Does secondhand smoke exposure increase the risk of acute respiratory infections among children aged 0–59 months in households that use clean cooking fuel? A cross‐sectional study based on 601 509 households in India

Abstract

Globally, 5.2 million children have died before completing five years of age in 2019, wherein about 49 percent of all under-five mortality occurred in low-and middle-income countries (LMICs). 1 Preventable and modifiable illnesses such as pneumonia and other acute respiratory infections were the major causes of under-five mortality worldwide. 2 Acute respiratory infections (ARI) are acute infections of the upper and lower respiratory system, 3 the most common symptoms of ARI recorded globally are cough, blocked or running nose, short breaths, and throat and ear ache. 4 About, 40 percent of the global under-five ARI mortality burden is shared by South Asian countries, 5 wherein about 165 000 children younger than 5 years die every year from lower respiratory infections. 6 Also, India solely accounted to the 15 percent of under-five ARI mortality in 2018. 7 The high prevalence of ARI is mostly observed in LMICs due to the inadequate and nonaccessible medical health facilities and services. 8

Re-examining the Nexus Between Maternal Smoking Behavior and Under-Five Children’s ARI in India: A Comprehensive Study

“…The study also included a range of covariates to ensure the reliability of the association between mothers’ smoking behavior and ARIs among under-five children. 3 , 9 , 11 The covariates were improved toilet facility, improved water facility, hand wash facility, children’s age, and sex, size at birth, children’s breastfeeding and immunization status, skilled birth attendant delivery, and C-section delivery. 11 , 14 - 16 Similarly, the present study also included several socioeconomic and geographical factors as covariates, including the mother’s education, religion, household wealth quintile, seasonal variability, place of residence, and region.…”

“…7 Like regional variation, household-level variation in the prevalence of ARIs among children under-five is also significant in LMICs. 8,9 In particular, household-level factors such as using cooking fuel, having a separate kitchen, ventilation, WASH (water, sanitation, and hand washing) practices, household wealth quintile, and tuberculosis among household members are significant predictors of ARIs. 10,11 Household wealth-based inequality in ARIs among under-five children is also noteworthy in highly focused ARI-prone regions like sub-Saharan African and South Asian countries.…”

“… 3 , 11 Similarly, household having passive smoking exposures like maternal smoking or other family member smoking increased the risk of developing ARIs among under-five children. 9 Existing studies suggested maternal smoking may significantly affect ARIs more than other indoor exposures due to prolonged proximity. 14 The literature on the association between maternal smoking behavior and the risk of ARIs among under-five children is substantial in India and elsewhere.…”