Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children

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.