Household air pollution from cooking fuels and its association with under-five mortality in Bangladesh

Background: Solid fuel use was found to be associated with under-five mortality in low- and lower-middle income countries (LMICs) though current understanding is lacking for Bangladesh. This study investigated the associations between HAP and neonatal, infant and under-five child mortality in Bangladesh. Methods: We analysed 4189 mother-child dyads data extracted from the 2017/18 Bangladesh Demographic and Health Survey data. Fuel types and levels of exposure to HAP (unexposed, moderately exposed, highly exposed) were considered as exposure variables and several forms of child mortality was considered as outcome variables. Relationships between the exposure and outcome variables were explored by using the multilevel mixed-effect logistic regression model adjusting for possible confounders. Results: Solid fuels were found to be used in nearly 80% of the total mothers analysed. A higher likelihood of mortality was found among neonates (aOR, 3.78; 95% CI, 1.14-12.51) and infants (aOR, 2.93; 95% CI, 1.60-6.15) of the women who used solid fuels as compared to the mothers who used clean fuel. The association was found strongest when we considered solid fuel used together with place of cooking. The likelihood of neonatal and infant mortality was found 4.33 (95% CI, 1.16-16.23) and 2.05 (95% CI, 1.18-7.23) times higher among mothers who were highly exposed to solid fuel used as compared to the mothers who were unexposed to solid fuel used. Conclusion: Solid fuels used is an important cause of neonatal and under-five mortality in Bangladesh. Administrative initiatives to increase clean fuel use are need to be prioritized in the national level policies and programs. Awareness building programs covering adverse effects of solid fuels used on human health, particularly child health, should also be taken to motivate mothers not to bring their under-five aged children in the cooking place.