Influence of Cooking and Heating Fuel Use on 1–59 Month Old Mortality in South Africa

Abstract

To determine the association between the combustion of wood, animal dung, coal and paraffin (polluting fuels) for cooking and heating and 1-59 month old mortality in South Africa, whilst adjusting for a number of confounders. Data from 3,556 children (142 deaths) living in 2,828 households were extracted from the 1998 South African Demographic and Health Survey (SADHS) database. The SADHS was the first national health survey conducted across the entire country and provided the opportunity to examine the prevalence and determinants of various morbidity and mortality outcomes in a representative national population. The results suggest that exposure to cooking and heating smoke from polluting fuels is significantly associated with 1-59 month mortality, after controlling for mother's age at birth, water source, asset index and household crowdedness (RR=1.95; 95% CI=1.04, 3.68). Although there is potential for residual confounding despite adjustment, the better documented evidence on outdoor air pollution and mortality suggest this association may be real. As nearly half of households in South Africa still rely on polluting fuels and women of childbearing age perform most cooking tasks, the attributable risk arising from this association, if confirmed, could be substantial. It is trusted that more detailed analytical intervention studies will scrutinise these results in order to develop integrated intervention programmes to reduce children's exposure to air pollution emanating from cooking and heating fuels.