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Associations between Indoor Air Pollution and Acute Respiratory Infections among Under-Five Children in Afghanistan: Do SES and Sex Matter?

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  • Juwel Rana

    (Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA
    Department of Environmental and Occupational Health Sciences, EHESP French School of Public Health, Paris 93210, France
    South Asia Institute for Social Transformation (SAIST), Dhaka 1205, Bangladesh)

  • Jalal Uddin

    (Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233, USA)

  • Richard Peltier

    (Department of Environmental Health, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA)

  • Youssef Oulhote

    (Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA)

Abstract

Background : Low-income families often depend on fuels such as wood, coal, and animal dung for cooking. Such solid fuels are highly polluting and are a primary source of indoor air pollutants (IAP). We examined the association between solid fuel use (SFU) and acute respiratory infection (ARI) among under-five children in Afghanistan and the extent to which this association varies by socioeconomic status (SES) and gender. Materials and Methods : This is a cross-sectional study based on de-identified data from Afghanistan’s first standard Demographic and Health Survey (DHS) conducted in 2015. The sample consists of ever-married mothers with under-five children in the household ( n = 27,565). We used mixed-effect Poisson regression models with robust error variance accounting for clustering to examine the associations between SFU and ARI among under-five children after adjusting for potential confounders. We also investigated potential effect modification by SES and sex. Additional analyses were conducted using an augmented measure of the exposure to IAP accounting for both SFU and the location of cooking/kitchen (High Exposure, Moderate, and No Exposure). Results : Around 70.2% of households reported SFU, whereas the prevalence of ARI was 17.6%. The prevalence of ARI was higher in children living in households with SFU compared to children living in households with no SFU (adjusted prevalence ratio (aPR) = 1.10; 95% CI: (0.98, 1.23)). We did not observe any effect modification by SES or child sex. When using the augmented measure of exposure incorporating the kitchen’s location, children highly exposed to IAP had a higher prevalence of ARI compared to unexposed children (aPR = 1.17; 95% CI: (1.03, 1.32)). SES modified this association with the strongest associations observed among children from the middle wealth quintile. Conclusion : The findings have significant policy implications and suggest that ARI risk in children may be reduced by ensuring there are clean cookstoves as well as clean fuels and acting on the socio-environmental pathways.

Suggested Citation

  • Juwel Rana & Jalal Uddin & Richard Peltier & Youssef Oulhote, 2019. "Associations between Indoor Air Pollution and Acute Respiratory Infections among Under-Five Children in Afghanistan: Do SES and Sex Matter?," IJERPH, MDPI, vol. 16(16), pages 1-13, August.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:16:p:2910-:d:257462
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    References listed on IDEAS

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    1. Sahana Mathiarasan & Anke Hüls, 2021. "Impact of Environmental Injustice on Children’s Health—Interaction between Air Pollution and Socioeconomic Status," IJERPH, MDPI, vol. 18(2), pages 1-10, January.
    2. Daniel B. Odo & Ian A. Yang & Luke D. Knibbs, 2021. "A Systematic Review and Appraisal of Epidemiological Studies on Household Fuel Use and Its Health Effects Using Demographic and Health Surveys," IJERPH, MDPI, vol. 18(4), pages 1-31, February.
    3. Ishwar Tiwari & Raphael M. Herr & Adrian Loerbroks & Shelby S. Yamamoto, 2020. "Household Air Pollution and Angina Pectoris in Low- and Middle-Income Countries: Cross-Sectional Evidence from the World Health Survey 2002–2003," IJERPH, MDPI, vol. 17(16), pages 1-14, August.
    4. Zelalem G. Terfa & Sayem Ahmed & Jahangir Khan & Louis W. Niessen & on behalf of the IMPALA Consortium, 2022. "Household Microenvironment and Under-Fives Health Outcomes in Uganda: Focusing on Multidimensional Energy Poverty and Women Empowerment Indices," IJERPH, MDPI, vol. 19(11), pages 1-17, May.

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