Household air pollution from cooking fuels and its association with under-five mortality in Bangladesh

BackgroundSolid fuel use was found to be associated with under-five mortality in low- and lower-middle income countries (LMICs). However, the current understanding of this association for Bangladesh is absent through around 80% of the total households in Bangladesh used solid fuel and the higher under-five mortality rate is a significant public health burden. We explored the associations of household cooking fuels used and the level of exposure to HAP through cooking fuels used with neonatal, infant, and under-five child mortality in Bangladesh.MethodsWe analysed 4,198 mother-child dyads data extracted from the 2017/18 Bangladesh Demographic and Health Survey data. Type of cooking fuels used (solid fuel, clean fuel) and level of exposure to HAP through cooking fuels used (unexposed, moderately exposed, highly exposed) were considered as exposure variables. Neonatal, infant and under-five mortality were considered as the outcome variables. Relationships between the exposure and outcome variable were explored by using the multilevel mixed-effect logistic regression model adjusting for possible confounders.ResultsSolid fuels were found to be used in nearly 80% of the total mothers analysed. A higher likelihood of mortality was found among neonates (aOR, 3.78; 95% CI, 1.14-12.51) and infants (aOR, 2.93; 95% CI, 1.60-6.15) of the women who used solid fuels as compared to the mothers who used clean fuel. The association was found strongest when we considered solid fuel used together with place of cooking. The likelihood of neonatal and infant mortality was found 4.33 (95% CI, 1.16-16.23) and 2.05 (95% CI, 1.18-7.23) times higher among mothers who were highly exposed to solid fuel used as compared to the mothers who were unexposed to solid fuel used.ConclusionSolid fuel used and its increased exposure increased the occurrence of neonatal and infant mortality. Prioritizing the use of clean fuel use and increasing awareness about the adverse effects of solid fuel use are important.