Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys
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(2020) 25:67
Environmental Health and Preventive Medicine
RESEARCH ARTICLE
Open Access
Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys Fanuel Meckson Bickton1, Latif Ndeketa1, Grace Thandekire Sibande2, Juvenal Nkeramahame3,4, Chipiliro Payesa1 and Edith B. Milanzi5*
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. Underfive 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: Household air pollution, Under-five mortality, Sub-Saharan Africa, Demographic Health Survey
Background Exposure to household air pollution (HAP) is a major public health hazard worldwide and among the top leading risk factors for global disability and mortality [1–3]. Close to four million deaths are attributed to HAP exposure annually [4]. Household use of biomass fuels is one of the largest sources of HAP globally [5]. Biomass fuels refer to fuel that comes from plant-based or animal-based material, including charcoal, wood, dung, * Correspondence: [email protected] 5 MRC Clinical Trials Unit, University College London, 90 High Holborn, WC16LJ, London, UK Full list of author information is available at the end of the article
and crop residues. The inefficient and incomplete combustion of these energy sources produces harmful smoke, including pollutants such as carbon monoxide and particulate matter–a mixture of organic and inorganic particles [6]. The use of biomass fuels for cooking substantially contributes to ambient air pollution which was attributed to five percent of all-cause mortality in
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