Experts Blame Firewood for Increase in Lung Cancer among Ugandan Women

Doctors at the Uganda Cancer Institute (UCI) are reporting a disturbing trend –  an increasing number of Ugandan women are developing lung cancer despite having no history of cigarette smoking, long regarded as the disease’s leading risk factor.

Dr Najib Bogere, a medical oncologist at UCI, says their team recently followed a group of women diagnosed with lung cancer and discovered lung damage strikingly similar to that found in long-term smokers. On closer review, most of the patients had been exposed to firewood smoke from early childhood, some as young as eight years old.

In many Ugandan households, especially in rural areas, cooking is done over open fires using wood or crop residue. Without adequate ventilation, soot and ash release microscopic particles that remain suspended in indoor air for hours and penetrate deep into the lungs, where they can trigger inflammation, chronic respiratory disease, and cancer.

Dr Bogere emphasised that even when firewood smoke is not visibly thick, the fine particles can cause long-term damage, and that by the time symptoms like persistent cough and breathlessness appear, the disease may already be advanced.

He added that while ash and smoke from firewood are bad on their own, for many women, the situation is worsened by the fact that their kitchens are not well ventilated, exposing them to soot. 

The UCI findings mirror a recent study by the Makerere University Lung Institute, where researchers screened women across several districts between 2021 and 2025. Dr Irene Najjingo, who led the study, said more than 60 per cent of the women screened tested positive for lung cancer, yet very few reported ever smoking.

Of the 311 confirmed cases, most cooked daily with shrubs and firewood. She adds that women who cooked outdoors had a noticeably lower risk, but those confined to indoor kitchens, especially without chimneys or windows, were far more vulnerable.   

Indoor air pollution from cooking with solid fuels is a well-documented killer. The World Health Organisation estimates that around seven million people die prematurely each year from air pollution, with household smoke a major contributor.

Across East Africa, air pollution causes an estimated 300,000 deaths annually, making it the second-largest health risk factor after malnutrition. Women and children are disproportionately affected because they spend more time near cooking fires.

Dr Najjingo recommends a multi-pronged response that includes transitioning to cleaner cooking fuels such as liquefied petroleum gas (LPG), biogas, or electricity wherever possible. For households that must continue using wood or charcoal, they advise building well-ventilated kitchens or cooking outdoors to disperse smoke and reduce inhalation of harmful particles.

In addition, Dr Patricia Alupo, a respiratory physician, urges clinicians to incorporate air-quality assessments into patient histories so that exposure risks are identified early and appropriate guidance on safer cooking practices can be provided.

“Just like we prescribe medication, we must also prescribe clean air, educating families about the risks of smoke exposure and advocating for safer cooking practices,” she said.

Government initiatives such as subsidies for cleaner stoves and community education campaigns could further reduce exposure, while local innovators are developing affordable, efficient cook-stoves that use less wood and emit less smoke.