The paper finds that solid fuel use was very common (87% in households with child deaths and 77% in households with living children).
The paper notes that more girls than boys died from exposure to solid fuels. Solid fuel use was also associated with non-fatal pneumonia (boys: PR 1.54 95%CI 1.01-2.35; girls: PR 1.94 95%CI 1.13-3.33). After adjustment for demographic factors and living conditions, solid-fuel use significantly increase child deaths at ages 1-4 (prevalence ratio (PR) boys: 1.30, 95%CI 1.08-1.56; girls: 1.33, 95%CI 1.12-1.58).
The researchers find that with the exception of the colder regions of India, girl deaths at ages 1-4 years had higher prevalence of solid-fuel use when compared to living girls of the same age than did boys. The frequency of self-reported pneumonia was not different between boys and girls but they observed higher solid-fuel use among girls with self-reported pneumonia. Time spent indoors and proximity to pollution source influence the level of exposure and data also suggest that girls spend more time indoors than boys. Other factors such as gender preference, believe the researchers, may also influence treatment access and we believe that differential access to health services may explain the higher mortality among girls. Indeed, hospital based studies have shown that boys are more likely than girls to be admitted for acute respiratory infections.
Such findings are sometimes interpreted as if boys had a higher susceptibility to respiratory infections than girls, but the higher hospital admission rates for boys may be a consequence of the gender differences in access to health care, according to the study. Treating child respiratory symptoms from solid fuel smoke may prevent child deaths while not affecting the incidence of respiratory symptoms, and indeed boys and girls had equal incidence of self-reported pneumonia but girls had higher mortality.
Other factors may explain the gender differences in survival after the onset of pneumonia and further studies are needed to clarify the role of severity of respiratory diseases and other biological factors (i.e. ability to overcome disease/survive), says the paper. The study says it is less subject to gender-based selection bias because it collects information directly in the household.
The researchers compared household solid fuel use in 1998 between 6790 child deaths, from all causes, in the previous year and 609601 living children from 1.1 million nationally-representative homes in India. Analysis were stratified by child’s gender, age (neonatal, post-neonatal, 1-4 years) and colder versus warmer states. They also examined the association of solid fuel to non-fatal pneumonias.
Most households in developing countries, including in India, use solid fuels (coal/coke/lignite, firewood, dung, and crop residue) for cooking and heating. Such fuels increase child mortality, chiefly from acute respiratory infection. There are, however, few direct estimates of the impact of solid fuel on child mortality in India.
Read the Full Paper here:
by Diego G Bassani, Prabhat Jha, Neeraj Dhingra, Rajesh Kumar
