Indoor air pollution from biomass combustion and acute respiratory illness in preschool age children in Zimbabwe
International Journal of Epidemiology
Acute respiratory infections (ARI) are a leading cause of childhood illness and death worldwide, accounting for an estimated 6.5% of the entire global burden of disease. 1 In Zimbabwe, as in many other developing countries, ARI are the leading cause of childhood mortality. 2 This study examines the association between household use of high pollution biomass fuels (wood, dung, or straw) and ARI prevalence in children in Zimbabwe using data from a recent nationally representative household
... ve household survey. Biomass fuels are at the low end of the energy ladder in terms of combustion efficiency and cleanliness. 3 Smoke from biomass combustion produces a large number of health-damaging air pollutants including respirable particulate matter, carbon monoxide (CO), nitrogen oxides, formaldehyde, benzene, 1,3 butadiene, polycyclic aromatic hydrocarbons (such as benzo[a]pyrene), and many other toxic organic compounds. In developing countries, where large proportions of households rely on biomass fuels for cooking and space heating, concentrations of these air pollutants tend to be highest indoors. 4 The fuels are typically burned in simple, inefficient, and mostly unvented household cookstoves, which, combined with poor ventilation, generate large volumes of smoke indoors. Moreover, cookstoves are typically used for several hours each day at times when people are present indoors, resulting in much higher exposure to air pollutants than from outdoor sources. 5 Background Reliance on biomass for cooking and heating exposes many women and young children in developing countries to high levels of air pollution indoors. This study investigated the association between household use of biomass fuels for cooking and acute respiratory infections (ARI) in preschool age children (Ͻ5 years) in Zimbabwe. Methods Analysis is based on 3559 children age 0-59 months included in the 1999 Zimbabwe Demographic and Health Survey (ZDHS). Children who suffered from cough accompanied by short, rapid breathing during the 2 weeks preceding the survey were defined as having suffered from ARI. Logistic regression was used to estimate the odds of suffering from ARI among children from households using biomass fuels (wood, dung, or straw) relative to children from households using cleaner fuels (liquid petroleum gas [LPG]/natural gas, or electricity), after controlling for potentially confounding factors. Results About two-thirds (66%) of children lived in households using biomass fuels and 16% suffered from ARI during the 2 weeks preceding the survey interview. After adjusting for child's age, sex, birth order, nutritional status, mother's age at childbirth, education, religion, household living standard, and region of residence, children in households using wood, dung, or straw for cooking were more than twice as likely to have suffered from ARI as children from households using LPG/natural gas or electricity (OR = 2.20; 95% CI: 1. 16, 4.19). Conclusions Household use of high pollution biomass fuels is associated with ARI in children in Zimbabwe. The relationship needs to be further investigated using more direct measures of smoke exposure and clinical measures of ARI.