.84 [1.20–2.83]), ARI (AOR: 1.77 [1.10–2.79]) and in rural areas ARI (AOR: 1.23 [1.03–1.47]) and risk of fever (AOR: 1.23 [1.03–1.47]) were associated with wood fuel usage. Conclusions: Risk of respiratory symptoms was higher among children living in wood compared to charcoal fuel-burning households, with policy implications for mitigation of associated harmful health impacts.

Background: A variety of public health interventions have been undertaken in low- and middle-income countries (LMICs) to prevent morbidity and mortality associated with household air pollution (HAP) due to cooking, heating and lighting with solid biomass fuels. Pregnant women and children under five are particularly vulnerable to the effects of HAP, due to biological susceptibility and typically higher exposure levels. However, the relative health benefits of interventions to reduce HAP exposure among these groups remain unclear. This systematic review aims to assess, among pregnant women, infants and children (under 5 years) in LMIC settings, the effectiveness of interventions which aim to reduce household air pollutant emissions due to household solid biomass fuel combustion, compared to usual cooking practices, in terms of health outcomes associated with HAP exposure. Methods: This protocol follows standard systematic review processes and abides by the PRISMA-P reporting guidelines. Searches will be undertaken in MEDLINE, EMBASE, CENTRAL, WHO International Clinical Trials Registry Platform (ICTRP), The Global Index Medicus (GIM), ClinicalTrials.gov and Greenfile, combining terms for pregnant women and children with interventions or policy approaches to reduce HAP from biomass fuels or HAP terms and LMIC countries. Included studies will be those reporting (i) pregnant women and children under 5 years; (ii) fuel transition, structural, educational or policy interventions; and (iii) health events associated with HAP exposure which occur among pregnant women or among children within the perinatal period, infancy and up to 5 years of age. A narrative synthesis will be undertaken for each population-intervention-outcome triad stratified by study design. Clinical and methodological homogeneity within each triad will be used to determine the feasibility for undertaking meta-analyses to give a summary estimate of the effect for each outcome. Discussion: This systematic review will identify the effectiveness of existing HAP intervention measures in LMIC contexts, with discussion on the context of implementation and adoption, and summarise current literature of relevance to maternal and child health. This assessment reflects the need for HAP interventions which achieve measurable health benefits, which would need to be supported by policies that are socially and economically acceptable in LMIC settings worldwide. Systematic review registration: PROSPERO CRD42020164998

The study assessed the impact of volatile fatty acids (VFA) to total alkalinity (TA) ratio (VFA/TA), and percentage volatile solids (VS) reduction of batch and semi-continuous anaerobic co-digestion of palm nut paste waste (PNPW) and anaerobic-digested rumen waste (ADRW) on digester stability and biogas production under the environmental condition of 50 ± 1°C and hydraulic retention time of 21 days for the batch studies and 14 days for semi-continuous co-digestion. The co-digestion ratios were based on percentage digester volume corresponding to 90%:10%, 75%:25% and 50%:50%. During batch and semi-continuous anaerobic co-digestion, VFA/TA of 0.32–1.0 and VS reduction of 53–67% were observed as the stable range at which biogas production was maximum. In terms of semi-continuous anaerobic digestion (AD), except for the 50%:50% ratio where biogas production progressed steadily from the first to fourteenth days, biogas production initially dropped from 180.1 to 171.3 mL between the first and third days of the 90%:10% reaching a maximum of 184 mL on the fourteenth day. Biogas production declined from 198.8 to 187.5 mL on the second day and then increased to 198.8 ± 0.5 mL in the case of the 75%:25% with a significant difference between the treatment ratios at p < 0.05. Therefore, the study can confirm that the 50%:50% ratio (PNPW:ADRW) is a suitable option for managing crude fat-based waste under thermophilic AD due to its potential for rapid start-up and complete biodegradation of active biomass within a 21-day period. This presupposes that residual methane as greenhouse gas will be void in the effluent if disposed of.

Household air pollution (HAP) from cooking on biomass fuel presents significant health, environmental and socioeconomic consequences worldwide. However, there is a lack of understanding of the factors influencing cooking behaviours that affect HAP exposure in Rwanda (e.g., cooking location, removing children from the cooking area). Sixteen qualitative in-depth interviews were undertaken with women living in an underprivileged neighbourhood in Kigali, Rwanda. Deductive thematic analysis was carried out using the Behaviour Change Wheel (Capability—ability to engage with chosen activity, Opportunity—factors which are beyond the individual’s control and Motivation—brain processes which direct behaviour: COM-B) to determine the thoughts and perceptions around cooking location and removing children from the cooking area. Facilitators and barriers were subsequently identified within the COM-B framework for the following HAP mitigation interventions: outdoor cooking, removing children from the cooking area and Liquid Petroleum Gas (LPG) use. Of the 16 interviewed, 12 cooked outdoors (75%), two (12.5%) cooked indoors (in the main home) and two (12.5%) in a separate kitchen. Despite the majority cooking outdoors, this was reported not to be a favourable cooking location. Levels of awareness of HAP sources and knowledge of the health effects of air pollution were observed to be limited, reducing women’s capability to change, along with stated barriers of cost, housing constraints and safety. Factors out of the individuals’ control (opportunities) included weather, socio-economic and educational factors. Preconceived beliefs, experiencing smoke reduction and the briefly described short-term health effects, directed motivation. Furthermore, participants identified a need for community-based education as a facilitator to changing their behaviour. Despite a high level of observed motivation towards reducing HAP exposure, many women lacked the capability and opportunity to change their behaviour. There are research and policy implications concerning development of community-based interventions which involved end-users and relevant stakeholders in the development process.