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. 2020 Nov 4;25(1):67.
doi: 10.1186/s12199-020-00902-4.

Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys

Fanuel Meckson Bickton  1 , Latif Ndeketa  1 , Grace Thandekire Sibande  2 , Juvenal Nkeramahame  3   4 , Chipiliro Payesa  1 , Edith B Milanzi  5
Affiliations

Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys

Fanuel Meckson Bickton et al. Environ Health Prev Med. .

Abstract

Background: Globally, over four million deaths are attributed to exposure to household air pollution (HAP) annually. Evidence of the association between exposure to HAP and under-five mortality in sub-Saharan Africa (SSA) is insufficient. We assessed the association between exposure to HAP and under-five mortality risk in 14 SSA countries.

Methods: We pooled Demographic and Health Survey (DHS) data from 14 SSA countries (N = 164376) collected between 2015 and 2018. We defined exposure to HAP as the use of biomass fuel for cooking in the household. Under-five mortality was defined as deaths before age five. Data were analyzed using mixed effects logistic regression models.

Results: Of the study population, 73% were exposed to HAP and under-five mortality was observed in 5%. HAP exposure was associated with under-five mortality, adjusted odds ratio (OR) 1.33 (95% confidence interval (CI) [1.03-1.71]). Children from households who cooked inside the home had higher risk of under-five mortality compared to households that cooked in separate buildings [0.85 (0.73-0.98)] or outside [0.75 (0.64-0.87)]. Lower risk of under-five mortality was also observed in breastfed children [0.09 (0.05-0.18)] compared to non-breastfed children.

Conclusions: HAP exposure may be associated with an increased risk of under-five mortality in sub-Saharan Africa. More carefully designed longitudinal studies are required to contribute to these findings. In addition, awareness campaigns on the effects of HAP exposure and interventions to reduce the use of biomass fuels are required in SSA.

Keywords: Demographic Health Survey; Household air pollution; Sub-Saharan Africa; Under-five mortality.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of under-five mortality by country
Fig. 2
Fig. 2
Association between HAP exposure and under-five mortality. Angola used as reference country
Fig. 3
Fig. 3
Stratified analyses by kitchen location and breastfeeding status
Fig. 4
Fig. 4
Association between HAP exposure and under-5 mortality: leave-one-out analysis for model I
See this image and copyright information in PMC

References

    1. Rees N, Wickham A, Choi Y. Silent Suffocation in Africa Air Pollution is a growing menace, affecting the poorest children the most. World Heal Organ. 2019:14. Available from: https://www.unicef.org/media/55081/file/Silent_suffocation_in_africa_air....
    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–2260. doi: 10.1016/S0140-6736(12)61766-8. - DOI - PMC - PubMed
    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747–1757. doi: 10.1016/S0140-6736(06)68770-9. - DOI - PubMed
    1. World Health Organization . Household air pollution and health. 2018.
    1. Piddock KC, Gordon SB, Ngwira A, Msukwa M, Nadeau G, Davis KJ, Nyirenda MJ, Mortimer K. A cross-sectional study of household biomass fuel use among a periurban population in Malawi. Ann Am Thorac Soc. 2014;11(6):908–914. doi: 10.1513/AnnalsATS.201311-413OC. - DOI - PMC - PubMed