Health effects associated with emissions from household generators used for backup power in Africa: a scoping review

Abstract

In many low- and middle-income countries, unreliable electricity supply has led to widespread reliance on petrol (gasoline) and diesel generators. The type of fuel influences both the quantity and composition of emissions, which contribute substantially to air pollution and pose significant health risks. Emissions from household generators, similar to diesel exhaust, contain volatile organic compounds and particulate matter linked to adverse outcomes, including cancer. This review synthesizes evidence on health impacts associated with domestic generator emissions in Africa and proposes mitigation recommendations. We searched PubMed and Google Scholar for English-language studies using combinations of terms related to backup generators, emissions, air pollution, human health, and households. Studies were included if they explicitly examined household generator use as the exposure of interest in relation to health outcomes. Nine articles met the inclusion criteria. Generator emissions were found to contain harmful pollutants such as nitrogen oxides (NO x ), sulphur dioxide (SO₂), and fine particulate matter (PM₂. 5 and PM₁₀), all associated with well-established health risks. Exposure was linked to respiratory and cardiovascular diseases and increased mortality. However, epidemiological evidence was limited, with only 2% of screened studies addressing health outcomes directly. Overall, the included studies indicated high levels of pollution associated with generator use and suggest potential public health impacts, though measurement of exposures and outcomes remains insufficiently developed. Evidence on the health effects of generator emissions in Africa is limited and methodologically inconsistent. While some studies indicate associations with respiratory symptoms, carbon monoxide poisoning, and possible long-term risks such as cancer and hypertension, these findings largely rely on indirect evidence, self-reports, or modelling approaches rather than robust epidemiological data. No studies established a direct causal relationship between generator-related air pollution and health outcomes. Strengthening the evidence base through well-designed epidemiological studies is essential to better understand and quantify the health burden associated with household generator use.