Abstract
Objectives Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among young children in low and lower-middle income countries. This study examines for the first time trends in the association between HAP from cooking fuel and under-five mortality and measures the potential impact of interventions to reduce HAP using Nepal Demographic and Health Survey datasets (2001–2011). Methods A total of 17,780 living children across four age-groups (neonatal 0–28 days, post-neonatal 1–11 months, child 12–59 months and under-five 0–59 months) were included and multi-level logistic regression models were used for analyses. Population attributable fractions of key risk factors and potential impact fractions assessing the impact of previous interventions to reduce exposure prevalence were also calculated. Results Use of cooking fuel was associated with total under-five mortality (OR 2.19, 95% CI 1.37–3.51, P = 0.001) in Nepal, with stronger associations evident for sub-group analyses of neonatal mortality (OR 2.67, 95% CI 1.47–4.82, P = 0.001). Higher association was found in rural areas and for households without a separate kitchen using polluting fuel for cooking, and in women who had never breastfed for all age-groups of children. PIF estimates, assuming a 63% of reduction of HAP based on previously published interventions in Nepal, suggested that a burden of 40% of neonatal and 33% of under-five mortality cases associated with an indoor kitchen using polluting fuel could be avoidable. Conclusion Improved infrastructure and behavioral interventions could help reduce the pollution from cooking fuel in the household resulting in further reduction in under-five mortality in Nepal.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Acharya, P., Mishra, S. R., & Berg-Beckhoff, G. (2015). Solid fuel in kitchen and acute respiratory tract infection among under five children: Evidence from Nepal demographic and health survey 2011. Journal of Community Health, 40(3), 515–521.
Alternative Energy Promotion Centre. (2013). A year in review: Making renewable energy: Mainstream supply to rural areas of Nepal NYF 2069/70 (July 12–July 13): Alternative Energy Promotion Centre, Government of Nepal, Ministry of Science, Technology & Environment. Retrieved May 22, 2017, from http://www.aepc.gov.np/docs/resource/rescenter/20140518044620_Annual%20progress%20Review%20of%20AEPC%202012-2013.pdf
Barendregt, J. J. (2009). Ersatz user guide. Brisbane: Epigear. Retrieved May 22, 2017, from http://www.epigear.com/index_files/Ersatz%20User%20Guide.pdf
Barendregt, J. J., & Veerman, J. L. (2010). Categorical versus continuous risk factors and the calculation of potential impact fractions. Journal of Epidemiology and Community Health, 64(3), 209–212.
Bassani, D. G., Jha, P., Dhingra, N., & Kumar, R. (2010). Child mortality from solid-fuel use in India: A nationally-representative case-control study. BMC Public Health, 10(1), 491.
Bates, M. N., Chandyo, R. K., Valentiner-Branth, P., Pokhrel, A. K., Mathisen, M., Basnet, S., … Smith, K. R. (2013). Acute lower respiratory infection in childhood and household fuel use in Bhaktapur, Nepal. Environmental Health Perspectives, 121(5), 637.
Central Bureau of Statistics. (2012). National population and housing census 2011 (National Report): Government of Nepal, National Planning Commission Secretariat, Central Bureau of Statistics, Kathmandu, Nepal. Retrieved May 22, 2017, from http://unstats.un.org/unsd/demographic/sources/census/wphc/Nepal/Nepal-Census-2011-Vol1.pdf
Dasgupta, S., Huq, M., Khaliquzzaman, M., Pandey, K., & Wheeler, D. (2006). Indoor air quality for poor families: New evidence from Bangladesh. Indoor Air, 16(6), 426–444. doi:10.1111/j.1600-0668.2006.00436.x.
Devakumar, D., Semple, S., Osrin, D., Yadav, S., Kurmi, O., Saville, N., … Ayres, J. (2014). Biomass fuel use and the exposure of children to particulate air pollution in southern Nepal. Environment International, 66, 79–87.
Dhimal, M., Baral, K., Shrestha, N., Dhakal, P., & Maskey, M. (2010). Environmental burden of acute respiratory infection and pneumonia due to indoor smoke. Journal of Nepal Health Research Council, 8, 1–4.
Epstein, M. B., Bates, M. N., Arora, N. K., Balakrishnan, K., Jack, D. W., & Smith, K. R. (2013). Household fuels, low birth weight, and neonatal death in India: The separate impacts of biomass, kerosene, and coal. International Journal of Hygiene and Environmental Health, 216(5), 523–532. doi:10.1016/j.ijheh.2012.12.006.
Ezeh, O. K., Agho, K. E., Dibley, M. J., Hall, J. J., & Page, A. N. (2014). The effect of solid fuel use on childhood mortality in Nigeria: Evidence from the 2013 cross-sectional household survey. Environmental Health, 13(1), 113.
Filmer, D., & Pritchett, L. H. (2001). Estimating wealth effects without expenditure data–or tears: An application to educational enrollments in states of India. Demography, 38(1), 115–132.
Fullerton, D. G., Bruce, N., & Gordon, S. B. (2008). Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102(9), 843–851.
Gurley, E., Homaira, N., Salje, H., Ram, P., Haque, R., Petri, W., … Luby, S. (2013). Indoor exposure to particulate matter and the incidence of acute lower respiratory infections among children: A birth cohort study in urban Bangladesh. Indoor Air, 23(5), 379–386.
IHME. (2010). Global Burden of Disease (GBD) Profile: Nepal: Institute for Health Metrics and Evaluation. Retrieved May 22, 2017, from http://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_nepal.pdf
Joshi, S. K. (2006). Solid biomass fuel: Indoor air pollution and health effects. Kathmandu University Medical Journal, 4(2), 141–142.
Khalequzzaman, M., Kamijima, M., Sakai, K., Ebara, T., Hoque, B. A., & Nakajima, T. (2011). Indoor air pollution and health of children in biomass fuel-using households of Bangladesh: Comparison between urban and rural areas. Environmental Health and Preventive Medicine, 16(6), 375–383. doi:10.1007/s12199-011-0208-z.
Ladomenou, F., Moschandreas, J., Kafatos, A., Tselentis, Y., & Galanakis, E. (2010). Protective effect of exclusive breastfeeding against infections during infancy: A prospective study. Archives of Disease in Childhood, 95, 1004–1008.
Ministry of Health and Population, N. E., ICF International Inc. (2012). Nepal Demography and Health Survey 2011: Population Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal; New ERA, Kathmandu, Nepal; Macro International Inc., Calverton, Maryland USA. Retrieved May 22, 2017, from http://dhsprogram.com/pubs/pdf/fr191/fr191.pdf
Munroe, R. L., & Gauvain, M. (2012). Exposure to open-fire cooking and cognitive performance in children. International Journal of Environmental Health Research, 22(2), 156–164.
Murray, C. J., Ezzati, M., Lopez, A. D., Rodgers, A., & Vander Hoorn, S. (2003). Comparative quantification of health risks: Conceptual framework and methodological issues. Population Health Metrics, 1(1), 1.
Naz, S., Page, A., & Agho, K. E. (2015). Household air pollution and under-five mortality in Bangladesh (2004–2011). International Journal of Environmental Research and Public Health, 12(10), 12847–12862.
Naz, S., Page, A., & Agho, K. E. (2016). Household air pollution and under-five mortality in India (1992–2006). Environmental Health, 15(1), 1.
PMNCH, WHO, World Bank, & AHPSR. (2014). Success factors for Women’s and Children’s Health: Policy and programme highlights from 10 fast-track countries: World Health Organization, Geneva. Retrieved May 22, 2017, from http://www.who.int/pmnch/knowledge/publications/success_factors_highlights.pdf
Ranabhat, C. L., Kim, C.-B., Kim, C.-S., Jha, N., Deepak, K., & Connel, F. A. (2015). Consequence of indoor air pollution in rural area of Nepal: A simplified measurement approach. Frontiers in Public Health, 3, 5.
Rehfuess, E. A., Tzala, L., Best, N., Briggs, D. J., & Joffe, M. (2009). Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children. Journal of Epidemiology and Community Health, 63(11), 887–892.
Rockhill, B., Newman, B., & Weinberg, C. (1998). Use and misuse of population attributable fractions. American Journal of Public Health, 88(1), 15–19.
Rutstein, S. O., & Rojas, G. (2006). Guide to DHS statistics. Calverton, MD: ORC Macro. Retrieved May 22, 2017, from http://www.dhsprogram.com/pubs/pdf/DHSG1/Guide_to_DHS_Statistics_29Oct2012_DHSG1.pdf
Singh, A., Tuladhar, B., Bajracharya, K., & Pillarisetti, A. (2012). Assessment of effectiveness of improved cook stoves in reducing indoor air pollution and improving health in Nepal. Energy for Sustainable Development, 16(4), 406–414. doi:10.1016/j.esd.2012.09.004.
Tielsch, J. M., Katz, J., Thulasiraj, R. D., Coles, C. L., Sheeladevi, S., Yanik, E. L., & Rahmathullah, L. (2009). Exposure to indoor biomass fuel and tobacco smoke and risk of adverse reproductive outcomes, mortality, respiratory morbidity and growth among newborn infants in south India. International Journal of Epidemiology, 38(5), 1351–1363.
Victora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton, S., Krasevec, J., … Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490.
WHO. (2007). Indoor air pollution: National burden of disease estimates. Retrieved May 22, 2017, from http://www.who.int/indoorair/publications/indoor_air_national_burden_estimate_revised.pdf
WHO. (2014). Burden of disease from Household Air Pollution for 2012: Summary of Results. Retrieved May 22, 2017, from http://www.who.int/phe/health_topics/outdoorair/databases/FINAL_HAP_AAP_BoD_24March2014.pdf
Wilson, L. F., Page, A. N., Dunn, N. A., Pandeya, N., Protani, M. M., & Taylor, R. J. (2013). Population attributable risk of modifiable risk factors associated with invasive breast cancer in women aged 45–69 years in Queensland, Australia. Maturitas, 76(4), 370–376.
Acknowledgements
This study was part of the first author’s thesis for a doctoral dissertation with the School of Medicine at the Western Sydney University, Australia. We are grateful to The DHS Program, ORC Macro, Calverton, Maryland, USA for providing the Nepal DHS data sets for this analysis.
Funding
The research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Author information
Authors and Affiliations
Contributions
SN and AP contributed to the conception and design of this study. SN performed the literature review and analysis and drafted the manuscript. AP and KEA contributed to the interpretation, and critical revisions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Naz, S., Page, A. & Agho, K.E. Potential Impacts of Modifiable Behavioral and Environmental Exposures on Reducing Burden of Under-five Mortality Associated with Household Air Pollution in Nepal. Matern Child Health J 22, 59–70 (2018). https://doi.org/10.1007/s10995-017-2355-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-017-2355-3