title: The effect of exposure to wood smoke on outcomes of childhood pneumonia in Botswana.
abstract: METHODS
  Tertiary hospital in Gaborone, Botswana.
  
  
  OBJECTIVE
  To examine whether exposure to wood smoke worsens outcomes of childhood pneumonia.
  
  
  METHODS
  Prospective cohort study of children aged 1-23 months meeting clinical criteria for pneumonia. Household use of wood as a cooking fuel was assessed during a face-to-face questionnaire with care givers. We estimated crude and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for treatment failure at 48 h by household use of wood as a cooking fuel. We assessed for effect modification by age (1-5 vs. 6-23 months) and malnutrition (none vs. moderate vs. severe).
  
  
  RESULTS
  The median age of the 284 enrolled children was 5.9 months; 17% had moderate or severe malnutrition. Ninety-nine (35%) children failed treatment at 48 h and 17 (6%) died. In multivariable analyses, household use of wood as a cooking fuel increased the risk of treatment failure at 48 h (RR 1.44, 95%CI 1.09-1.92, P = 0.01). This association differed by child nutritional status (P = 0.02), with a detrimental effect observed only among children with no or moderate malnutrition.
  
  
  CONCLUSIONS
  Exposure to wood smoke worsens outcomes for childhood pneumonia. Efforts to prevent exposure to smoke from unprocessed fuels may improve pneumonia outcomes among children.
authors: Botswana-UPenn Partnership, Gaborone, Botswana; Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA;Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
authors: M S
authors: MS
authors: Kelly
authors: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors: K E
authors: KE
authors: Wirth
authors: Department of Environmental and Occupational Health, Rutgers School of Public Health, Piscataway, New Jersey, USA.
authors: J
authors: J
authors: Madrigano
authors: Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: K A
authors: KA
authors: Feemster
authors: Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA.
authors: C K
authors: CK
authors: Cunningham
authors: Botswana-UPenn Partnership, Gaborone, Botswana; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: T
authors: T
authors: Arscott-Mills
authors: Botswana-UPenn Partnership, Gaborone, Botswana.
authors: S
authors: S
authors: Boiditswe
authors: Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: S S
authors: SS
authors: Shah
authors: Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: R
authors: R
authors: Finalle
authors: Botswana-UPenn Partnership, Gaborone, Botswana; Global Health Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors: A P
authors: AP
authors: Steenhoff
mesh_terms: D001902:Botswana / Q000453:epidemiology; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003296:Cooking; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology; D015999:Multivariate Analysis; D011014:Pneumonia / Q000188:drug therapy* / Q000453:epidemiology*; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012906:Smoke / Q000009:adverse effects*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014934:Wood
chemical_list: D001993:Bronchodilator Agents; D012906:Smoke