Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys

Katherine E. Woolley; G. Neil Thomas; Bruce Kirenga; Gabriel Okello; Telesphore Kabera; Xiang-Qian Lao; Francis D. Pope; Sheila M. Greenfield; Malcolm J. Price; Suzanne E. Bartington

doi:10.1016/j.atmosenv.2022.119055

Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys

Katherine E. Woolley, G. Neil Thomas^*, Bruce Kirenga, Gabriel Okello, Telesphore Kabera, Xiang-Qian Lao, Francis D. Pope, Sheila M. Greenfield, Malcolm J. Price, Suzanne E. Bartington

^*Corresponding author for this work

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

7 Citations (Scopus)

Abstract

Background: Cooking location among households using solid biomass cooking fuels may have implications for exposure to harmful levels of Household Air Pollution (HAP). However, little is known about the predictors of cooking location and their association with Acute Respiratory Infections (ARI); a leading cause of mortality in children aged under five years worldwide, which has child nutritional status, vaccination status and season as known risk factors.

Objectives: This cross-sectional study aimed to ascertain (i) the determinants of household cooking location behaviour and (ii) the association between cooking location and risk of respiratory symptoms and ARIs in children under five years residing in solid biomass cooking households, using Demographic and Health Survey data from Sub-Saharan Africa (SSA).

Methods: Data were obtained for 30 SSA countries including of 263,948 children aged under five years living in solid biomass burning households only. The occurrence of respiratory symptoms (cough, shortness of breath) and fever in the two weeks prior to interview were obtained by maternal-report; generating composite variables for ARI (shortness of breath, cough) and severe ARI (SARI) (shortness of breath, cough, fever). Associations for determinants of household cooking location behaviour, respiratory symptoms and ARIs were determined through logistic regression analysis, adjusting for country, regional, household and individual-level confounding factors.

Results: After adjustment, outdoor cooking was more likely among households with lower wealth index, younger and lower educated household heads, fewer household members, cooking fuel type (charcoal, coal), empowered females, urban place of residence, wet season, compared to indoor. Reduced odds ratios of SARI (AOR:0.87[0.80–0.94]), ARI (AOR:0.89[0.83–0.95]), cough (AOR:0.90[0.86–0.95]), shortness of breath (AOR:0.91[0.85–0.89]) and fever (AOR:0.85[0.81–0.89]) were observed among children residing in outdoor compared to cooking in the house. In rural areas only outdoor cooking was associated with reduced odds ratios of cough (AOR:0.89[0.82,0.95]), fever (AOR:0.86[0.79–0.92]), ARI (AOR:0.92[0.87–0.96]) and SARI (AOR:0.86[0.77–0.95]). However, in urban areas cough (AOR:0.90[0.82–0.98]), shortness of breath (AOR:0.89[0.79–0.99]), fever (AOR: 0.81[0.75–0.88]) and ARI (AOR:0.88[0.78–0.99]) were associated with outdoor cooking.

Discussion: Outdoor household cooking locations mitigates HAP exposure and is associated with reduced respiratory health impacts among children aged under five years in resource poor settings. Further mixed-methods research is necessary to understand the enablers and barriers of outdoor cooking among those living in biomass fuel households, to develop a health promotion intervention.

Original language	English
Article number	119055
Journal	Atmospheric Environment
Volume	276
Online published	12 Mar 2022
DOIs	https://doi.org/10.1016/j.atmosenv.2022.119055
Publication status	Published - 1 May 2022
Externally published	Yes

Funding

This study would not have been possible without the approval and access to the DHS data archive. The project was funded with KEW holding a University of Birmingham Global Challenges PhD Scholarship, the University of Birmingham 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. This study would not have been possible without the approval and access to the DHS data archive. The project was funded with KEW holding a University of Birmingham Global Challenges PhD Scholarship, the University of Birmingham 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.

Research Keywords

Acute respiratory infection
Child health
Household air pollution
Outdoor cooking
Solid biomass fuels

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Woolley, K. E., Thomas, G. N., Kirenga, B., Okello, G., Kabera, T., Lao, X.-Q., Pope, F. D., Greenfield, S. M., Price, M. J., & Bartington, S. E. (2022). Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys. Atmospheric Environment, 276, Article 119055. https://doi.org/10.1016/j.atmosenv.2022.119055

@article{acbd343c4ddc4be1a992b71066706031,

title = "Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys",

abstract = "Background: Cooking location among households using solid biomass cooking fuels may have implications for exposure to harmful levels of Household Air Pollution (HAP). However, little is known about the predictors of cooking location and their association with Acute Respiratory Infections (ARI); a leading cause of mortality in children aged under five years worldwide, which has child nutritional status, vaccination status and season as known risk factors. Objectives: This cross-sectional study aimed to ascertain (i) the determinants of household cooking location behaviour and (ii) the association between cooking location and risk of respiratory symptoms and ARIs in children under five years residing in solid biomass cooking households, using Demographic and Health Survey data from Sub-Saharan Africa (SSA). Methods: Data were obtained for 30 SSA countries including of 263,948 children aged under five years living in solid biomass burning households only. The occurrence of respiratory symptoms (cough, shortness of breath) and fever in the two weeks prior to interview were obtained by maternal-report; generating composite variables for ARI (shortness of breath, cough) and severe ARI (SARI) (shortness of breath, cough, fever). Associations for determinants of household cooking location behaviour, respiratory symptoms and ARIs were determined through logistic regression analysis, adjusting for country, regional, household and individual-level confounding factors. Results: After adjustment, outdoor cooking was more likely among households with lower wealth index, younger and lower educated household heads, fewer household members, cooking fuel type (charcoal, coal), empowered females, urban place of residence, wet season, compared to indoor. Reduced odds ratios of SARI (AOR:0.87[0.80–0.94]), ARI (AOR:0.89[0.83–0.95]), cough (AOR:0.90[0.86–0.95]), shortness of breath (AOR:0.91[0.85–0.89]) and fever (AOR:0.85[0.81–0.89]) were observed among children residing in outdoor compared to cooking in the house. In rural areas only outdoor cooking was associated with reduced odds ratios of cough (AOR:0.89[0.82,0.95]), fever (AOR:0.86[0.79–0.92]), ARI (AOR:0.92[0.87–0.96]) and SARI (AOR:0.86[0.77–0.95]). However, in urban areas cough (AOR:0.90[0.82–0.98]), shortness of breath (AOR:0.89[0.79–0.99]), fever (AOR: 0.81[0.75–0.88]) and ARI (AOR:0.88[0.78–0.99]) were associated with outdoor cooking. Discussion: Outdoor household cooking locations mitigates HAP exposure and is associated with reduced respiratory health impacts among children aged under five years in resource poor settings. Further mixed-methods research is necessary to understand the enablers and barriers of outdoor cooking among those living in biomass fuel households, to develop a health promotion intervention. {\textcopyright} 2022 Elsevier Ltd.",

keywords = "Acute respiratory infection, Child health, Household air pollution, Outdoor cooking, Solid biomass fuels",

author = "Woolley, {Katherine E.} and Thomas, {G. Neil} and Bruce Kirenga and Gabriel Okello and Telesphore Kabera and Xiang-Qian Lao and Pope, {Francis D.} and Greenfield, {Sheila M.} and Price, {Malcolm J.} and Bartington, {Suzanne E.}",

note = "Publisher Copyright: {\textcopyright} 2022 Elsevier Ltd",

year = "2022",

month = may,

day = "1",

doi = "10.1016/j.atmosenv.2022.119055",

language = "English",

volume = "276",

journal = "Atmospheric Environment",

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}

Woolley, KE, Thomas, GN, Kirenga, B, Okello, G, Kabera, T, Lao, X-Q, Pope, FD, Greenfield, SM, Price, MJ & Bartington, SE 2022, 'Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys', Atmospheric Environment, vol. 276, 119055. https://doi.org/10.1016/j.atmosenv.2022.119055

Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys. / Woolley, Katherine E.; Thomas, G. Neil; Kirenga, Bruce et al.
In: Atmospheric Environment, Vol. 276, 119055, 01.05.2022.

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

TY - JOUR

T1 - Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys

AU - Woolley, Katherine E.

AU - Thomas, G. Neil

AU - Kirenga, Bruce

AU - Okello, Gabriel

AU - Kabera, Telesphore

AU - Lao, Xiang-Qian

AU - Pope, Francis D.

AU - Greenfield, Sheila M.

AU - Price, Malcolm J.

AU - Bartington, Suzanne E.

PY - 2022/5/1

Y1 - 2022/5/1

N2 - Background: Cooking location among households using solid biomass cooking fuels may have implications for exposure to harmful levels of Household Air Pollution (HAP). However, little is known about the predictors of cooking location and their association with Acute Respiratory Infections (ARI); a leading cause of mortality in children aged under five years worldwide, which has child nutritional status, vaccination status and season as known risk factors. Objectives: This cross-sectional study aimed to ascertain (i) the determinants of household cooking location behaviour and (ii) the association between cooking location and risk of respiratory symptoms and ARIs in children under five years residing in solid biomass cooking households, using Demographic and Health Survey data from Sub-Saharan Africa (SSA). Methods: Data were obtained for 30 SSA countries including of 263,948 children aged under five years living in solid biomass burning households only. The occurrence of respiratory symptoms (cough, shortness of breath) and fever in the two weeks prior to interview were obtained by maternal-report; generating composite variables for ARI (shortness of breath, cough) and severe ARI (SARI) (shortness of breath, cough, fever). Associations for determinants of household cooking location behaviour, respiratory symptoms and ARIs were determined through logistic regression analysis, adjusting for country, regional, household and individual-level confounding factors. Results: After adjustment, outdoor cooking was more likely among households with lower wealth index, younger and lower educated household heads, fewer household members, cooking fuel type (charcoal, coal), empowered females, urban place of residence, wet season, compared to indoor. Reduced odds ratios of SARI (AOR:0.87[0.80–0.94]), ARI (AOR:0.89[0.83–0.95]), cough (AOR:0.90[0.86–0.95]), shortness of breath (AOR:0.91[0.85–0.89]) and fever (AOR:0.85[0.81–0.89]) were observed among children residing in outdoor compared to cooking in the house. In rural areas only outdoor cooking was associated with reduced odds ratios of cough (AOR:0.89[0.82,0.95]), fever (AOR:0.86[0.79–0.92]), ARI (AOR:0.92[0.87–0.96]) and SARI (AOR:0.86[0.77–0.95]). However, in urban areas cough (AOR:0.90[0.82–0.98]), shortness of breath (AOR:0.89[0.79–0.99]), fever (AOR: 0.81[0.75–0.88]) and ARI (AOR:0.88[0.78–0.99]) were associated with outdoor cooking. Discussion: Outdoor household cooking locations mitigates HAP exposure and is associated with reduced respiratory health impacts among children aged under five years in resource poor settings. Further mixed-methods research is necessary to understand the enablers and barriers of outdoor cooking among those living in biomass fuel households, to develop a health promotion intervention. © 2022 Elsevier Ltd.

AB - Background: Cooking location among households using solid biomass cooking fuels may have implications for exposure to harmful levels of Household Air Pollution (HAP). However, little is known about the predictors of cooking location and their association with Acute Respiratory Infections (ARI); a leading cause of mortality in children aged under five years worldwide, which has child nutritional status, vaccination status and season as known risk factors. Objectives: This cross-sectional study aimed to ascertain (i) the determinants of household cooking location behaviour and (ii) the association between cooking location and risk of respiratory symptoms and ARIs in children under five years residing in solid biomass cooking households, using Demographic and Health Survey data from Sub-Saharan Africa (SSA). Methods: Data were obtained for 30 SSA countries including of 263,948 children aged under five years living in solid biomass burning households only. The occurrence of respiratory symptoms (cough, shortness of breath) and fever in the two weeks prior to interview were obtained by maternal-report; generating composite variables for ARI (shortness of breath, cough) and severe ARI (SARI) (shortness of breath, cough, fever). Associations for determinants of household cooking location behaviour, respiratory symptoms and ARIs were determined through logistic regression analysis, adjusting for country, regional, household and individual-level confounding factors. Results: After adjustment, outdoor cooking was more likely among households with lower wealth index, younger and lower educated household heads, fewer household members, cooking fuel type (charcoal, coal), empowered females, urban place of residence, wet season, compared to indoor. Reduced odds ratios of SARI (AOR:0.87[0.80–0.94]), ARI (AOR:0.89[0.83–0.95]), cough (AOR:0.90[0.86–0.95]), shortness of breath (AOR:0.91[0.85–0.89]) and fever (AOR:0.85[0.81–0.89]) were observed among children residing in outdoor compared to cooking in the house. In rural areas only outdoor cooking was associated with reduced odds ratios of cough (AOR:0.89[0.82,0.95]), fever (AOR:0.86[0.79–0.92]), ARI (AOR:0.92[0.87–0.96]) and SARI (AOR:0.86[0.77–0.95]). However, in urban areas cough (AOR:0.90[0.82–0.98]), shortness of breath (AOR:0.89[0.79–0.99]), fever (AOR: 0.81[0.75–0.88]) and ARI (AOR:0.88[0.78–0.99]) were associated with outdoor cooking. Discussion: Outdoor household cooking locations mitigates HAP exposure and is associated with reduced respiratory health impacts among children aged under five years in resource poor settings. Further mixed-methods research is necessary to understand the enablers and barriers of outdoor cooking among those living in biomass fuel households, to develop a health promotion intervention. © 2022 Elsevier Ltd.

KW - Acute respiratory infection

KW - Child health

KW - Household air pollution

KW - Outdoor cooking

KW - Solid biomass fuels

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DO - 10.1016/j.atmosenv.2022.119055

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Woolley KE, Thomas GN, Kirenga B, Okello G, Kabera T, Lao XQ et al. Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys. Atmospheric Environment. 2022 May 1;276:119055. Epub 2022 Mar 12. doi: 10.1016/j.atmosenv.2022.119055

Association of household cooking location behaviour with acute respiratory infections among children aged under five years; a cross sectional analysis of 30 Sub-Saharan African Demographic and Health Surveys

Abstract

Funding

Research Keywords

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