Cooking and Season as Risk Factors for Acute Lower XXXX in African @entity1 : A Cross-Sectional Multi-Country Analysis.

@entity1 @entity15788 @entity26853 @entity48491 @entity20864 @entity1729 @entity15878 @entity204 @entity20797
BACKGROUND: Acute lower @entity1729 (ALRI) are a leading cause of @entity204 among African @entity1 under five. A significant proportion of these are attributable to household air pollution from solid fuel use. METHODS: We assessed the relationship between cooking practices and ALRI in pooled datasets of Demographic and Health Surveys conducted between 2000 and 2011 in countries of sub-Saharan Africa. The impacts of main cooking fuel, cooking location and stove ventilation were examined in 18 (n = 56,437), 9 (n = 23,139) and 6 countries (n = 14,561) respectively. We used a causal diagram and multivariable logistic mixed models to assess the influence of covariates at individual, regional and national levels. RESULTS: Main cooking fuel had a statistically significant impact on ALRI risk (p<0.0001), with season acting as an effect modifier (p = 0.034). During the rainy season, relative to clean fuels, the odds of suffering from ALRI were raised for @entity15788 ( @entity20864 ; CI: 0.99, 2.71), coal and charcoal ( @entity20797 ; CI: 1.21, 1.97), wood (OR 1.20; CI: 0.95, 1.51) and lower-grade biomass fuels (OR 1.49; CI: 0.93, 2.35). In contrast, during the dry season the corresponding odds were reduced for @entity15788 ( @entity48491 ; CI: 0.77, 1.95), coal and charcoal ( @entity26853 ; CI: 1.06, 1.72) and lower-grade biomass fuels (OR 1.07; CI: 0.69, 1.66) but increased for wood ( @entity15878 ; CI: 1.04, 1.66). Cooking location also emerged as a season-dependent statistically significant (p = 0.0070) determinant of ALRI, in particular cooking indoors without a separate kitchen during the rainy season (OR 1.80; CI: 1.30, 2.50). Due to infrequent use in Africa we could, however, not demonstrate an effect of stove ventilation. CONCLUSIONS: We found differential and season-dependent risks for different types of solid fuels and @entity15788 as well as cooking location on @entity1 ALRI. Future household air pollution studies should consider potential effect modification of cooking fuel by season.
