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Rafiq L, Zahra Naqvi SH, Shahzad L, Ali SM. Exploring the links between indoor air pollutants and health outcomes in South Asian countries: a systematic review. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:741-752. [PMID: 36302378 DOI: 10.1515/reveh-2022-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Indoor air pollution (IAP) has adverse effects on the health of people, globally. The objective of this systematic review was to present the range of health problems studied in association with indoor air pollutants in South Asian countries. We searched five databases, including PubMed, Web of Science, Scopus, Google Scholar, and CAB Direct for articles published between the years 2000 and 2020. We retrieved 5,810 articles, out of which we included 90 articles in our review. Among South Asian countries, only five countries have published results related to relationship between indoor air pollutants and adverse health conditions. All studies have shown adversity of indoor air pollutants on human's health. We found indoor solid fuel burning as a key source of indoor air pollution in the included studies, while women and children were most affected by their exposure to solid fuel burning. More than half of the studies accounted particulate matter responsible for indoor air pollution bearing negative health effects. In the included studies, eyes and lungs were the most commonly affected body organs, exhibiting common symptoms like cough, breathing difficulty and wheezing. This might have developed into common conditions like respiratory tract infection, chronic obstructive pulmonary diseases and eye cataract. In addition to promote research in South Asian countries, future research should focus on novel digital ways of capturing effects of indoor air pollutants among vulnerable segments of the population. As a result of this new knowledge, public health agencies should develop and test interventions to reduce people's exposure levels and prevent them to develop adverse health outcomes.
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Affiliation(s)
- Laiba Rafiq
- Sustainable Development Study Centre, Faculty of Mathematical and Physical Sciences, Government College University, Lahore, Pakistan
| | - Syeda Hamayal Zahra Naqvi
- Sustainable Development Study Centre, Faculty of Mathematical and Physical Sciences, Government College University, Lahore, Pakistan
| | - Laila Shahzad
- Sustainable Development Study Centre, Faculty of Mathematical and Physical Sciences, Government College University, Lahore, Pakistan
| | - Syed Mustafa Ali
- Center of Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
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Azanaw J, Melaku MS. Spatial variation and factors associated of solid fuel use in Ethiopia a multilevel and spatial analysis based on EDHS 2016. Sci Rep 2023; 13:20279. [PMID: 37985673 PMCID: PMC10662317 DOI: 10.1038/s41598-023-46897-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
Cooking and heating using solid fuels, such as dung, wood, agricultural residues, grass, straw, charcoal, and coal, is a main source of household air pollution. This indoor combustion encompasses a diversity of health detrimental pollutants, especially for people from low-income countries like Ethiopia since solid fuels are accessible easily at a lesser cost. Limited studies done showing factors affecting in choosing fuel type and no study, which revealed spatial heterogeneity of solid fuel used based on such nationally representative data. Therefore, this study, aimed at investigating spatial variation and determinants of solid fuel use in Ethiopia. This study was done using the data from the Ethiopian Demographic and Health Survey 2016, a national representative sample (16,650) households were included. Spatial and Multi-level logistic regression analysis was done by considering the DHS data hierarchal nature. Variables in the final model with a p-value < 0.05 were reported as significant predictors of using solid fuel. All analyses were done using ArcGIS V.10.7.1 and STATA V.14 software. The finding of this study revealed that 90.8% (95% CI (87.9%, 91.2%)) of households depend on solid fuel for cooking. Based on the final model ;Male household head (AOR 1.38, 95% CI (1.12-1.71)), age of household head (AOR 1.61, 95% CI (1.20, 2.17)), and 1.49 (OR 1.49, 95% CI (1.12, 1.99)) respectively for the age classes of < 30, and 30-40, education attainment no education (OR 3.14, 95% CI (1.13, 8.71)) and primary education (AOR 2.16, 95% CI (2.78, 5.96), wealth index Poorest (AOR 11.05, 95% CI (5.68, 15.78)), Poorer (OR 5.19, 95% CI (5.43, 13.19)), Middle (OR 3.08, 95% CI (2.44, 8.73)), and Richer (OR 1.30, 95IC (1.07, 13.49)) compared to richest, and not accessibility of electricity (AOR 31.21, 95% CI (35.41, 42.67)), were individual-level factors significantly associated with using solid fuel. Community-level factors like households found at large city (AOR 2.80, 95CI (1.65, 4.77)), small city (AOR 2.58, 95% CI (1.55, 4.32)) town (AOR 4.02, 95% CI (2.46, 6.55)), and countryside (AOR 14.40, 95% CI (6.23, 21.15)) compared households found in capital city, community level media exposure (AOR 6.00, 95% CI (4.61, 7.82)) were statistically predictors in using solid fuel for cooking. This finding revealed that a large proportion of households in Ethiopia heavily depend on biomass, especially wood, for cooking. There was a greater disparity on solid fuel use for cooking in Ethiopia. Implementing major policy interventions should be introduced to reduce solid fuel use for cooking and inequalities in accessing clean fuel in Ethiopia.
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Affiliation(s)
- Jember Azanaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Mequannent Sharew Melaku
- Department of Health Informatics, Institute of Public Health, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
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Takabayashi S, Hirata T, Zhao W, Kimura T, Ukawa S, Tsushita K, Wakai K, Kawamura T, Ando M, Tamakoshi A. Association of dietary diversity with all‐cause mortality by body mass index in Japanese older adults: An age‐specific prospective cohort study (
NISSIN
project). Geriatr Gerontol Int 2022; 22:736-744. [DOI: 10.1111/ggi.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/17/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Saeka Takabayashi
- Department of Public Health Graduate School of Medicine, Hokkaido University Sapporo Japan
| | - Takumi Hirata
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
- Institute for Clinical and Translational Science, Nara Medical University Kashihara Japan
| | - Wenjing Zhao
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
- School of Public Health and Emergency Management Southern University of Science and Technology Shenzhen People's Republic of China
| | - Takashi Kimura
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
| | - Shigekazu Ukawa
- Department of Social Services and Clinical Psychology Graduate School of Human Life Science, Osaka City University Osaka Japan
| | - Kazuyo Tsushita
- Comprehensive Health Science Center, Aichi Health Promotion Public Interest Foundation Japan
| | - Kenji Wakai
- Department of Preventive Medicine Nagoya University, Graduate School of Medicine Nagoya Japan
| | | | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research Nagoya University Hospital Nagoya Japan
| | - Akiko Tamakoshi
- Department of Public Health Graduate School of Medicine, Hokkaido University Sapporo Japan
- Department of Public Health Hokkaido University Faculty of Medicine Sapporo Japan
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Risk Factors for Respiratory Syncytial Virus Lower Respiratory Tract Infections: Evidence from an Indonesian Cohort. Viruses 2021; 13:v13020331. [PMID: 33669911 PMCID: PMC7924644 DOI: 10.3390/v13020331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/07/2021] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Abstract
Although risk factors for hospitalization from a respiratory syncytial virus (RSV) are well known, RSV lower respiratory tract infections (LRIs) in the community are much less studied or understood, especially in developing countries. In a prospective, cohort study we studied factors predisposing Indonesian infants and children under 5 years of age to developing RSV LRIs. Subjects were enrolled in two cohorts: a birth cohort and a cross-sectional cohort of children <48 months of age. Subjects were visited weekly at home to identify any LRI, using the World Health Organization’s criteria. RSV etiology was determined through analysis of nasal washings by enzyme immunoassay and polymerase chain reaction. Risk factors for the development of the first documented RSV LRI were identified by multivariate analysis using logistic regression and Cox proportional hazard modeling. Of the 2014 children studied, 999 were enrolled within 30 days of birth. There were 149 first episodes of an RSV. Risk factors for an RSV LRI were poverty (p < 0.01), use of kerosene as a cooking fuel (p < 0.05), and household ownership of rabbits and chickens (p < 0.01). Our findings suggested that in a middle-income country such as Indonesia, with a substantial burden of RSV morbidity and mortality, lower socioeconomic status, environmental air quality, and animal exposure are predisposing factors for developing an RSV LRI.
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Arku RE, Brauer M, Duong M, Wei L, Hu B, Ah Tse L, Mony PK, Lakshmi PVM, Pillai RK, Mohan V, Yeates K, Kruger L, Rangarajan S, Koon T, Yusuf S, Hystad P. Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study. ENVIRONMENTAL RESEARCH 2020; 188:109851. [PMID: 32798956 PMCID: PMC7748391 DOI: 10.1016/j.envres.2020.109851] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - MyLinh Duong
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Li Wei
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rajamohanan K Pillai
- School of Health Policy, Kerala University of Health Sciences, Trivandrum, India
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lanthe Kruger
- North-West University, Africa Unit for Transdisciplinary Health Research (AUTHeR), South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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Household air pollution in India and respiratory diseases: current status and future directions. Curr Opin Pulm Med 2020; 26:128-134. [PMID: 31724964 DOI: 10.1097/mcp.0000000000000642] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Combustion of solid cooking fuels employed by more than 3 billion people globally, contributes to approximately one third of ambient air pollution. In the recent past, the issue has drawn global attention because of its threat to the health of rural communities, particularly women and children. This review is focused on the evidence from India on effects of household air pollution (HAP) on respiratory health and interventions to replace the solid fuels. RECENT FINDINGS HAP exposure is a major risk factor for increased respiratory symptoms, respiratory infections, and chronic obstructive pulmonary disease. In most studies, the odds ratio for the risk of development of respiratory disorders is more than one in HAP exposed individuals. HAP is also associated with increased risk of tuberculosis, asthma, mortality from cardio-respiratory illnesses, and nonrespiratory problems such as adverse pregnancy outcomes, prematurity, and low birth weight. SUMMARY Household air pollution is a common but preventable risk factor for respiratory diseases. Replacement of solid cooking fuels with clean fuels such as LPG gas as exemplified by the 'Ujjwala' program of India is likely to be most effective intervention to reduce the HAP related disease burden.
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Carlsten C, Salvi S, Wong GWK, Chung KF. Personal strategies to minimise effects of air pollution on respiratory health: advice for providers, patients and the public. Eur Respir J 2020; 55:1902056. [PMID: 32241830 PMCID: PMC7270362 DOI: 10.1183/13993003.02056-2019] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/24/2020] [Indexed: 11/11/2022]
Abstract
As global awareness of air pollution rises, so does the imperative to provide evidence-based recommendations for strategies to mitigate its impact. While public policy has a central role in reducing air pollution, exposure can also be reduced by personal choices. Qualified evidence supports limiting physical exertion outdoors on high air pollution days and near air pollution sources, reducing near-roadway exposure while commuting, utilising air quality alert systems to plan activities, and wearing facemasks in prescribed circumstances. Other strategies include avoiding cooking with solid fuels, ventilating and isolating cooking areas, and using portable air cleaners fitted with high-efficiency particulate air filters. We detail recommendations to assist providers and public health officials when advising patients and the public regarding personal-level strategies to mitigate risk imposed by air pollution, while recognising that well-designed prospective studies are urgently needed to better establish and validate interventions that benefit respiratory health in this context.
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Affiliation(s)
- Christopher Carlsten
- Air Pollution Exposure Laboratory, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Gary W K Wong
- Dept of Pediatrics and School of Public Health, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kian Fan Chung
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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James BS, Shetty RS, Kamath A, Shetty A. Household cooking fuel use and its health effects among rural women in southern India-A cross-sectional study. PLoS One 2020; 15:e0231757. [PMID: 32339177 PMCID: PMC7185712 DOI: 10.1371/journal.pone.0231757] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 04/01/2020] [Indexed: 11/18/2022] Open
Abstract
The use of biomass fuel is associated with the deterioration of human health and women are more likely to develop health conditions due to their exposure to indoor air pollution during cooking. This study was conducted to assess the pattern of fuel used for cooking in households as well as to determine the association between the types of fuel used with respect to socio-demographic characteristics and health status of women. A community based cross-sectional survey was conducted between August 2016 and September 2018 in four rural areas and one semi-urban area of Udupi district, Karnataka, India. The study comprised 587 families including 632 women. A pre-tested semi-structured questionnaire was used to collect data on the type of fuel as well as self-reported health conditions. Overall, 72.5% of the families used biomass, where 67.2% families were currently using both biomass and liquefied petroleum gas while only biomass was used in 5.3% of the families for cooking. Among women, being ever exposed to biomass fuel was significantly associated with their age, literacy level, occupation and socio-economic status (p < 0.001). Those who were exposed to biomass fuel showed a significant association with self-reported ophthalmic (AOR = 3.85; 95% CI: 1.79–8.29), respiratory (OR = 5.04; 95% CI: 2.52–10.07), cardiovascular (OR = 6.07; 95% CI: 1.88–19.67), dermatological symptoms /conditions (AOR = 3.67; 95% CI: 1.07–12.55) and history of adverse obstetric outcomes (AOR = 2.45; 95% CI: 1.08–5.57). A positive trend was observed between cumulative exposure to biomass in hour-years and various self-reported health symptoms/conditions (p < 0.001). It was observed that more than two-thirds of women using biomass fuel for cooking were positively associated with self-reported health symptoms. Further longitudinal studies are essential to determine the level of harmful air pollutants in household environment and its association with various health conditions among women in this region.
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Affiliation(s)
| | - Ranjitha S. Shetty
- Department of Community Medicine, Manipal Academy of Higher Education, Kasturba Medical College Manipal, Manipal, Karnataka, India
- * E-mail:
| | - Asha Kamath
- Department of Data Science, Manipal Academy of Higher Education, Prasanna School of Public Health, Manipal, Karnataka, India
| | - Avinash Shetty
- Department of Community Medicine, Manipal Academy of Higher Education, Kasturba Medical College Manipal, Manipal, Karnataka, India
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Ozoh OB, Okwor TJ, Adetona O, Akinkugbe AO, Amadi CE, Esezobor C, Adeyeye OO, Ojo O, Nwude VN, Mortimer K. Cooking Fuels in Lagos, Nigeria: Factors Associated with Household Choice of Kerosene or Liquefied Petroleum Gas (LPG). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040641. [PMID: 29614713 PMCID: PMC5923683 DOI: 10.3390/ijerph15040641] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/26/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
Abstract
Cooking with dirty-burning fuels is associated with health risk from household air pollution. We assessed the prevalence of and factors associated with the use of cooking fuels, and attitudes and barriers towards use of liquefied petroleum gas (LPG). This was a cross-sectional, population-based survey conducted in 519 households in Lagos, Nigeria. We used a structured questionnaire to obtain information regarding choice of household cooking fuel and the attitudes towards the use of LPG. Kerosene was the most frequently used cooking fuel (n = 475, 91.5%; primary use n = 364, 70.1%) followed by charcoal (n = 159, 30.6%; primary use n = 88, 17%) and LPG (n = 86, 16.6%; primary use n = 63, 12.1%). Higher level of education, higher income and younger age were associated with LPG vs. kerosene use. Fuel expenditure on LPG was significantly lower than for kerosene ( N (Naira) 2169.0 ± 1507.0 vs. N 2581.6 ± 1407.5). Over 90% of non-LPG users were willing to switch to LPG but cited safety issues and high cost as potential barriers to switching. Our findings suggest that misinformation and beliefs regarding benefits, safety and cost of LPG are important barriers to LPG use. An educational intervention program could be a cost-effective approach to improve LPG adoption and should be formally addressed through a well-designed community-based intervention study.
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Affiliation(s)
- Obianuju B Ozoh
- College of Medicine, University of Lagos, Idi-Araba, Lagos 100254, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Tochi J Okwor
- University of Nigeria Teaching Hospital Ituku Ozalla, Enugu 400114, Nigeria.
| | - Olorunfemi Adetona
- College of Public Health, Ohio State University, Columbus, OH 43210, USA.
| | - Ayesha O Akinkugbe
- College of Medicine, University of Lagos, Idi-Araba, Lagos 100254, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Casmir E Amadi
- College of Medicine, University of Lagos, Idi-Araba, Lagos 100254, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Christopher Esezobor
- College of Medicine, University of Lagos, Idi-Araba, Lagos 100254, Nigeria.
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Olufunke O Adeyeye
- College of Medicine, Lagos State University, Ikeja, Lagos 100271, Nigeria.
| | - Oluwafemi Ojo
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Vivian N Nwude
- Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria.
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
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Bates MN, Pokhrel AK, Chandyo RK, Valentiner-Branth P, Mathisen M, Basnet S, Strand TA, Burnett RT, Smith KR. Kitchen PM 2.5 concentrations and child acute lower respiratory infection in Bhaktapur, Nepal: The importance of fuel type. ENVIRONMENTAL RESEARCH 2018; 161:546-553. [PMID: 29241064 DOI: 10.1016/j.envres.2017.11.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Globally, solid fuels are used by about 3 billion people for cooking and a smaller number use kerosene. These fuels have been associated with acute lower respiratory infection (ALRI) in children. Previous work in Bhaktapur, Nepal, showed comparable relationships of biomass and kerosene cooking fuels with ALRI in young children, compared to those using electricity for cooking. We examine the relationship of kitchen PM2.5 concentrations to ALRI in those households. METHODS ALRI cases and age-matched controls were enrolled from a cohort of children 2-35 months old. 24-h PM2.5 was measured once in each participant's kitchen. The main analysis was carried out with conditional logistic regression, with PM2.5 measures specified both continuously and as quartiles. RESULTS In the kitchens of 393 cases and 431 controls, quartiles of increasing PM2.5 concentration were associated with a monotonic increase in odds ratios (OR): 1.51 (95% CI: 1.00, 2.27), 2.22 (1.47, 3.34), 2.48 (1.63, 3.77), for the 3 highest exposure quartiles. The general kitchen concentration-response shape across all stoves was supralinear. There was evidence for increased risk with biomass stoves, but the slope for kerosene stoves was steeper, the highest quartile OR being 5.36 (1.35, 21.3). Evidence for increased risk was also found for gas stoves. CONCLUSION Results support previous reports that biomass and kerosene cooking fuels are both ALRI risk factors, but suggests that PM2.5 from kerosene is more potent on a unit mass basis. Further studies with larger sample sizes and preferably using electricity as the baseline fuel are needed.
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Affiliation(s)
- Michael N Bates
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.
| | - Amod K Pokhrel
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720-7360, USA
| | - Ram K Chandyo
- Centre for International Health, University of Bergen, N-5009 Bergen, Norway
| | - Palle Valentiner-Branth
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen S, Denmark
| | - Maria Mathisen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Sudha Basnet
- Centre for International Health, University of Bergen, N-5009 Bergen, Norway; Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Tor A Strand
- Centre for International Health, University of Bergen, N-5009 Bergen, Norway; Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | | | - Kirk R Smith
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720-7360, USA
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Naz S, Page A, Agho KE. Attributable risk and potential impact of interventions to reduce household air pollution associated with under-five mortality in South Asia. Glob Health Res Policy 2018; 3:4. [PMID: 29376138 PMCID: PMC5772697 DOI: 10.1186/s41256-018-0059-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/03/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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, P = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1-81.5%) of the 13,290 estimated cases of under-five mortality was attributable to HAP. Joint PIF estimates (assuming achievable reductions in HAP reported in intervention studies conducted in South Asia) indicates 47% of neonatal and 43% of under-five mortality cases associated with HAP could be avoidable in the four South Asian countries studied. CONCLUSIONS Elimination of exposure to use of cooking fuel in the household targeting valuable intervention strategies (such as cooking in separate kitchen, improved cook stoves) could reduce substantially under-five mortality in South Asian countries.
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Affiliation(s)
- Sabrina Naz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Kingsley Emwinyore Agho
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
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Alexander D, Northcross A, Wilson N, Dutta A, Pandya R, Ibigbami T, Adu D, Olamijulo J, Morhason-Bello O, Karrison T, Ojengbede O, Olopade CO. Randomized Controlled Ethanol Cookstove Intervention and Blood Pressure in Pregnant Nigerian Women. Am J Respir Crit Care Med 2017; 195:1629-1639. [PMID: 28081369 DOI: 10.1164/rccm.201606-1177oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Hypertension during pregnancy is a leading cause of maternal mortality. Exposure to household air pollution elevates blood pressure (BP). OBJECTIVES To investigate the ability of a clean cookstove intervention to lower BP during pregnancy. METHODS We conducted a randomized controlled trial in Nigeria. Pregnant women cooking with kerosene or firewood were randomly assigned to an ethanol arm (n = 162) or a control arm (n = 162). BP measurements were taken during six antenatal visits. In the primary analysis, we compared ethanol users with control subjects. In subgroup analyses, we compared baseline kerosene users assigned to the intervention with kerosene control subjects and compared baseline firewood users assigned to ethanol with firewood control subjects. MEASUREMENTS AND MAIN RESULTS The change in diastolic blood pressure (DBP) over time was significantly different between ethanol users and control subjects (P = 0.040); systolic blood pressure (SBP) did not differ (P = 0.86). In subgroup analyses, there was no significant intervention effect for SBP; a significant difference for DBP (P = 0.031) existed among preintervention kerosene users. At the last visit, mean DBP was 2.8 mm Hg higher in control subjects than in ethanol users (3.6 mm Hg greater in control subjects than in ethanol users among preintervention kerosene users), and 6.4% of control subjects were hypertensive (SBP ≥140 and/or DBP ≥90 mm Hg) versus 1.9% of ethanol users (P = 0.051). Among preintervention kerosene users, 8.8% of control subjects were hypertensive compared with 1.8% of ethanol users (P = 0.029). CONCLUSIONS To our knowledge, this is the first cookstove randomized controlled trial examining prenatal BP. Ethanol cookstoves have potential to reduce DBP and hypertension during pregnancy. Accordingly, clean cooking fuels may reduce adverse health impacts associated with household air pollution. Clinical trial registered with www.clinicaltrials.gov (NCT02394574).
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Affiliation(s)
| | - Amanda Northcross
- 2 Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | | | - Anindita Dutta
- 1 Center for Global Health.,4 Department of Medicine, and
| | | | - Tope Ibigbami
- 6 Healthy Life for All Foundation, Ibadan, Nigeria; and
| | - Damilola Adu
- 6 Healthy Life for All Foundation, Ibadan, Nigeria; and
| | | | | | - Theodore Karrison
- 8 Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Oladosu Ojengbede
- 7 Department of Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
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Jafta N, Barregard L, Jeena PM, Naidoo RN. Indoor air quality of low and middle income urban households in Durban, South Africa. ENVIRONMENTAL RESEARCH 2017; 156:47-56. [PMID: 28319817 DOI: 10.1016/j.envres.2017.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Elevated levels of indoor air pollutants may cause cardiopulmonary disease such as lower respiratory infection, chronic obstructive lung disease and lung cancer, but the association with tuberculosis (TB) is unclear. So far the risk estimates of TB infection or/and disease due to indoor air pollution (IAP) exposure are based on self-reported exposures rather than direct measurements of IAP, and these exposures have not been validated. OBJECTIVE The aim of this paper was to characterize and develop predictive models for concentrations of three air pollutants (PM10, NO2 and SO2) in homes of children participating in a childhood TB study. METHODS Children younger than 15 years living within the eThekwini Municipality in South Africa were recruited for a childhood TB case control study. The homes of these children (n=246) were assessed using a walkthrough checklist, and in 114 of them monitoring of three indoor pollutants was also performed (sampling period: 24h for PM10, and 2-3 weeks for NO2 and SO2). Linear regression models were used to predict PM10 and NO2 concentrations from household characteristics, and these models were validated using leave out one cross validation (LOOCV). SO2 concentrations were not modeled as concentrations were very low. RESULTS Mean indoor concentrations of PM10 (n=105), NO2 (n=82) and SO2 (n=82) were 64μg/m3 (range 6.6-241); 19μg/m3 (range 4.5-55) and 0.6μg/m3 (range 0.005-3.4) respectively with the distributions for all three pollutants being skewed to the right. Spearman correlations showed weak positive correlations between the three pollutants. The largest contributors to the PM10 predictive model were type of housing structure (formal or informal), number of smokers in the household, and type of primary fuel used in the household. The NO2 predictive model was influenced mostly by the primary fuel type and by distance from the major roadway. The coefficients of determination (R2) for the models were 0.41 for PM10 and 0.31 for NO2. Spearman correlations were significant between measured vs. predicted PM10 and NO2 with coefficients of 0.66 and 0.55 respectively. CONCLUSION Indoor PM10 levels were relatively high in these households. Both PM10 and NO2 can be modeled with a reasonable validity and these predictive models can decrease the necessary number of direct measurements that are expensive and time consuming.
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Affiliation(s)
- Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, 321 George Campbell Building, Howard College Campus, Durban 4041, South Africa.
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Sahlgrenska Academy at Gothenburg University, Box 414, S-405 30 Gothenburg, Sweden
| | - Prakash M Jeena
- Discipline of Pediatrics and Child Health, School of Clinical Medicine, University of KwaZulu-Natal, Private Bag X1, Congella, Durban 4013, South Africa
| | - Rajen N Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, 321 George Campbell Building, Howard College Campus, Durban 4041, South Africa
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Naz S, Page A, Agho KE. Household air pollution from use of cooking fuel and under-five mortality: The role of breastfeeding status and kitchen location in Pakistan. PLoS One 2017; 12:e0173256. [PMID: 28278260 PMCID: PMC5344381 DOI: 10.1371/journal.pone.0173256] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/17/2017] [Indexed: 11/19/2022] Open
Abstract
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 those aged 12-59 months for households without a separate kitchen using polluting fuels, and in children whose mother never breastfed. The results of this study suggest that HAP from cooking fuel is associated with a modest increase in the risk of death among children under five years of age in Pakistan, but particularly in those aged 12-59 months, and those living in poorer socioeconomic conditions. To reduce exposure to cooking fuel which is a preventable determinant of under-five mortality in Pakistan, the challenge remains to promote behavioural interventions such as breastfeeding in infancy period, keeping young children away from the cooking area, and improvements in housing and kitchen design.
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Affiliation(s)
- Sabrina Naz
- Centre of Health Research, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Andrew Page
- Centre of Health Research, School of Medicine, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
| | - Kingsley Emwinyore Agho
- School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, New South Wales, Australia
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Das I, Jagger P, Yeatts K. Biomass Cooking Fuels and Health Outcomes for Women in Malawi. ECOHEALTH 2017; 14:7-19. [PMID: 27800583 PMCID: PMC5357447 DOI: 10.1007/s10393-016-1190-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/05/2016] [Accepted: 09/26/2016] [Indexed: 05/05/2023]
Abstract
In sub-Saharan Africa, biomass fuels account for approximately 90% of household energy consumption. Limited evidence exists on the association between different biomass fuels and health outcomes. We report results from a cross-sectional sample of 655 households in Malawi. We calculated odds ratios between hypothesized determinants of household air pollution (HAP) exposure (fuel, stove type, and cooking location) and five categories of health outcomes (cardiopulmonary, respiratory, neurologic, eye health, and burns). Reliance on high- or low-quality firewood or crop residue (vs. charcoal) was associated with significantly higher odds of shortness of breath, difficulty breathing, chest pains, night phlegm, forgetfulness, dizziness, and dry irritated eyes. Use of high-quality firewood was associated with significantly lower odds of persistent phlegm. Cooks in rural areas (vs. urban areas) had significantly higher odds of experiencing shortness of breath, persistent cough, and phlegm, but significantly lower odds of phlegm, forgetfulness, and burns. With deforestation and population pressures increasing reliance on low-quality biomass fuels, prevalence of HAP-related cardiopulmonary and neurologic symptoms will likely increase among cooks. Short- to medium-term strategies are needed to secure access to high-quality biomass fuels given limited potential for scalable transitions to modern energy.
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Affiliation(s)
- Ipsita Das
- Department of Public Policy, University of North Carolina at Chapel Hill (UNC-CH), Campus Box #3435, Abernethy Hall, Chapel Hill, NC, 27599-3435, USA
| | - Pamela Jagger
- Department of Public Policy, University of North Carolina at Chapel Hill (UNC-CH), Campus Box #3435, Abernethy Hall, Chapel Hill, NC, 27599-3435, USA.
- Curriculum for the Environment and Ecology, UNC-CH, Campus Box #3435, Abernethy Hall, Chapel Hill, NC, USA.
- Carolina Population Center, UNC-CH, Chapel Hill, NC, USA.
| | - Karin Yeatts
- Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC, USA
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Capuno JJ, Tan CAR, Javier X. Cooking and coughing: Estimating the effects of clean fuel for cooking on the respiratory health of children in the Philippines. Glob Public Health 2016; 13:20-34. [PMID: 27376172 DOI: 10.1080/17441692.2016.1202297] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Household air pollution (HAP) arising from the use of solid fuels for cooking is known to have adverse health effects including acute respiratory infections in children, which remains a major public health concern in developing countries. Hence, various interventions to reduce HAP have been advocated or piloted in many countries. To provide additional evidence on the effectiveness and applicability of the interventions in various settings, we investigate the effects of clean fuel for cooking on the risks of respiratory illness of children below five years old in the Philippines. We apply the propensity score matching method on a subsample of households culled from the 2013 round of the National Demographic and Health Survey to account for the systematic differences in their characteristics that could influence their choices of cooking fuel. We find that the use of electricity, liquefied petroleum gas, natural gas or biogas can lower by 2.4 percentage points the incidence of severe coughing with difficulty in breathing in young children. Our results support worldwide initiatives to promote the household use of clean fuels for cooking and heating to reduce HAP and its undesirable impacts on population health.
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Affiliation(s)
- Joseph J Capuno
- a School of Economics , University of the Philippines , Quezon City , Philippines
| | - Carlos Antonio R Tan
- a School of Economics , University of the Philippines , Quezon City , Philippines
| | - Xylee Javier
- a School of Economics , University of the Philippines , Quezon City , Philippines
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Pant P, Guttikunda SK, Peltier RE. Exposure to particulate matter in India: A synthesis of findings and future directions. ENVIRONMENTAL RESEARCH 2016; 147:480-496. [PMID: 26974362 DOI: 10.1016/j.envres.2016.03.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/01/2016] [Accepted: 03/05/2016] [Indexed: 06/05/2023]
Abstract
Air pollution poses a critical threat to human health with ambient and household air pollution identified as key health risks in India. While there are many studies investigating concentration, composition, and health effects of air pollution, investigators are only beginning to focus on estimating or measuring personal exposure. Further, the relevance of exposures studies from the developed countries in developing countries is uncertain. This review summarizes existing research on exposure to particulate matter (PM) in India, identifies gaps and offers recommendations for future research. There are a limited number of studies focused on exposure to PM and/or associated health effects in India, but it is evident that levels of exposure are much higher than those reported in developed countries. Most studies have focused on coarse aerosols, with a few studies on fine aerosols. Additionally, most studies have focused on a handful of cities, and there are many unknowns in terms of ambient levels of PM as well as personal exposure. Given the high mortality burden associated with air pollution exposure in India, a deeper understanding of ambient pollutant levels as well as source strengths is crucial, both in urban and rural areas. Further, the attention needs to expand beyond the handful large cities that have been studied in detail.
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Affiliation(s)
- Pallavi Pant
- Department of Environmental Health Sciences, University of Massachusetts, Amherst MA 01003, USA
| | - Sarath K Guttikunda
- Institute of Climate Studies, Indian Institute of Technology, Bombay, Mumbai, India; Division of Atmospheric Sciences, Desert Research Institute, 225 Raggio Parkway, Reno, NV 89512, USA
| | - Richard E Peltier
- Department of Environmental Health Sciences, University of Massachusetts, Amherst MA 01003, USA.
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Naz S, Page A, Agho KE. Household air pollution and under-five mortality in India (1992-2006). Environ Health 2016; 15:54. [PMID: 27113939 PMCID: PMC4845508 DOI: 10.1186/s12940-016-0138-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/19/2016] [Indexed: 05/16/2023]
Abstract
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 sub-group 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.
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Affiliation(s)
- Sabrina Naz
- />Centre of Health Research, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Andrew Page
- />Centre of Health Research, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Kingsley Emwinyore Agho
- />School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
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Household Air Pollution and Under-Five Mortality in Bangladesh (2004-2011). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:12847-62. [PMID: 26501296 PMCID: PMC4627003 DOI: 10.3390/ijerph121012847] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/30/2015] [Accepted: 10/09/2015] [Indexed: 11/17/2022]
Abstract
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.
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