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Abstracts of the 2019 Annual Conference of the International Society for Environmental Epidemiology, August 25-28 2019, Utrecht, the Netherlands

Associations between Indoor Air Pollution and Acute Respiratory Infections among Under-Five Children in Afghanistan: Do socioeconomic status and sex matter?

J, Rana1,,2,,3; J, Uddin4; R, Peltier1; Y, Oulhote1

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doi: 10.1097/01.EE9.0000609548.64512.7f
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OPS 09: Cookstoves and children, Room 114, Floor 1, August 26, 2019, 1:30 PM - 3:00 PM

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 sex.

Methods: This is a cross-sectional study based on the de-identified data from Afghanistan’s first standard Demographic and Health Survey 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 and household level variations to examine the association between SFU and ARI among under-five children after adjusting for potential confounders and 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 (High Exposure, Moderate, and No Exposure).

Results: Prevalence of SFU was 70.2% 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 ratios [aPR] = 1.10; 95%CI: 0.98, 1.23). We did not observe any effect modification by SES and child sex. When using the augmented measure of exposure incorporating the kitchen’s location, children highly exposed to IAP (aPR 1.17; 95% CI: 1.03, 1.32) had higher prevalence of ARI compared to unexposed children to IAP. This association was modified by SES 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 acting on clean fuels and socio-environmental pathways.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Environmental Epidemiology. All rights reserved.