Replacing wood with charcoal fuel prevents 1.7 million acute respiratory infections worldwide; evidence from 360,000 children in 30 low-and-middle-income countries

Abstract

BACKGROUND AND AIM: Household air pollution from solid biomass fuel cooking is responsible for 45% of acute respiratory infections (ARI) in children under five years in low and middle income countries (LMICs). Transition towards less polluting solid biomass fuel sources in LMIC settings, such as moving from wood to charcoal, may reduce HAP-related global respiratory disease burden in the short to medium-term. However, there remains a paucity of evidence concerning the relative health benefits. This study aimed to assess the association between ARIs in children under five years residing in wood and charcoal cooking households in 30 LMICs using the Demographic and Health survey (DHS) data. METHODS: Cross-sectional data was extracted for 30 LMIC countries with 359,647 children residing in wood or charcoal, using outcome measures obtained from maternally reported respiratory symptoms two weeks prior to interview. Composite measures of ARI (cough and shortness of breath) and severe ARI (cough, shortness of breath and fever) were formed. Multilevel logistic regression analyses was deployed, with adjustment for relevant factors at an individual, household, regional and country level. RESULTS:Residence in a wood cooking household was observed to increase the odds ratio of shortness of breath (AOR:1.04[1.00-1.08]) fever (AOR:1.08[1.04-1.13]), ARI (AOR:1.04[1.00-1.08]) and severe ARI (AOR:1.09[1.05-1.13]) compared to residing in charcoal cooking households. Living in a rural areas has an observed association with cough (AOR:1.11[1.04-1.19]), fever (AOR:1.10[1.04-1.18]), ARI (AOR:1.10[1.04-1.18]) and severe ARI (AOR:1.08[1.01-1.15]) and wood fuel usage, whereas only fever (AOR:1.10[1.02-1.18]) was associated with living in urban areas CONCLUSIONS:Evidence from this population-based multilevel study suggest that 1.7 million ARI cases annually could be prevented in children under five years through transitioning from wood to charcoal cooking fuel in resource poor settings. KEYWORDS: Air pollution, Children’s environmental health, Risk assessment, Environmental Epidemiology, Infectious Disease