Household Air Pollution And Its Health Effects Among Under-five Children In Wolaita Sodo Ethiopia.

Background: Household air pollution is among the top ranked global public health concernrnparticularly in developing nations, like Africa. Eighty percent of the population of sub-SaharanrnAfrica and 90% of the Ethiopian population use biomass fuels for cooking. It is linked to many healthrnproblems including acute respiratory infection in children. The cause of this health problems isrnattributable to many factors including household air pollution. Acute respiratory infection is thernmost common illnesses in childhood, comprising as many as 50% of all illnesses in children less thanrn5 years old in the world. Household air pollution is still a big problem in developing countries. InrnEthiopia, pneumonia alone contributed to 27% of all illness and 18% of all deaths to under-fivernchildren. Exposure assessment on indoor air pollution, specifically linked to acute respiratoryrninfection is limited in Ethiopia. rnObjective: To assess household air pollution and its health effects among under-five age childrenrnin Wolaita Sodo town, Ethiopia. rnMethods: A community-based unmatched case-control and cross-sectional study design were usedrnin the study. Census has been conducted prior to the actual data collection to specify samplingrnframe. One thousand one hundred forty-four (1144) children with cases to controls ratio of 1:3 (i.e.rn286 cases and 858 controls) aged 0-59 months paired with their mothers were participated in thernstudy. Cases are defined as a child who fulfilled the world health organization criteria of acuternrespiratory infection (i.e. a child who suffered from cough, followed by rapid breathing in the twornweeks that preceded the survey date), while controls are a child who is free of any complaints ofrnrespiratory illnesses in the two weeks that preceded the survey date. In an eleven Kebele (thernsmallest administrative structure/unit of the government) in the town, six Kebeles were selectedrnrandomly. Sample sizes were distributed based on probability proportional to size of thernhouseholds in each Kebele. Census of all children in the selected Kebeles were conducted to setrnthe sampling frame. Based on the sampling frame, cases and controls of acute respiratory infectionrnin a child were identified using case definition of acute respiratory infection by interviewing theirrnmothers. The mother of a child was interviewed about her child health history for assessment ofrncases and controls.rnFor exposure assessment, a sub sample of 110 kitchens and 66 were involved to determine thernlevel of particulate matter (PMrn2.5rn) and carbon monoxide pollution respectively from biomass fuel rnXIIrnusing a monitoring equipment designed by the University of California, Berkeley Particle Monitorrn(UCB-PM) and HOBO CO data logger, respectively. Data were managed and analyzed using EpirnInfo and SPSS version 21. Exposure data were managed using UCB Monitor Manager softwarern(Version 2.1.3) and BoxCar Pro software (Version 4.3) software. Descriptive statistics, Odds ratio,rnChi-squired tests, Unconditional logistic regression, Linear regression, ANOVA, Pearson'srncorrelation coefficient and Eta-test were employed.rnrnResults: The study was conducted with the response rate of 99.65%. The mean age of the childrenrnwas 24.15 (SD=14.98) months, while the age group between 12-23 months was accounted to 330rn(28.86%). More than three-fourth of children lived in households that used mainly polluting fuelrnfor cooking, biomass fuel 1001 (87.5%), while the rest only 143 (12.5%) of the households usedrnmixed type of fuel energy, such as biomass, electricity, biogas and liquefied petroleum gas. Aboutrn712 (62.23%) of households had a kitchen separated from the main house, while 351 (30.68%) ofrnthe households had kitchen inside the living house. About 417 (58.5%) of the kitchen had nornchimney, 666 (93.54%) didn’t open windows during the cooking time. rnThe prevalence of acute respiratory infection in under-five children were 10.1% (95% CI 9.5,rn10.8). Biomass fuel users for cooking (AOR=2.08, 95% CI 1.03-4.22), poorly ventilated housesrn(AOR=4.31, 95% CI 2.60-7.15), less than 2 years of child birth interval (AOR=1.40, 95% CI 1.021.91),rnlargernrnfamily size, (AOR=1.85, 95% CI 1.30-2.61), petty trade job of mother (AOR=0.50,rn95% CI 0.31-0.81) were significant risk factors of acute respiratory infection in under five children. rnA 24 hour Geometric mean concentration of PMrn2.5rn in all monitored households were 413.27rnµg/mrn3rn. The arithmetic mean 772.03 µg/mrn3 rn(837.39) with 95% CI 613.04, 931.01. The 24 hourrnmeasurement of mean concentration of carbon monoxide in all monitored households were 14.26rnmg/mrn3rn (SD=10.06). Type of fuel use, type of stoves (improved/traditional) and duration of timernspent in cooking had significant differences on the level of particulate matter and Carbonrnmonoxide. rnConclusions: The prevalence of acute respiratory infection is still a public health concern givenrnthe high level of household air pollution. Biomass fuel sources and poor house ventilation had arnsignificant association on acquiring of acute respiratory infection. Mother’s unemployment, higherrnfamily size, child birth interval of less than 2 years, biomass fuel use for cooking, living a poor rnventilated house and carrying child while cooking were risk factors of acute respiratory infectionrnamong children. The geometric mean concentration of particulate matter and carbon monoxidernwere much more exceeded the World Health Organization Air Quality Guideline values. rnRecommendations: Promotion and distribution of improved cooking stoves, introducing betterrnhouse design, promote a separate kitchen, to incorporate a sufficient number of windows andrnrooms in the house are sustainable solutions. Health education and promotion on the preventivernmeasures of acute respiratory infection, the risk of biomass fuel combustion and engaging or carryrnchild in the back while cooking and the importance of house ventilation should be delivered.rnSustainable urban electrification (clean energy supply) is highly recommended solution to solvernthe cooking fuel related health problems.

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