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

Katherine Woolley, Suzanne Bartington, Telesphore Kabera, Xiang Qian Lao, Francis Pope, Sheila Greenfield, Malcolm Price, G Neil Thomas

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Abstract

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.
Original languageEnglish
Article number9305
Number of pages18
JournalInternational Journal of Environmental Research and Public Health
Volume18
Issue number17
DOIs
Publication statusPublished - 3 Sept 2021

Bibliographical note

Funding Information:
This study has been funded by a University of Birmingham Global Challenges Scholarship held by KW, the Institute for Global Innovation (IGI) ?Clean Air? and ?Resilient Cities? themes and UK Department for International Development (DFID) via the East Africa Research Fund (EARF) grant ?A Systems Approach to Air Pollution (ASAP) East Africa and EPSRC (EP/T030100/1). MJP is supported by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The APC was funded by the University of Birmingham Library service.

Funding Information:
Funding: This study has been funded by a University of Birmingham Global Challenges Scholarship held by KW, the Institute for Global Innovation (IGI) ’Clean Air’ and ‘Resilient Cities’ themes and UK Department for International Development (DFID) via the East Africa Research Fund (EARF) grant ‘A Systems Approach to Air Pollution (ASAP) East Africa and EPSRC (EP/T030100/1). MJP is supported by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The APC was funded by the University of Birmingham Library service.

Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Keywords

  • acute respiratory infection
  • biomass fuel
  • household air pollution
  • respiratory symptoms
  • low-and middle-income countries
  • Household air pollution
  • Respiratory symptoms
  • Low-and middle-income countries
  • Acute respiratory infection
  • Biomass fuel

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Pollution
  • Health, Toxicology and Mutagenesis

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