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Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries

Background: The World Health Organisation reported that 45% of global acute respiratory infection (ARI) deaths in children under five years are attributable to household air pollution, which has been recognised to be strongly associated with solid biomass fuel usage in domestic settings. The introdu...

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Autores principales: Woolley, Katherine E., Bartington, Suzanne E., Kabera, Telesphore, Lao, Xiang-Qian, Pope, Francis D., Greenfield, Sheila M., Price, Malcolm J., Thomas, G. Neil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431364/
https://www.ncbi.nlm.nih.gov/pubmed/34501907
http://dx.doi.org/10.3390/ijerph18179305
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author Woolley, Katherine E.
Bartington, Suzanne E.
Kabera, Telesphore
Lao, Xiang-Qian
Pope, Francis D.
Greenfield, Sheila M.
Price, Malcolm J.
Thomas, G. Neil
author_facet Woolley, Katherine E.
Bartington, Suzanne E.
Kabera, Telesphore
Lao, Xiang-Qian
Pope, Francis D.
Greenfield, Sheila M.
Price, Malcolm J.
Thomas, G. Neil
author_sort Woolley, Katherine E.
collection PubMed
description Background: The World Health Organisation reported that 45% of global acute respiratory infection (ARI) deaths in children under five years are attributable to household air pollution, which has been recognised to be strongly associated with solid biomass fuel usage in domestic settings. The introduction of legislative restrictions for charcoal production or purchase can result in unintended consequences, such as reversion to more polluting biomass fuels such as wood; which may increase health and environmental harms. However, there remains a paucity of evidence concerning the relative health risks between wood and charcoal. This study compares the risk of respiratory symptoms, ARI, and severe ARI among children aged under five years living in wood and charcoal fuel households across 30 low- and middle-income countries. Methods: Data from children (N = 475,089) residing in wood or charcoal cooking households were extracted from multiple population-based Demographic and Health Survey databases (DHS) (N = 30 countries). Outcome measures were obtained from a maternal report of respiratory symptoms (cough, shortness of breath and fever) occurring in the two weeks prior to the survey date, generating a composite measure of ARI (cough and shortness of breath) and severe ARI (cough, shortness of breath and fever). Multivariable logistic regression analyses were implemented, with adjustment at individual, household, regional and country level for relevant demographic, social, and health-related confounding factors. Results: Increased odds ratios of fever (AOR: 1.07; 95% CI: 1.02–1.12) were observed among children living in wood cooking households compared to the use of charcoal. However, no association was observed with shortness of breath (AOR: 1.03; 95% CI: 0.96–1.10), cough (AOR: 0.99; 95% CI: 0.95–1.04), ARI (AOR: 1.03; 95% CI: 0.96–1.11) or severe ARI (AOR: 1.07; 95% CI: 0.99–1.17). Within rural areas, only shortness of breath was observed to be associated with wood cooking (AOR: 1.08; 95% CI: 1.01–1.15). However, an increased odds ratio of ARI was observed in Asian (AOR: 1.25; 95% CI: 1.04–1.51) and East African countries (AOR: 1.11; 95% CI: 1.01–1.22) only. Conclusion: Our population-based observational data indicates that in Asia and East Africa there is a greater risk of ARI among children aged under 5 years living in wood compared to charcoal cooking households. These findings have major implications for understanding the existing health impacts of wood-based biomass fuel usage and may be of relevance to settings where charcoal fuel restrictions are under consideration.
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spelling pubmed-84313642021-09-11 Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries Woolley, Katherine E. Bartington, Suzanne E. Kabera, Telesphore Lao, Xiang-Qian Pope, Francis D. Greenfield, Sheila M. Price, Malcolm J. Thomas, G. Neil Int J Environ Res Public Health Article Background: The World Health Organisation reported that 45% of global acute respiratory infection (ARI) deaths in children under five years are attributable to household air pollution, which has been recognised to be strongly associated with solid biomass fuel usage in domestic settings. The introduction of legislative restrictions for charcoal production or purchase can result in unintended consequences, such as reversion to more polluting biomass fuels such as wood; which may increase health and environmental harms. However, there remains a paucity of evidence concerning the relative health risks between wood and charcoal. This study compares the risk of respiratory symptoms, ARI, and severe ARI among children aged under five years living in wood and charcoal fuel households across 30 low- and middle-income countries. Methods: Data from children (N = 475,089) residing in wood or charcoal cooking households were extracted from multiple population-based Demographic and Health Survey databases (DHS) (N = 30 countries). Outcome measures were obtained from a maternal report of respiratory symptoms (cough, shortness of breath and fever) occurring in the two weeks prior to the survey date, generating a composite measure of ARI (cough and shortness of breath) and severe ARI (cough, shortness of breath and fever). Multivariable logistic regression analyses were implemented, with adjustment at individual, household, regional and country level for relevant demographic, social, and health-related confounding factors. Results: Increased odds ratios of fever (AOR: 1.07; 95% CI: 1.02–1.12) were observed among children living in wood cooking households compared to the use of charcoal. However, no association was observed with shortness of breath (AOR: 1.03; 95% CI: 0.96–1.10), cough (AOR: 0.99; 95% CI: 0.95–1.04), ARI (AOR: 1.03; 95% CI: 0.96–1.11) or severe ARI (AOR: 1.07; 95% CI: 0.99–1.17). Within rural areas, only shortness of breath was observed to be associated with wood cooking (AOR: 1.08; 95% CI: 1.01–1.15). However, an increased odds ratio of ARI was observed in Asian (AOR: 1.25; 95% CI: 1.04–1.51) and East African countries (AOR: 1.11; 95% CI: 1.01–1.22) only. Conclusion: Our population-based observational data indicates that in Asia and East Africa there is a greater risk of ARI among children aged under 5 years living in wood compared to charcoal cooking households. These findings have major implications for understanding the existing health impacts of wood-based biomass fuel usage and may be of relevance to settings where charcoal fuel restrictions are under consideration. MDPI 2021-09-03 /pmc/articles/PMC8431364/ /pubmed/34501907 http://dx.doi.org/10.3390/ijerph18179305 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Woolley, Katherine E.
Bartington, Suzanne E.
Kabera, Telesphore
Lao, Xiang-Qian
Pope, Francis D.
Greenfield, Sheila M.
Price, Malcolm J.
Thomas, G. Neil
Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries
title Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries
title_full Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries
title_fullStr Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries
title_full_unstemmed Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries
title_short Comparison of Respiratory Health Impacts Associated with Wood and Charcoal Biomass Fuels: A Population-Based Analysis of 475,000 Children from 30 Low- and Middle-Income Countries
title_sort comparison of respiratory health impacts associated with wood and charcoal biomass fuels: a population-based analysis of 475,000 children from 30 low- and middle-income countries
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431364/
https://www.ncbi.nlm.nih.gov/pubmed/34501907
http://dx.doi.org/10.3390/ijerph18179305
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