Household Air Pollution and Under-Five Mortality in Bangladesh (2004–2011) (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...
Environmental Health: A Global Access Science Source, 2017
BACKGROUND:Household air pollution (HAP) from cooking with solid fuels has become a leading cause of death and disability in many developing countries including Bangladesh. We assess the association between HAP and risk of selected adverse birth and maternal health outcomes. METHODS:Data for this study were extracted from Bangladesh Demographic and Health Survey conducted during 2007-2014. Selected adverse birth outcomes were acute respiratory infection (ARI) among children, stillbirth, low birth weight (LBW), under-five mortality, neonatal mortality and infant mortality. Maternal pregnancy complications and cesarean delivery were considered as the adverse maternal health outcomes. Place of cooking, use of solid fuel within the house boundary and in living room were the exposure variables. To examine the association between exposure and outcome variables, we used a series of multiple logistic regression models accounted for complex survey design. RESULTS:Around 90% of the respondents used solid fuel within the house boundary, 11% of them used solid fuel within the living room. Results of multiple regression indicated that cooking inside the house increased the risk of neonatal mortality (aOR,1.25; 95% CI, 1.02-1.52), infant mortality (aOR, 1.18; 95% CI, 1.00-1.40), ARI (aOR, 1.18; 95% CI, 1.08-1.33), LBW (aOR, 1.25; 95% CI, 1.10-1.43), and cesarean delivery (aOR,1.18; 95% CI, 1.01-1.29). Use of solid fuel, irrespective of cooking places, increased the risk of pregnancy complications (aOR, 1.36; 95% CI, 1.19-1.55). Compared to participants who reported cooking outside the house, the risk of ARI, LBW were significantly high among those who performed cooking within the house, irrespective of type of cooking fuel. CONCLUSION:Indoor cooking and use of solid fuel in household increase the risk of ARI, LBW, cesarean delivery, and pregnancy complication. These relationships need further investigation using more direct measures of smoke exposure and clinical measures of health outcomes. The use of clean fuels and structural improvement in household design such as provision of stove ventilation should be encouraged to reduce such adverse health consequences.
World Development, 2020
Reduction in health risks from household air pollution (HAP) and ambient air pollution (AAP) is critical for achieving sustainable development globally, especially in low-income countries. Children are at particularly high risk because their respiratory and immune systems are not fully developed. Previous studies have identified the adverse impacts of air pollution on child health. However, most studies do not focus on HAP and AAP simultaneously nor address differences in the timings and magnitudes of prenatal and postnatal exposures across genders. Therefore, this study examines how prenatal and postnatal exposures to ambient particulate matter with aerodynamic diameter of 2.5 lm or less (PM 2.5) along with household use of solid fuels (a main cause of HAP) are correlated with child health in Bangladesh. We combine individual-level data from nationally representative surveys with satellite-based highresolution data on ambient PM 2.5. We find that (1) the use of solid fuels is associated with respiratory illness among girls but not boys, (2) prenatal exposure to ambient PM 2.5 is associated with stunting in boys but not girls, and (3) postnatal exposure is associated with stunting in both genders. These results provide new evidence for heterogeneous influences of AAP and HAP on child health across gender and timing of exposure. The main policy implications are that interventions against HAP would be more effective by targeting girls, and interventions against AAP should also target pregnant women. In sum, our findings highlight the importance of protecting women from air pollution and achieving Target 3.9 of the Sustainable Development Goals.
Maternal and child health journal, 2017
Objectives Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among young children in low and lower-middle income countries. This study examines for the first time trends in the association between HAP from cooking fuel and under-five mortality and measures the potential impact of interventions to reduce HAP using Nepal Demographic and Health Survey datasets (2001-2011). Methods A total of 17,780 living children across four age-groups (neonatal 0-28 days, post-neonatal 1-11 months, child 12-59 months and under-five 0-59 months) were included and multi-level logistic regression models were used for analyses. Population attributable fractions of key risk factors and potential impact fractions assessing the impact of previous interventions to reduce exposure prevalence were also calculated. Results Use of cooking fuel was associated with total under-five mortality (OR 2.19, 95% CI 1.37-3.51, P = 0.001) in Nepal, with stronger associations evide...
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....
Household air pollution and under-five mortality in India (1992–2006)
Environmental Health, 2016
Background: Household air pollution (HAP)-predominantly from cooking fuel is a major public health hazard and one of the leading causes of respiratory illness and deaths among children under-five years in India. This study investigates the association between HAP from cooking fuel and under-five mortality using India's National Family and Health Survey (NFHS) datasets over the period 1992-2006 (total of 166,382 children), and the extent to which the association differed by environmental and behavioral factors affecting level of exposure. Methods: The association between HAP and under-five mortality of three age-groups (neonatal age between 0-28 days, post-neonatal age between 1-11 months and children aged between 12-59 months) was examined using multi-level logistic regression models. Results: HAP was associated with mortality among children aged under-five (OR = 1.30, 95%CI = 1.18-1.43, P < 0.001) and was more strongly associated in subgroup analyses of post-neonatal mortality (OR = 1.42, 95%CI = 1.19-1.71, P < 0.001) and child mortality (OR = 1.42, 95%CI = 1.05-1.91, P = 0.021) than neonatal mortality (OR = 1.23, 95%CI = 1.09-1.39, P = 0.001). The association was stronger for households in rural areas and for households without a separate kitchen using polluting fuel, and in women who had never breastfed for all age-groups. Conclusion: Use of cooking fuel in the household is associated with increased risk of mortality in children aged under-five years. Factors relating to access to clean fuels, improvements in infrastructure and household design and behavioral factors are discussed, and can result in further declines in under-five mortality in India.
PloS one, 2017
Household air pollution (HAP) mainly from cooking fuel is one of the major causes of respiratory illness and deaths among young children in low and middle-income countries like Pakistan. This study investigates for the first time the association between HAP from cooking fuel and under-five mortality using the 2013 Pakistan Demographic and Health Survey (PDHS) data. Multi-level logistic regression models were used to examine the association between HAP and under-five mortality in a total of 11,507 living children across four age-groups (neonatal aged 0-28 days, post-neonatal aged 1-11 months, child aged 12-59 months and under-five aged 0-59 months). Use of cooking fuel was weakly associated with total under-five mortality (OR = 1.22, 95%CI = 0.92-1.64, P = 0.170), with stronger associations evident for sub-group analyses of children aged 12-59 months (OR = 1.98, 95%CI = 0.75-5.25, P = 0.169). Strong associations between use of cooking fuel and mortality were evident (ORs >5) in th...
Who suffers from indoor air pollution? Evidence from Bangladesh
Health Policy and Planning, 2006
In this paper, we investigate individuals' exposure to indoor air pollution. Using new survey data from Bangladesh, average hours spent by members of households in the cooking area, living area and outdoors in a typical day are combined with the estimates of pollution concentration in different locations in order to estimate exposure. We analyse exposure at two levels: differences within households attributable to family roles, and differences across households attributable to income and education. Within households, we relate individuals' exposure to pollution in different locations during their daily round of activities. We find high levels of exposure for children and adolescents of both sexes, with particularly serious exposure for children under 5 years. Among prime-age adults, we find that men have half the exposure of women (whose exposure is similar to that of children and adolescents). We also find that elderly men have significantly lower exposure than elderly women. Across households, we draw on results from a previous paper, which relate pollution variation across households to choices of cooking fuel, cooking locations, construction materials and ventilation practices. We find that these choices are significantly affected by family income and adult education levels (particularly for women). Overall, we find that the poorest, least-educated households have twice the pollution levels of relatively high-income households with highly educated adults. Our findings further suggest that young children and poorly educated women in poor households face pollution exposures that are four times those for men in higher income households organized by more highly educated women. Since infants and young children suffer the worst mortality and morbidity from indoor air pollution, in this paper we consider measures for reducing their exposure. Our recommendations for reducing the exposure of infants and young children are based on a few simple, robust findings. Hourly pollution levels in cooking and living areas are quite similar because cooking smoke diffuses rapidly and nearly completely into living areas. However, outdoor pollution is far lower. At present, young children are only outside for an average of 3 hours per day. For children in a typical household, pollution exposure can be halved by adopting two simple measures: increasing their outdoor time from 3 to 5 or 6 hours per day, and concentrating outdoor time during peak cooking periods.
Association of Low Birthweight and Indoor Air Pollution: Biomass Fuel Use in Bangladesh
Background. More than 90% of all low birthweight (LBW) babies are born in developing countries, and half of the population in developing nations uses solid fuels as their primary source of energy for cooking. An association between household use of solid biomass fuels and reduced newborn weight has been found in a number of countries. Bangladesh has a high prevalence of LBW babies (22%), and 88% of the population use solid fuels for cooking. Objectives. This study aims to explore whether indoor air pollution is associated with LBW in Bangladesh, an important determinant of infant mortality and morbidity. Methods. The 2011 Bangladesh Demographic and Health Survey (BDHS) was used for the present analysis. The total number of births reported in the previous five years by respondents in the survey sample was 8,753. Mothers' recall of their baby's weight was the dependent dichotomous variable. A mixed effects logistic regression model was fitted using region as a random effect and several independent fixed effects. Results. High pollutant cooking fuels, such as coal and wood, resulted in higher odds of having a LBW child compared to use of electricity/gas (odds ratio (OR): 2.6, confidence interval (CI): 1.1–6.2 and OR: 1.1, CI: 1.0–1.2). Factors which lowered the odds include mothers with a bachelor's degree or higher education (OR: 0.6, CI: 0.4–0.9), third order children (OR: 0.8, CI: 0.6–0.9), fourth or higher order children (OR: 0.8, CI: 0.6–1.0), having a male child (OR: 0.7, CI: 0.7–0.8), and receiving sufficient antenatal care (OR: 0.8, CI: 0.6–0.9). Factors which increase the odds of having a LBW infant include mothers who are underweight compared to normal weight mothers (OR: 1.1, CI: 1.1–1.2), mistimed pregnancies (OR: 1.2, CI: 1.0–1.4), or unplanned pregnancies (OR: 1.3, CI: 1.0–1.7), compared to planned pregnancies. Conclusions. This is the first paper to show an association between use of highly pollutant biomass fuel and prevalence of LBW babies in Bangladesh, suggesting that besides polluting the air and causing respiratory illnesses, biomass fuel combustion may also affect the health of fetuses in utero. Further longitudinal studies are required to establish this finding among mothers in developing countries.
Environmental Health and Preventive Medicine
Background Little is known regarding the effect of exposure to biomass fuel smoke inhalation on respiratory symptoms in the Bangladeshi population which is a major health hazard in most of the developing countries. This study aims to explore the association between respiratory symptoms and biomass fuel smoke exposure among children under 5 years of age. Methods Data were extracted from the Bangladesh Urban Health Survey conducted in 2013. A total of 10,575 mothers with at least one surviving children were selected. Respiratory symptoms among children under 5 years of age were considered as the primary outcome. Sequential multiple logistic regression models were used to observe the association between respiratory symptoms and biomass fuel smoke exposure adjusting the effect of residential factors and mother and child characteristics. Results Around 40% of the mothers exclusively used biomass fuel irrespective of the kitchen location and 54% of them were habituated in indoor cooking. ...