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

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 and has child national status, vaccination status and season as 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 enablers and barriers of outdoor cooking among those living in biomass fuel households, to develop a health promotional intervention.