POKUASE, Accra- Every evening, as the sun began to fade over her neighborhood, Grace Antwi would prepare dinner on her narrow porch. The charcoal stove sat low to the ground, thin grey smoke curling into the air. For years, this was how cooking was done — her seven-year-old daughter nearby, peeling onions, stirring soup, or just watching quietly.

But then her daughter started falling sick more often. Antwi assumed they were common childhood illnesses that would pass. But when a cough got worse and the child struggled to breathe she took her to hospital.

Doctors diagnosed her daughter with a lower respiratory tract infection, but one question caught Antwi off guard. “What fuel did she cook with?” doctors asked. When Antwi told them it was charcoal, they immediately raised concerns.

“I didn’t think anything was wrong. That’s how we have always cooked,” says Antwi, the 41-year-old who trades from a small provisions shop in front of her house. For the first time Antwi learned of the danger that she had unknowingly put herself and her daughter in.

“He told me the smoke is dangerous for children,” Antwi says. “He said my daughter is still growing, so breathing that smoke can affect her health.”

As many as 30 percent of Ghana’s 8.3 milion households rely on charcoal for cooking, while roughly half of households still depend on firewood according to the Ghana Statistical Service. Health researchers say that indoor aid pollution is quietly contributing to a major public health crisis for all Ghanaians. More than 32,000 deaths in Ghana were linked to air pollution in 2023, according to the State of Global Air report, with many more people sickened.

Children, with smaller organs, remain among the most vulnerable. For Antwi, the warning from the doctor forced her to rethink something she had never questioned.

Today, the charcoal stove that once filled the porch with smoke has been replaced with a smaller gas stove. It uses liquefied petroleum gas know as LPG, that is released from a cylinder and ignited to produce a steady blude flame. Because the gas burns more completely, it does not give off smoke or soot that charcoal produces.

Antwi now tries to keep her daughter away from the cooking area and makes sure the space is more open when preparing meals. The experience has also changed the conversations she has with neighbours.

“When people come to buy things from my shop, sometimes we talk about it,” she says. “I tell them what happened to my daughter. I tell them the smoke is not good for children.”

Doctors and public health officials say these kinds of small conversations could play a powerful role in preventing illness before it starts. Health experts say simple advice given during routine consultations such as asking how families cook or where children spend most of their time can help identify hidden risk factors that might otherwise go unnoticed.

For women like Antwi, the use of traditional fuels is still widespread. For a very long time it has been their go to method for cooking. Globally, household air pollution remains one of the most significant environmental health risks. The World Health Organization estimates that smoke from cooking with polluting fuels contributes to more than three million premature deaths each year worldwide, with women and young children facing the highest exposure because they spend more time near cooking areas.

“When you burn wood or charcoal, you are not just producing heat. You are also producing pollutants that affect human health,” says Professor Reginald Quansah, an environmental epidemiologist.

Extremely small pollutants penetrate deep into the lungs and even enter the bloodstream. Once inside the body, they can trigger inflammation, worsen respiratory infections and increase the risk of long-term health problems including diabetes, stroke, cardiovascular disease and cancer.

Cooking with traditional fuels can also release carbon monoxide, a colourless and odorless gas that interferes with the body’s ability to carry oxygen in the blood. According to Professor Quansah, burning just one kilogram of wood during cooking can produce carbon monoxide levels many times higher than international health guidelines recommend. The smoke also contains chemicals similar to those found in cigarette smoke.

“If you compare cigarette smoke with smoke from traditional cooking fuels, they share many of the same harmful components,” he says. “So the health risks are very serious.”

Some medical practitioners are taking it upon themselves to inform people like Antwi.  Dr Richard Bright Danyoh, a pediatrician who has been raising awareness about household air pollution among medical professionals and families, says the connection between cooking smoke and childhood illness is often overlooked.

During his medical training, Dr Danyoh says he began noticing how frequently children admitted to hospitals with respiratory illnesses were coming from environments where cooking smoke was common.

“So I asked myself what I could do publicly to help reduce household air pollution,” he says.

Rather than waiting for national policies alone to tackle the issue, Dr Danyoh began encouraging fellow doctors to pay closer attention to environmental factors when diagnosing illnesses. That includes asking parents simple but important questions about cooking practices and children’s exposure to smoke inside the home.

For him, those conversations represent an important shift in how healthcare professionals approach disease prevention. Instead of focusing only on treatment, he says hospitals can also become centres for education and prevention.

But that sort of effort is not widespread in the Ghana Health Service. Despite growing scientific evidence about the dangers of polluted air, public health experts say the issue often receives limited attention for one important reason:

“The air pollution conversation is still at an infancy stage because its effects are not instant,” says Enoch Akyeampong, a public health specialist and lecturer.

Unlike diseases such as malaria or infections that show clear symptoms shortly after exposure, the health consequences of polluted air can develop gradually over many years. As a result, deaths linked to air pollution are often attributed to other causes, making the problem less visible.

“Most parents are not told that their child died from inhaling poor air from the home or workplace,” he says.

That lack of awareness makes behaviour change difficult. For many families, charcoal and firewood remain the most affordable and accessible cooking fuels. Switching to cleaner alternatives such as gas or electricity can be expensive.

The economic reality, Akyeampong says, creates a powerful barrier to change. But awareness, he adds, is still an essential first step. Doctors, researchers and community leaders all have roles to play in helping families understand how environmental exposures affect health.

For mother, Grace Antwi, that awareness came through her daughter’s illness. Now, when she prepares dinner each evening, the air around the cooking area looks different. The heavy smoke that once drifted across the porch has largely disappeared. Her daughter no longer spends long periods sitting beside the stove.

Antwi says the child’s health has improved, and she has no plans to return to the old way of cooking. Sometimes, when neighbours stop by her shop to buy tomatoes, rice or cooking oil, she shares the lesson she learned.

“I tell them what the doctor told me, If we know something is not good for our children, we should try to change it,” she says.

For doctors and researchers trying to reduce the health risks of air pollution, those small changes inside individual homes could be one of the most powerful tools for protecting children’s health.

This story is a collaboration with New Narratives. Funding came from the Clean Air Fund which had no say in the story’s content.

For more news, join The Chronicle Newspaper channel on WhatsApp: https://whatsapp.com/channel/0029VbBSs55E50UqNPvSOm2z