Duration of solid fuel cookstove use is associated with increased risk of acute lower respiratory infection among children under six months in rural central India

Autoři: Lauren Arlington aff001;  Archana B. Patel aff002;  Elizabeth Simmons aff001;  Kunal Kurhe aff002;  Amber Prakash aff002;  Sowmya R. Rao aff001;  Patricia L. Hibberd aff001
Působiště autorů: Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America aff001;  Lata Medical Research Foundation, Nagpur, Maharashtra, India aff002;  Department of Pediatrics, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224374



India has a higher number of deaths due to acute lower respiratory infections (ALRIs) in children <5 years than any other country. The underlying cause of half of ALRI deaths is household air pollution from burning of solid fuels, according to the World Health Organization. If there is a direct association between duration of exposure and increased ALRI risk, a potential strategy might be to limit the child’s exposure to burning solid fuel.

Methods and materials

Children born to pregnant women participating in the Global Network for Women and Children's Health Maternal and Newborn Health Registry near Nagpur, India were followed every two weeks from birth to six months to diagnose ALRI. The number of hours per day that the child’s mother spent in front of a burning solid fuel cookstove was recorded. Children of mothers using only clean cookstoves were classified as having zero hours of exposure. Odds Ratios with 95% confidence intervals were obtained from Generalized Estimating Equations logistic models that assessed the relationship of exposure to solid fuels with risk of ≥1 ALRI, adjusted for sex of the child, household smoking, wealth, maternal age, birth weight and parity.


Between August 2013 and March 2014, 302 of 1,586 children (19%) had ≥1 episode of ALRI. Results from the multivariable analysis indicate that the odds of ALRI significantly increased from 1.2 (95% CI: 0.7–2.2) for <1 hour of exposure to 2.1 (95% CI: 1.4–3.3) for >3 hours of exposure to solid fuel cookstoves compared with no exposure (p<0.01). Additionally, decreasing wealth [middle: 1.2 (0.9, 1.6); poor: 1.4 (1.2–1.7); p<0.001] was associated with ALRIs.


Our study findings indicate that increasing the time mothers spend cooking near solid fuel cookstoves while children are in the house may be associated with development of ≥1 ALRI in children <6 months.

Klíčová slova:

Birth weight – Fuels – Children – India – Infants – Mothers – Pollution – Pregnancy


1. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. Elsevier Ltd; 2015;385: 430–440. doi: 10.1016/S0140-6736(14)61698-6

2. Child Health Epidemiology Reference Group. Child Causes of Death Annual Estimates by Country, 2010–2011 [Internet]. Child Health Epidemiology Reference Group; 2012 [cited 2 Mar 2017]. http://cherg.org/projects/underlying_causes.html

3. Mulholland K, Hilton S, Adegbola R, Usen S, Oparaugo A, Omosigho C, et al. Randomised trial of Haemophilus influenzae type-b tetanus protein conjugate for prevention of pneumonia and meningitis in Gambian infants. Lancet. 1997;349: 1191–1197. doi: 10.1016/s0140-6736(96)09267-7 9130939

4. Cutts FT, Zaman SMA, Enwere G, Jaffar S, Levine OS, Okoko JB, et al. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. The LancetThe Lancet. 2005;365: 1139–46. doi: 10.1016/S0140-6736(05)71876-6 15794968

5. Indian Academy of Pediatrics. IAP Immunization Schedule 2016 [Internet]. 2017 [cited 5 Dec 2017]. http://acvip.org/professional/columns/iap-immunization-Schedule-2016-Figure-form

6. Government of India M of H and FW. Shri J P Nadda launches Pneumococcal Conjugate Vaccine (PCV) under Universal Immunization Programme (UIP) [Internet]. 2017 [cited 5 Dec 2017]. http://pib.nic.in/newsite/PrintRelease.aspx?relid=161763

7. Forouzanfar MH, Afshin A, Alexander LT, Biryukov S, Brauer M, Cercy K, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388: 1659–1724. doi: 10.1016/S0140-6736(16)31679-8 27733284

8. Dandona L, Dandona R, Kumar GA, Shukla DK, Paul VK, Balakrishnan K, et al. Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study. Lancet. 2017; 1–24. doi: 10.1016/S0140-6736(17)32804-0 29150201

9. Balakrishnan K, Thangavel G, Ghosh S, Sambandam S, Mukhopadhyay K, Adair-Rohani H, et al. The Global Household Air Pollution Database 2011 (Version 3.0) [Internet]. World Health Organization. Geneva; 2011. http://www.who.int/indoorair/health_impacts/databases_iap/en/

10. Pope CA III, Dockery DW. Health Effects of Fine Particulate Air Pollution: Lines that Connect. J Air Waste Manage Assoc. 2006;56: 709–742. doi: 10.1080/10473289.2006.10464485 16805397

11. World Health Organization. WHO Air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide: Global Update 2005, Summary of risk assessment [Internet]. World Health Organization. Geneva, Switzerland; 2006. https://apps.who.int/iris/bitstream/handle/10665/69477/WHO_SDE_PHE_OEH_06.02_eng.pdf;jsessionid=D984E0D32F3FA3C11D9E13E9E8C69736?sequence=1

12. Balakrishnan K, Ghosh S, Ganguli B, Sambandam S, Bruce N, Barnes DF, et al. State and national household concentrations of PM2.5 from solid cookfuel use: Results from measurements and modeling in India for estimation of the global burden of disease. Environ Heal. 2013;12: 1–14. doi: 10.1186/1476-069X-12-77 24020494

13. Misra P, Srivastava R, Krishnan A, Sreenivaas V, Pandav CS. Indoor air pollution-related acute lower respiratory infections and low birthweight: A systematic review. J Trop Pediatr. 2012;58: 457–466. doi: 10.1093/tropej/fms017 22555386

14. Smith KR, McCracken JP, Weber MW, Hubbard A, Jenny A, Thompson LM, et al. Effect of reduction in household air pollution on childhood pneumonia in Guatemala (RESPIRE): A randomised controlled trial. Lancet. Elsevier Ltd; 2011;378: 1717–1726. doi: 10.1016/S0140-6736(11)60921-5

15. Thakur M, Nuyts PAW, Boudewijns EA, Flores Kim J, Faber T, Babu GR, et al. Impact of improved cookstoves on women’s and child health in low and middle income countries: A systematic review and meta-analysis. Thorax. 2018; 1026–1040. doi: 10.1136/thoraxjnl-2017-210952 29925674

16. Upadhyay AK, Singh A, Kumar K, Singh A. Impact of indoor air pollution from the use of solid fuels on the incidence of life threatening respiratory illnesses in children in India. BMC Public Health. 2015;15: 1–9.

17. Taylor ET, Nakai S. Prevalence of Acute Respiratory Infections in Women and Children in Western Sierra Leone due to Smoke from Wood and Charcoal Stoves. International Journal of Environmental Research and Public Health. 2012. doi: 10.3390/ijerph9062252 22829802

18. Collaborators GBD 2016 LRI. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis. Elsevier Science;, The Lancet Pub. Group; 2018;18: 1191–1210. doi: 10.1016/S1473-3099(18)30310-4 30243584

19. Global Alliance for Clean Cookstoves. Results report 2014: Sharing progress on the path to adoption of clean and efficient cooking solutions [Internet]. Washington D.C.; 2014. http://cleancookstoves.org/research-and-evaluation/measuring-progress/

20. Ministry of Petroleum and Natural Gas. Official Website of Pradhan Mantri Ujjwala Yojana. In: 2017? [Internet]. [cited 29 Nov 2017]. http://www.pmujjwalayojana.com/

21. Goudar SS, Carlo WA, McClure EM, Pasha O, Patel A, Esamai F, et al. The Maternal and Newborn Health Registry Study of the Global Network for Women’s and Children’s Health Research. Int J Gynecol Obstet. 2012;118: 190–193. doi: 10.1016/j.ijgo.2012.04.022 22738806

22. Patel AB, Meleth S, Pasha O, Goudar SS, Esamai F, Garces AL, et al. Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality—a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala. Matern Heal Neonatol Perinatol. Maternal Health, Neonatology and Perinatology; 2015;1: 1–12. doi: 10.1186/s40748-015-0019-0 27057335

23. ICF International. (2011). Demographic and Health Surveys Methodology—Questionnaires: Household, Woman’s, and Man’s. Retrieved from http://www.measuredhs.com/publications/publication-DHSQ6-DHS-Questionnaires-and-Manuals.cfm

24. Chakraborty D, Mondal NK, Datta JK. Indoor pollution from solid biomass fuel and rural health damage: A micro-environmental study in rural area of Burdwan, West Bengal. Int J Sustain Built Environ. 2014;3: 262–271. https://doi.org/10.1016/j.ijsbe.2014.11.002

25. World Health Organization. Integrated Management of Childhood Illness: Global Survey Report. Geneva, Switzerland; 2017.

26. Rutstein SO, Johnson K. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland; 2004.

27. Bates MN, Pokhrel AK, Chandyo RK, Valentiner-Branth P, Mathisen M, Basnet S, et al. Kitchen PM2.5 concentrations and child acute lower respiratory infection in Bhaktapur, Nepal: The importance of fuel type. Environ Res. Elsevier Inc.; 2018;161: 546–553. doi: 10.1016/j.envres.2017.11.056 29241064

28. Rylance J, Fullerton DG, Scriven J, Aljurayyan AN, Mzinza D, Barrett S, et al. Household air pollution causes dose-dependent inflammation and altered phagocytosis in human macrophages. Am J Respir Cell Mol Biol. 2015;52: 584–593. doi: 10.1165/rcmb.2014-0188OC 25254931

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