Effects of indoor pollution on acute respiratory infections among under-five children in India: Evidence from a nationally representative population-based study

Mondal, Dinabandhu; Paul, Pintu

doi:10.1371/journal.pone.0237611

Cited by 39 publications

(53 citation statements)

References 25 publications

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“…This finding is consistent with a prior study conducted in 27 African countries [ 41 ] and Afghanistan [ 15 ]. This indicates that cooking food in a separate building will lower the risk of ARI in children compared to cooking inside a building; this complies with findings from Tanzania [ 42 ], Nigeria [ 43 ], and the most recent one from India [ 18 ], all based on demographic and health survey data.…”

Section: Discussionsupporting

confidence: 87%

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Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005–2016 Ethiopian Demographic Health Survey data

et al. 2020

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Background Globally, acute respiratory infections are among the leading causes of under-five child mortality, especially in lower-income countries; it is associated with indoor exposure to toxic pollutants from solid biomass fuel. In Ethiopia, 90% of the population utilizes solid biomass fuel; respiratory illness is a leading health problem. However, there is a paucity of nationally representative data on the association of household cooking place and respiratory infections. Besides, evidence on the variability in the infection based on the data collected at different times is limited. Therefore, this study is intended to assess the association of food cooking place with acute respiratory infections and the variability in households and surveys. Methods The current analysis is based on the Ethiopian Demographic and Health Survey data collected in 2005, 2011, and 2016 and obtained via online registration. The association of food cooking place with acute respiratory infection was assessed using multilevel modeling after categorizing all factors into child level and survey level, controlling them in a full model. The analyses accounted for a complex survey design using a Stata command “svy.” Result A total of 30,895 under-five children were included in this study, of which 3677 (11.9%) children had an acute respiratory infection, with 12.7% in 2005, 11.9% in 2011, and 11.1% in 2016. The risk of having an infection in under-five children in households that cooked food outdoors was 44% lower (AOR = 0.56, 95% CI = 0.40, 0.75) compared to those households that cooked the food inside the house. There was a statistically significant difference among the children among surveys to have an acute respiratory infection. Conclusion The risk of having children with acute respiratory infection is lower in the households of cooking food outdoor compared to indoor. The infection difference in different surveys suggests progress in the practices in either food cooking places or the fuel types used that minimize food cooking places location or the fuel types used that minimizes the risk. But, the infection is still high; therefore, measures promoting indoor cooking in a well-ventilated environment with alternative energy sources should take place.

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Section: Discussionsupporting

confidence: 87%

“…The evidence indicates controlling the exposure to biomass fuels could reduce the risk of adverse children and adult health outcomes by 20–50% [ 16 ]. Outdoor cooking and stove ventilation were some of the measures that substantially reduced the risks [ 15 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005–2016 Ethiopian Demographic Health Survey data

et al. 2020

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“…All studies were cross-sectional in design. The country most frequently analysed was India (13/45 studies) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ], followed by Nepal (4 studies) [ 38 , 39 , 40 , 41 ], then Bangladesh [ 23 , 24 , 42 ], Nigeria [ 43 , 44 , 45 ] and Pakistan [ 46 , 47 , 48 ] (3 studies each). South Africa [ 49 , 50 ] and Zimbabwe [ 51 , 52 ] each accounted for two studies, respectively.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review and Appraisal of Epidemiological Studies on Household Fuel Use and Its Health Effects Using Demographic and Health Surveys

Odo

Yang

Knibbs

2021

IJERPH

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The domestic combustion of polluting fuels is associated with an estimated 3 million premature deaths each year and contributes to climate change. In many low- and middle-income countries (LMICs), valid and representative estimates of people exposed to household air pollution (HAP) are scarce. The Demographic and Health Survey (DHS) is an important and consistent source of data on household fuel use for cooking and has facilitated studies of health effects. However, the body of research based on DHS data has not been systematically identified, nor its strengths and limitations critically assessed as a whole. We aimed to systematically review epidemiological studies using DHS data that considered cooking fuel type as the main exposure, including the assessment of the extent and key drivers of bias. Following PRISMA guidelines, we searched PubMed, Web of Science, Scopus and the DHS publication portal. We assessed the quality and risk of bias (RoB) of studies using a novel tool. Of 2748 records remaining after removing duplicates, 63 were read in full. A total of 45 out of 63 studies were included in our review, spanning 11 different health outcomes and representing 50 unique analyses. In total, 41 of 45 (91%) studies analysed health outcomes in children <5 years of age, including respiratory infections (n = 17), death (all-cause) (n = 14), low birthweight (n = 5), stunting and anaemia (n = 5). Inconsistencies were observed between studies in how cooking fuels were classified into relatively high- and low-polluting. Overall, 36/50 (80%) studies reported statistically significant adverse associations between polluting fuels and health outcomes. In total, 18/50 (36%) of the analyses were scored as having moderate RoB, while 16/50 (32%) analyses were scored as having serious or critical RoB. Although HAP exposure assessment is not the main focus of the DHS, it is the main, often only, source of information in many LMICs. An appreciable proportion of studies using it to analyse the association between cooking fuel use and health have potential for high RoB, mostly related to confounder control, exposure assessment and misclassification, and outcome ascertainment. Based on our findings, we provide some suggestions for ways in which revising the information collected by the DHS could make it even more amenable to studies of household fuel use and health, and reduce the RoB, without being onerous to collect and analyse.

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“…First, we included questions intended to measure current respiratory illness for the respondent (primary cook) and each child, asking whether these individuals experienced any of the following symptoms in the past week : runny nose, sore throat, difficulty breathing, wheezing or whistling in the chest, dry cough, cough with phlegm, or bloody cough. Respiratory symptom measures were drawn from other health surveys (e.g., the Indian National Family Health Survey [ 56 ]). Individuals reported to have any of these symptoms were coded as experiencing a respiratory illness.…”

Section: Methodsmentioning

confidence: 99%

Health impacts of a randomized biomass cookstove intervention in northern Ghana

et al. 2021

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Background Household air pollution (HAP) from cooking with solid fuels has adverse health effects. REACCTING (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana) was a randomized cookstove intervention study that aimed to determine the effects of two types of “improved” biomass cookstoves on health using self-reported health symptoms and biomarkers of systemic inflammation from dried blood spots for female adult cooks and children, and anthropometric growth measures for children only. Methods Two hundred rural households were randomized into four different cookstove groups. Surveys and health measurements were conducted at four time points over a two-year period. Chi-square tests were conducted to determine differences in self-reported health outcomes. Linear mixed models were used to assess the effect of the stoves on inflammation biomarkers in adults and children, and to assess the z-score deviance for the anthropometric data for children. Results We find some evidence that two biomarkers of oxidative stress and inflammation, serum amyloid A and C-reactive protein, decreased among adult primary cooks in the intervention groups relative to the control group. We do not find detectable impacts for any of the anthropometry variables or self-reported health. Conclusions Overall, we conclude that the REACCTING intervention did not substantially improve the health outcomes examined here, likely due to continued use of traditional stoves, lack of evidence of particulate matter emissions reductions from “improved” stoves, and mixed results for HAP exposure reductions. Clinical trial registry ClinicalTrials.gov (National Institutes of Health); Trial Registration Number: NCT04633135; Date of Registration: 11 November 2020 – Retrospectively registered. URL: https://clinicaltrials.gov/ct2/show/NCT04633135?term=NCT04633135&draw=2&rank=1

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Effects of indoor pollution on acute respiratory infections among under-five children in India: Evidence from a nationally representative population-based study

Cited by 39 publications

References 25 publications

Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005–2016 Ethiopian Demographic Health Survey data

Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005–2016 Ethiopian Demographic Health Survey data

A Systematic Review and Appraisal of Epidemiological Studies on Household Fuel Use and Its Health Effects Using Demographic and Health Surveys

Health impacts of a randomized biomass cookstove intervention in northern Ghana

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