The association between indoor air pollution and child stunting in the Democratic Republic of Congo Público

Abstract

Objectives Stunting is a major public health problem, affecting 156 million children under five. Respiratory infections are common among children in developing countries, especially those in biomass-fuel using households. Given that repeated infection during childhood has been linked to poor child growth, this study aimed to examine the relationship between exposure to air pollution from biomass fuel smoke and stunting in children under five in the Democratic Republic of Congo.

Methods Data are from the 2013-2014 Demographic Health Survey with a sample of 7,675 children under five with weight and height data available. Air pollution was measured by classifying both the reported cooking fuel used and the place cooking occurred in the household. Confounders controlled for were: maternal education level, child age, type of residence, wealth, maternal height, dietary diversity, parity, sex, maternal age at first birth, and if a household member smokes cigarettes inside.

Results In the adjusted model, exposure to biomass fuels cooked indoors, not in a separate room, was associated an increased risk of child stunting (OR=1.23; 95% CI 1.01, 1.50). Other significant covariates include maternal secondary or higher education (OR=0.72; 95% CI 0.60, 0.88), age of child (OR=1.04; 95% CI 1.03, 1.04), maternal height (OR=0.95; 95% CI 0.94, 0.96), and being in the richest wealth quintile (OR=0.95, 95% CI 0.94, 0.96).

Conclusions Indoor air pollution may be adversely impact child growth in this context. This research supports the need for a multi-sectoral approach that combines environmental, nutritional, and economic strategies to address child stunting.

Table of Contents

Page

Abbreviations

7

Chapter 1: Introduction

8

Chapter 2: Literature review

Malnutrition - global context

i. malnutrition background

ii. global burden of malnutrition

iii. stunting

iv. malnutrition and infections

Malnutrition - local context

Figure 1: Conceptual framework

Air pollution background & effects of exposure

Malnutrition and household air pollution

Table 1: Summary of studies examining indoor air pollution and stunting

9

Chapter 3: Manuscript

Introduction

Study Area and Population

- Data collection and sample size

Figure 1: Sample selection and data cleaning flowchart

- Ethical Considerations

- Analysis

Results

Table 1: Demographics of the study sample: DHS 2013-2014, children under five years (n=7675)

Table 2: Air pollution characteristics of the study sample

Table 3: Anthropometric calculations and measure distribution

Table 4: Crude & adjusted odds rations (ORs) and corresponding 95% confidence intervals (CIs) for the association between stunting and multiple factors in children under five

Table 5: Crude & adjusted model estimates for the association between height-for age z-score and multiple factors in children under five

Discussion

17

Chapter 4: Discussion

27

References

31

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	air pollution child health stunting
Committee Chair / Thesis Advisor	Young, Melissa Fox, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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