Household air pollution and under-five mortality in South Asia : epidemiology and policies for prevention

Household air pollution (HAP), predominantly from cooking fuel, is a major public health hazard and one of the leading causes of respiratory illness and death among young children under-five years of age. Approximately, 3 billion people still rely on solid fuels (e.g. wood, crop residue, coal, animal dung etc.) for their everyday cooking and heating. Exposure to HAP resulting from indoor smoke from solid fuels is a substantial cause of respiratory illness and death among young children in low and middle-income countries, and globally, more than 2.9 million annual deaths have been attributed to HAP. Very few studies in the South Asian region have addressed HAP related child mortality outcomes, which is an ongoing public health concern. Most of the studies in this region have mainly focused on HAP related morbidity outcomes among young children. This thesis examined the association between HAP from cooking fuel and under-five mortality in South Asia by using nationally representative surveys. Specifically, a series of studies for Bangladesh, India, Pakistan and Nepal were conducted in this thesis to investigate the following: (1) to establish the strength of the association between HAP from use of cooking fuel and under-five mortality in Bangladesh, India, Pakistan and Nepal; (2) to investigate trends in HAP and its impact on under-five mortality over time in South Asia; (3) to identify the role of key environmental and behavioral factors (for example, breastfeeding status, place of residence and location of kitchen) that might affect the level of HAP exposure from use of cooking fuel associated with under-five mortality within South Asian countries; (4) to assess the attributable risk associated with HAP from use of cooking fuel and under-five mortality, and to examine theoretical scenarios assessing the potential impact of interventions to reduce HAP exposure. A series of nationally representative Demographic and Health Survey (DHS) datasets for Bangladesh, India, Pakistan and Nepal were used to address these specific objectives