Adverse Birth Outcomes Due to Exposure to Household Air Pollution from Unclean Cooking Fuel among Women of Reproductive Age in Nigeria

Abstract

Exposure to household air pollution (HAP) from cooking with unclean fuels and indoor smoking has become a significant contributor to global mortality and morbidity, especially in low- and middle-income countries such as Nigeria. Growing evidence suggests that exposure to HAP disproportionately affects mothers and children and can increase risks of adverse birth outcomes. We aimed to quantify the association between HAP and adverse birth outcomes of stillbirth, preterm births, and low birth weight while controlling for geographic variability. This study is based on a cross-sectional survey of 127,545 birth records from 41,821 individual women collected as part of the 2018 Nigeria Demographic and Health Survey (NDHS) covering 2013–2018. We developed Bayesian structured additive regression models based on Bayesian splines for adverse birth outcomes. Our model includes the mother’s level and household characteristics while correcting for spatial effects and multiple births per mother. Model parameters and inferences were based on a fully Bayesian approach via Markov Chain Monte Carlo (MCMC) simulations. We observe that unclean fuel is the primary source of cooking for 89.3% of the 41,821 surveyed women in the 2018 NDHS. Of all pregnancies, 14.9% resulted in at least one adverse birth outcome; 14.3% resulted in stillbirth, 7.3% resulted in an underweight birth, and 1% resulted in premature birth. We found that the risk of stillbirth is significantly higher for mothers using unclean cooking fuel. However, exposure to unclean fuel was not significantly associated with low birth weight and preterm birth. Mothers who attained at least primary education had reduced risk of stillbirth, while the risk of stillbirth increased with the increasing age of the mother. Mothers living in the Northern states had a significantly higher risk of adverse births outcomes in 2018. Our results show that decreasing national levels of adverse birth outcomes depends on working toward addressing the disparities between states.

Adverse Perinatal Outcomes Among Grand Multiparous and Low Multiparous Women and Its Associated Factors in North Shewa Zone Public Hospitals: The Role of Parity

“…A secondary analysis of the Nigerian Demographic and Health Survey determined the magnitude of adverse perinatal outcomes at 14.9%. 5 A systematic review and metaanalysis study in Sub-Saharan Africa reported a pooled prevalence of 29.7%. 6 Besides, the magnitude of perinatal complication was 18.2% in Butajira, 7 21% in Bale Zone, 8 and 18.3% in Hawassa town.…”

Ambient temperature and stillbirth risks in northern Sweden, 1880–1950

“…On the contrary, low ambient temperature was likely linked to high levels of indoor air pollution from biofuel sources, and therefore might have increased the risk of adverse birth outcomes, as demonstrated by a number of studies in low-income settings. 38 – 40 However, these health effects (temperature impacts on birth outcomes mediated by indoor pollution) would occur at longer time lags than investigated in the present study.…”

Integrated Human Exposure to Air Pollution

“…Adverse birth outcomes (stillbirth, preterm births and low birth weight) due to exposure to household air pollution from unclean cooking fuel in Nigeria were also assessed in a study using Bayesian models, taking into account geographic variability [15]. Using data obtained in a national cross-sectional survey, unclean fuel was the primary source of cooking for 89.3% of the women and the risk of stillbirth was significantly higher for mothers using this type of cooking fuel.…”