Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries

Abstract

Background: Over one-third of the world's population is exposed to household air pollution (HAP) but the separate effects of cooking with solid fuel and kerosene on childhood mortality are unclear. Objectives: To evaluate the effects of both solid fuels and kerosene on neonatal (0-28 days) and child (29 days-59 months) mortality. Methods: We used Demographic and Health Surveys from 47 countries and calculated adjusted relative risks (aRR) using Poisson regression models. Results: The aRR of neonatal and child mortality in households exposed to solid fuels were 1.24 (95% CI: 1.14, 1.34) and 1.21 (95% CI: 1.12, 1.30), respectively, and the aRR for neonatal and child mortality in households exposed to kerosene were 1.34 (95% CI: 1.18, 1.52) and 1.12 (95% CI: 0.99, 1.27), controlling for individual, household, and country-level predictors of mortality. Conclusions: Kerosene should not be classified as a clean fuel. Neonates are at risk for mortality from exposure to solid fuels and kerosene.

Independent and combined effects of maternal smoking and solid fuel on infant and child mortality in sub‐Saharan Africa

“…Data from a multicountry cohort study in India, Pakistan, Kenya, Zambia and Guatemala showed that the risks of neonatal mortality and macerated stillbirth were 80% and 66%, respectively, higher in households using polluting fuels such as kerosene, charcoal, coal, wood straw, crop waste and dung . Demographic and Health Survey (DHS) data in 47 countries revealed that neonatal mortality rates were 24% and child mortality rates 21% higher in households that used solid fuels for cooking . Similar evidence has been documented in Nigeria , India and Bangladesh .…”

“…Beyond the neonatal period, low birthweight is also a risk factor for post‐neonatal mortality and early onset of non‐communicable diseases in adulthood . These leading risk factors – preterm birth, pneumonia and low birthweight – have been shown to be associated with exposure to household air pollution from maternal smoking and use of solid fuel for cooking .…”

“…Thirdly, sub‐Saharan Africa presents a context different from Asia and the developed countries, where the effects of maternal smoking on childhood mortality have been largely documented. For example, socio‐economic status is generally lower, and the energy source for household cooking is mostly solid fuels . Maternal and child health services are less commonly utilised than in Asia and the developed countries .…”

Cooking fuel and risk of under-five mortality in 23 Sub-Saharan African countries: a population-based study

“…Several studies have indicated that children under the age of five compose the most susceptible group for fatalities caused by pollutant cooking fuels (Smith et al 2000;Gajate-Garrido 2013;Upadhyay et al 2015). Recent evidence in SSA also indicates that children under five are at a greater risk of death when solid fuel is used in the household (Ezeh et al 2014;Kleimola et al 2015). Nevertheless, the relationship between cooking fuel and risk of under-five mortality, on a much wider scale, has not been adequately determined in SSA.…”

A cross-sectional study of exhaled carbon monoxide as a biomarker of recent household air pollution exposure

“…Epidemiologic studies have implicated HAP in respiratory tract cancers, respiratory infections and chronic lung diseases (4-8). Personal exposure assessment is necessary to understand the association between HAP and health outcomes (9-11) and define exposure response relationships (12); use of exposure proxies such as questionnaires may lead to substantial exposure misclassification.…”