title: Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children.
abstract: BACKGROUND
  Almost half of global child deaths due to acute lower respiratory infections (ALRIs) occur in sub-Saharan Africa, where three-quarters of the population cook with solid fuels. This study aims to quantify the impact of fuel type and cooking practices on childhood ALRI mortality in Africa, and to explore implications for public health interventions.
  
  
  METHODS
  Early-release World Health Survey data for the year 2003 were pooled for 16 African countries. Among 32,620 children born during the last 10 years, 1455 (4.46%) were reported to have died prior to their fifth birthday. Survival analysis was used to examine the impact of different cooking-related parameters on ALRI mortality, defined as cough accompanied by rapid breathing or chest indrawing based on maternal recall of symptoms prior to death.
  
  
  RESULTS
  Solid fuel use increases the risk of ALRI mortality with an adjusted hazard ratio of 2.35 (95% CI 1.22 to 4.52); this association grows stronger with increasing outcome specificity. Differences between households burning solid fuels on a well-ventilated stove and households relying on cleaner fuels are limited. In contrast, cooking with solid fuels in the absence of a chimney or hood is associated with an adjusted hazard ratio of 2.68 (1.38 to 5.23). Outdoor cooking is less harmful than indoor cooking but, overall, stove ventilation emerges as a more significant determinant of ALRI mortality.
  
  
  CONCLUSIONS
  This study shows substantial differences in ALRI mortality risk among African children in relation to cooking practices, and suggests that stove ventilation may be an important means of reducing indoor air pollution.
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany. rehfuess@ibe.med.uni-muenchen.de
authors.forename: E A
authors.initials: EA
authors.lastname: Rehfuess
authors.forename: L
authors.initials: L
authors.lastname: Tzala
authors.forename: N
authors.initials: N
authors.lastname: Best
authors.forename: D J
authors.initials: DJ
authors.lastname: Briggs
authors.forename: M
authors.initials: M
authors.lastname: Joffe
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D046688:Child Mortality; D002675:Child, Preschool; D003296:Cooking / Q000379:methods*; D005579:Fossil Fuels / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D016016:Proportional Hazards Models; D012141:Respiratory Tract Infections / Q000401:mortality*; D012307:Risk Factors; D012906:Smoke / Q000009:adverse effects*; D014691:Ventilation / Q000379:methods; D014934:Wood / Q000009:adverse effects
chemical_list: D005579:Fossil Fuels; D012906:Smoke