Child mortality from solid-fuel use in India: a nationally-representative case-control study

Diego G Bassani,Prabhat Jha,Rajesh Kumar,Neeraj Dhingra

doi:10.1186/1471-2458-10-491

Abstract

BackgroundMost households in low and middle income countries, including in India, use solid fuels (coal/coke/lignite, firewood, dung, and crop residue) for cooking and heating. Such fuels increase child mortality, chiefly from acute respiratory infection. There are, however, few direct estimates of the impact of solid fuel on child mortality in India.MethodsWe compared household solid fuel use in 1998 between 6790 child deaths, from all causes, in the previous year and 609 601 living children living in 1.1 million nationally-representative homes in India. Analyses were stratified by child's gender, age (neonatal, post-neonatal, 1-4 years) and colder versus warmer states. We also examined the association of solid fuel to non-fatal pneumonias.ResultsSolid fuel use was very common (87% in households with child deaths and 77% in households with living children). After adjustment for demographic factors and living conditions, solid-fuel use significantly increase child deaths at ages 1-4 (prevalence ratio (PR) boys: 1.30, 95%CI 1.08-1.56; girls: 1.33, 95%CI 1.12-1.58). More girls than boys died from exposure to solid fuels. Solid fuel use was also associated with non-fatal pneumonia (boys: PR 1.54 95%CI 1.01-2.35; girls: PR 1.94 95%CI 1.13-3.33).ConclusionsChild mortality risks, from all causes, due to solid fuel exposure were lower than previously, but as exposure was common solid, fuel caused 6% of all deaths at ages 0-4, 20% of deaths at ages 1-4 or 128 000 child deaths in India in 2004. Solid fuel use has declined only modestly in the last decade. Aside from reducing exposure, complementary strategies such as immunization and treatment could also reduce child mortality from acute respiratory infections.

Highlights

Most households in low and middle income countries, including in India, use solid fuels for cooking and heating
To study the association of solid-fuel use and child deaths, we explored the ratio of the prevalence of solidfuel use in the household via the following comparisons: (a) deaths at ages 1-4 years compared to living children of same age; (b) post-neonatal deaths compared to living children below 1 year of age and; (c) deaths at ages 1-4 years compared to neonatal deaths
Compared to living children ages 1-4 years, a larger proportion of deaths at ages 1-4 years came from houses built with low-quality materials

Summary

Introduction

Most households in low and middle income countries, including in India, use solid fuels (coal/coke/ lignite, firewood, dung, and crop residue) for cooking and heating Such fuels increase child mortality, from acute respiratory infection. Children under age 5 spend many hours breathing indoor smoke, especially during their first year of life - when they are carried by their mothers Such exposure to indoor smoke that contains several health-hazardous substances and particles is Direct measurement of the impact of solid fuel use on child survival has to take into account several risk factors that increase mortality and are associated with solid-fuel use, as a consequence of poverty, such as living conditions, sanitation and access to water [9,10].

Methods

Results

Conclusion