Variations in perinatal mortality associated with different polluting fuel types and kitchen location in Bangladesh

ABSTRACT

This study examines the association between household air pollution from use of polluting cooking fuels and perinatal mortality in Bangladesh. We analysed the data from the Bangladesh Demographic and Health Surveys (BDHS) 2004, 2007, 2011, and 2014. The two outcome variables were stillbirth and early neonatal mortality. The exposure variable was type of primary cooking fuel used in the household (clean vs. polluting). Bivariate and multivariable analyses were conducted to obtain the crude and adjusted odds ratio (aOR), respectively. In the adjusted model, the exposure to polluting fuels was associated with early neonatal mortality (aOR: 1.46, 95% confidence interval [CI]: 1.01–2.10), but not with stillbirth (aOR: 1.25, 95% CI: 0.85–1.84). The effect of cooking with agricultural crop waste was greater for stillbirth (aOR: 1.76, 95% CI: 1.10–2.80) and for early neonatal mortality (aOR: 1.78, 95% CI: 1.13–2.80) which was also associated with wood as the main fuel (aOR: 1.52, 95% CI: 1.04–2.21). Using polluting fuels in an indoor kitchen was associated with an increased odds of stillbirth (aOR: 4.12, 95% CI: 1.49–11.41). Cooking with polluting fuels is associated with perinatal mortality. The combined association of polluting cooking fuels and indoor kitchen location was greater for stillbirth. This effect and the effect of different fuel types need further investigation. Although this is a large sample, there are some limitations with the BDHS data in both recording the exposure and the outcomes. A large prospective trial is needed to determine the precise effect size.

KEYWORDS:

• Perinatal mortality
• Bangladesh
• cooking fuel
• household air pollution
• stillbirth
• early neonatal mortality

Acknowledgements

This paper is a part of MKN’s PhD thesis. We are grateful to Sydney Medical School, The University of Sydney, for funding MKN’s PhD (Early Career Researcher Postgraduate Scholarship). We would like to thank MEASURE DHS and NIPORT for permitting us to analyse the BDHS 2004–2014 data sets. CRG is funded by the National Health and Medical Research Council, Career Development Fellowship #1087062.

Authors’ contributions

MKN, CRG, and AA conceptualised and designed the study. MKN performed the literature review and statistical analysis and drafted the manuscript. MKN and CRG contributed to the interpretation of the data. CRG and AA contributed to the critical revision of the manuscript. All the authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.