Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children
E A Rehfuess1, L Tzala, N Best
1Department of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany. rehfuess@ibe.med.uni-muenchen.de
Insights
Cooking with solid fuels significantly increases childhood acute lower respiratory infection (ALRI) mortality in Africa. Improving stove ventilation is crucial for reducing indoor air pollution and child deaths.
Area of Science:
- Environmental Epidemiology
- Public Health
- Pediatrics
Background:
- Sub-Saharan Africa accounts for nearly half of global child deaths from acute lower respiratory infections (ALRIs).
- Solid fuel use for cooking is prevalent, affecting three-quarters of the population in this region.
- Understanding the link between cooking practices and ALRI mortality is vital for targeted public health interventions.
Purpose of the Study:
- To quantify the impact of fuel type and cooking practices on childhood ALRI mortality in Africa.
- To explore the implications of these findings for public health strategies aimed at reducing child mortality.
Main Methods:
- Utilized pooled World Health Survey data from 2003 for 16 African countries.
- Included 32,620 children born within the last 10 years, with 1455 reported deaths before age five.
- Employed survival analysis to assess the influence of cooking-related factors on ALRI mortality, based on maternal recall of symptoms.
Main Results:
- Solid fuel use was associated with a 2.35-fold increased risk of ALRI mortality (adjusted hazard ratio: 2.35; 95% CI: 1.22 to 4.52).
- Cooking with solid fuels without a chimney or hood showed a higher risk (adjusted hazard ratio: 2.68; 95% CI: 1.38 to 5.23).
- Stove ventilation proved to be a more significant factor in reducing ALRI mortality than outdoor cooking.
Conclusions:
- Cooking practices, particularly stove ventilation, significantly influence ALRI mortality risk in African children.
- Improving stove ventilation offers a promising strategy to mitigate indoor air pollution and decrease childhood ALRI deaths.
Background:
Almost half of global child deaths due to acute lower respiratory infections (ALRIs) occur in sub-Saharan Africa, where three-quarters of the population cook with solid fuels. This study aims to quantify the impact of fuel type and cooking practices on childhood ALRI mortality in Africa, and to explore implications for public health interventions.
Methods:
Early-release World Health Survey data for the year 2003 were pooled for 16 African countries. Among 32,620 children born during the last 10 years, 1455 (4.46%) were reported to have died prior to their fifth birthday. Survival analysis was used to examine the impact of different cooking-related parameters on ALRI mortality, defined as cough accompanied by rapid breathing or chest indrawing based on maternal recall of symptoms prior to death.
Results:
Solid fuel use increases the risk of ALRI mortality with an adjusted hazard ratio of 2.35 (95% CI 1.22 to 4.52); this association grows stronger with increasing outcome specificity. Differences between households burning solid fuels on a well-ventilated stove and households relying on cleaner fuels are limited. In contrast, cooking with solid fuels in the absence of a chimney or hood is associated with an adjusted hazard ratio of 2.68 (1.38 to 5.23). Outdoor cooking is less harmful than indoor cooking but, overall, stove ventilation emerges as a more significant determinant of ALRI mortality.
Conclusions:
This study shows substantial differences in ALRI mortality risk among African children in relation to cooking practices, and suggests that stove ventilation may be an important means of reducing indoor air pollution.
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