Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys (original) (raw)
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BackgroundSolid fuel use was found to be associated with under-five mortality in low- and lower-middle income countries (LMICs). However, the current understanding of this association for Bangladesh is absent through around 80% of the total households in Bangladesh used solid fuel and the higher under-five mortality rate is a significant public health burden. We explored the associations of household cooking fuels used and the level of exposure to HAP through cooking fuels used with neonatal, infant, and under-five child mortality in Bangladesh.MethodsWe analysed 4,198 mother-child dyads data extracted from the 2017/18 Bangladesh Demographic and Health Survey data. Type of cooking fuels used (solid fuel, clean fuel) and level of exposure to HAP through cooking fuels used (unexposed, moderately exposed, highly exposed) were considered as exposure variables. Neonatal, infant and under-five mortality were considered as the outcome variables. Relationships between the exposure and outco...
Background One in ten deaths of children under five are attributable to indoor air pollution, and Acute Respiratory Illness (ARI) are a direct cause. Objective This study made it possible to characterize indoor air pollution in West African Economic and Monetary Union (WAEMU) area and to estimate its impact on occurrence of ARI in children under five. Methods This is a secondary analysis on dataset from WAEMU member states’ Demographic and Health Survey (DHS). Pollution is characterized by using a composite variable called “Household level of air pollution”, created from questions related to degradation factors of indoor air quality (domestic combustion processes) and impact measurement was carried out by logistic regression. Results Burkina Faso stands out with a greater number of households with a high level of pollution (63.7%) followed by Benin (43.7%) then Togo (43.0%). The main exposure factor "Household level of air pollution" was only associated with ARI in Togo (p...
BMC Public Health
Background One out of ten deaths of children under five are attributable to indoor air pollution. And Acute Respiratory Illness (ARI) is among the direct causes. Objective This study showed the possibilities of characterizing indoor air pollution in West African Economic and Monetary Union (WAEMU) area and it also made it possible to estimate its impact on the occurrence of ARI in children under five. Methods It has been a secondary analysis based on Demographic and Health Surveys (DHSs) from WAEMU countries’ data.. “Household level of air pollution” is the created composite variable, from questions on the degradation factors of indoor air quality (domestic combustion processes) which served to characterize indoor air pollution and to measure its impact by a logistic regression. Results Burkina Faso stands out with a greater number of households with a high level of pollution (63.7%) followed by Benin (43.7%) then Togo (43.0%). The main exposure factor "Household level of air p...
Journal of Exposure Science & Environmental Epidemiology
Background Clean cooking interventions to reduce air pollution exposure from burning biomass for daily cooking and heating needs have the potential to reduce a large burden of disease globally. Objective The objective of this study is to evaluate the air pollution exposure impacts of a fan-assisted efficient biomassburning cookstove and a liquefied petroleum gas (LPG) stove intervention in rural Ghana. Methods We randomized 1414 households in rural Ghana with pregnant mothers into a control arm (N = 526) or one of two clean cooking intervention arms: a fan-assisted efficient biomass-burning cookstove (N = 527) or an LPG stove and cylinder refills as needed (N = 361). We monitored personal maternal carbon monoxide (CO) at baseline and six times after intervention and fine particulate matter (PM 2.5) exposure twice after intervention. Children received three CO exposure monitoring sessions. Results We obtained 5655 48-h maternal CO exposure estimates and 1903 for children, as well as 1379 maternal PM 2.5 exposure estimates. Median baseline CO exposures in the control, improved biomass, and LPG arms were 1.17, 1.17, and 1.30 ppm, respectively. Based on a differences-indifferences approach, the LPG arm showed a 47% reduction (95% confidence interval: 34-57%) in mean 48-h CO exposure compared to the control arm. Mean maternal PM 2.5 exposure in the LPG arm was 32% lower than the control arm during the post-intervention period (52 ± 29 vs. 77 ± 44 μg/m 3). The biomass stove did not meaningfully reduce CO or PM 2.5 exposure. Conclusions We show that LPG interventions lowered air pollution exposure significantly compared to three-stone fires. However, post-intervention exposures still exceeded health-relevant targets. Significance In a large controlled trial of cleaner cooking interventions, an LPG stove and fuel intervention reduced air pollution exposure in a vulnerable population in a low-resource setting.
Global health research and policy, 2018
Solid fuel use is the major source of household air pollution (HAP) and accounts for a substantial burden of morbidity and mortality in low and middle income countries. To evaluate and compare childhood mortality attributable to HAP in four South Asian countries. A series of Demographic and Health Survey (DHS) datasets for Bangladesh, India, Nepal and Pakistan were used for analysis. Estimates of relative risk and exposure prevalence relating to use of cooking fuel and under-five mortality were used to calculate population attributable fractions (PAFs) for each country. Potential impact fractions (PIFs) were also calculated assessing theoretical scenarios based on published interventions aiming to reduce exposure prevalence. There are an increased risk of under-five mortality in those exposed to cooking fuel compared to those not exposed in the four South Asian countries (OR = 1.30, 95% CI = 1.07-1.57, = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1-81....
Background: Although currently adoption of modern life style has resulted in reduction of consumption of solid fuels, the dependable source of household energy in developing countries still remain unclean and its incomplete combustion continue to be the most common source of cooking smoke in Ethiopia. As a result, 50-90 % of households emitted cooking smoke which intern leads to various public health concerns. The objective of this study was to describe the household level cooking smoke exposure practices in Ethiopia. Methods: A cross-sectional study was conducted January 18 to June 27, 2016. From 16,650 households recorded in the 2016 Ethiopian demographic and health survey dataset, households (n=10,904 (weighted)) were included in the study. Proportions were computed and presented in tables and bar graph. Bi-variable analysis was performed using x 2 test to assess the existence of association and multivariable binary logistic regression also computed to identify the independent determinants of cooking smoke exposure status. A p-value of less than 0.05 was considered as a statistical significance cut off value. Results: The study revealed that 6,695(61.4%, 95%CI: 59.6-63.2) of households had cooking smoke exposure. The majority of cooking smoke exposure by households was attributable to the uneducated status of household head and rural residence (61.6% and 63.7%respectively). Sex (AOR =0.74, 95% CI: 0.64-0.85), age group of house hold head (
International Journal of Environmental Health Research
Relationship between cooking fuel and under-five mortality has not been adequately established in Sub-Saharan Africa (SSA). We therefore investigated the association between cooking fuel and risk of under-five mortality in SSA, and further investigated its interaction with smoking. Using the most recent Demographic Health Survey data of 23 SSA countries (n = 783,691), Cox proportional hazard was employed to determine the association between cooking fuel and risk of under-five deaths. The adjusted hazard ratios were 1.21 (95 % CI, 1.10-1.34) and 1.20 (95 % CI, 1.08-1.32) for charcoal and biomass cooking fuel, respectively, compared to clean fuels. There was no positive interaction between biomass cooking fuel and smoking. Use of charcoal and biomass were associated with the risk of under-five mortality in SSA. Disseminating public health information on health risks of cooking fuel and development of relevant public health policies are likely to have a positive impact on a child's survival. Evidence before this study Globally, over 4 million deaths occur yearly due to indoor air pollution resulting from cooking fuel. Studies indicate that the under-five children are the most vulnerable group to pollutant cooking fuels with negative health outcome. Moreover, Sub-Saharan Africa (SSA) is the most affected region because 4 out of 5 of its population use solid biomass for cooking, and this may not decrease any time soon in the Sustainable Development Goals (SDGs) era where reduction of deaths as result of hazardous chemicals in the air, water, and soil is a key target. However, most studies have been country-specific and the effects of cooking fuel have majorly focused on ill-health, and not the fatal consequences. This study seeks to fill this gap in a much wider scale in SSA.
Household Air Pollution and Under-Five Mortality in Bangladesh (2004–2011)
International Journal of Environmental Research and Public Health, 2015
Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among children under five years in Bangladesh. This study investigates the association between HAP from cooking fuel and under-five mortality using Bangladesh Demographic and Health Survey (BDHS) datasets over the period 2004-2011 (n = 18,308 children), and the extent to which this association differed by environmental and behavioral factors affecting level of exposure. The association between HAP and neonatal (age between 0-28 days), infant (age between 0 and 11 months) and under-five (age between 0 and 59 months) mortality was examined using multilevel logistic regression models. HAP was not strongly associated with overall neonatal (OR = 1.49, 95% CI = 1.01-2.22, p = 0.043), infant (OR = 1.27, 95% CI = 0.91-1.77, p = 0.157) or under-five mortality (OR = 1.14, 95% CI = 0.83-1.55, p = 0.422) in the context of overall decreasing trends in under-five mortality. The association was stronger for households with an indoor kitchen using polluting fuels, and in women who had never breastfed. Reductions in exposure to pollution from cooking fuel, given it is a ubiquitous and modifiable risk factor, can result in further declines in under-five mortality with household design and behavioural interventions.
Chest, 2020
BACKGROUND: Exposure to household air pollution is associated with an increased risk of pneumonia in children in low-and middle-income countries; however, exposure-response data are limited, and there are uncertainties around the extent to which biomass-fueled cookstoves can reduce these exposures. RESEARCH QUESTION: What is the association between exposure to household air pollution and pneumonia in children under the age of 5 years in rural Malawi and what are the effects of a biomass-fueled cookstove intervention on personal exposure to household air pollution? STUDY DESIGN AND METHODS: We measured personal exposure to carbon monoxide (CO; 48 hours of continuous measurement and transcutaneous carboxyhemoglobin) every 6 months in children who participated in a cluster-randomized controlled trial of a cleaner burning biomass-fueled cookstove intervention to prevent pneumonia in children under the age of 5 years in rural Malawi (the Cooking And Pneumonia Study). Exposure-response and multivariable analyses were done. RESULTS: We recruited 1805 (928 intervention; 877 control) children (mean age, 25.6 months; 50.6% female). We found no evidence of an association between exposure to CO (incident rate ratio, 1.0; 95% CI, 0.967 to 1.014; P ¼ .53) or carboxyhemoglobin (incident rate ratio, 1.00; 95% CI, 0.993 to 1.003; P ¼ .41) in children who experienced pneumonia vs those who did not. Median exposure to CO in the intervention and control groups was was 0.34 (interquartile range, 0.15 to 0.81) and 0.37 parts per million (interquartile range, 0.15 toa 0.97), respectively. The group difference in means was 0.46 (95% CI, À0.95 to 0.012; P ¼ .06). INTERPRETATION: Exposure to CO in our population was low with no association seen between exposure to CO and pneumonia incidence and no effect of the Cooking And Pneumonia Study intervention on these exposures. These findings suggest that CO may not be an appropriate measure of household air pollution exposure in settings such as rural Malawi and that there is a need to develop ways to measure particulate matter exposures directly in young children instead. CLINICAL TRIAL REGISTRATION: ISRCTN59448623.