Association between household air pollution and child mortality in Myanmar using a multilevel mixed-effects Poisson regression with robust variance

Juwel Rana,Md Nuruzzaman Khan,Youssef Oulhote,Razia Aliani,Rakibul M Islam

doi:10.1038/s41598-021-92193-0

Abstract

Household air pollution (HAP) from solid fuel use (SFU) for cooking is a major public health threat for women and children in low and middle-income countries. This study investigated the associations between HAP and neonatal, infant, and under-five child mortality in Myanmar. The study consisted of 3249 sample of under-five children in the households from the first Myanmar Demographic and Health Survey 2016. Fuel types and levels of exposure to SFU (no, moderate and high) were proxies for HAP. We estimated covariate-adjusted relative risks (aRR) of neonatal, infant, and under-five child mortality with 95% confidence intervals, accounting for the survey design. The prevalence of SFU was 79.0%. The neonatal, infant, and under-five child mortality rates were 26, 45, and 49 per 1000 live births, respectively. The risks of infant (aRR 2.02; 95% CI 1.01–4.05; p-value = 0.048) and under-five mortality (aRR 2.16; 95% CI 1.07–4.36; p-value = 0.031), but not neonatal mortality, were higher among children from households with SFU compared to children from households using clean fuel. Likewise, children highly exposed to HAP had higher risks of mortality than unexposed children. HAP increases the risks of infant and under-five child mortality in Myanmar, which could be reduced by increasing access to clean cookstoves and fuels.

Highlights

Household air pollution (HAP) from solid fuel use (SFU) for cooking is a major public health threat for women and children in low and middle-income countries
In 2017, almost 70% of all deaths related to HAP occurred in LMICs6
The survey was funded by the United States Agency for International Development and implemented by the Ministry of Health and Sports, Myanmar, in coordination with the Millennium Development Goals (MDGs)

Summary

Introduction

Household air pollution (HAP) from solid fuel use (SFU) for cooking is a major public health threat for women and children in low and middle-income countries. In 2019, the estimated overall under-five, infant and neonatal mortality rates were 32, 26, and 20 per 1000 live births, respectively, in South-East Asia, while Myanmar has one of the highest child mortality rates in the region, which is more than the overall r ates[1,3] Multiple underlying factors such as socioeconomic inequalities, poor sanitation and lack of safe drinking water, and poor access to clean fuels might be responsible for these high under-five and infant m ortality[1,2,3,4]. About 3 billion people use solid fuels for cooking, including coal and biomass (wood, animal dung, lignite, charcoal, straw/shrubs, grass, and agricultural crop)[7,8], which are the major sources of H AP9

Methods

Results

Discussion

Conclusion