School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
Environ Res. 2013 Feb;121:17-22. doi: 10.1016/j.envres.2012.12.004. Epub 2013 Jan 31.
Several studies have linked biomass cooking fuel with adverse pregnancy outcomes such as preterm births, low birth weight and post-neonatal infant mortality, but very few have studied the associations with cooking fuel independent of other factors associated with stillbirths.
We analyzed the data from 188,917 ever-married women aged 15-49 included in India's 2003-2004 District Level Household Survey-II to investigate the association between household use of cooking fuels (liquid petroleum gas/electricity, kerosene, biomass) and risk of stillbirth. Prevalence ratios (PRs) were obtained using Poisson regression with robust standard errors after controlling for several potentially confounding factors (socio-demographic and maternal health characteristics).
Risk factors significantly associated with occurrence of stillbirth in the Poisson regression with robust standard errors model were: literacy status of the mother and father, lighting fuel and cooking fuel used, gravida status, history of previous abortion, whether the woman had an antenatal check up, age at last pregnancy >35 years, labor complications, bleeding complications, fetal and other complications, prematurity and home delivery. After controlling the effect of these factors, women who cook with firewood (PR 1.24; 95% CI: 1.08-1.41, p=0.003) or kerosene (PR 1.36; 95% CI: 1.10-1.67, p=0.004) were more likely to have experienced a stillbirth than those who cook with LPG/electricity. Kerosene lamp use was also associated with stillbirths compared to electric lighting (PR 1.15; 95% CI: 1.06-1.25, p=0.001). The population attributable risk of firewood as cooking fuel for stillbirths in India was 11% and 1% for kerosene cooking.
Biomass and kerosene cooking fuels are associated with stillbirth occurrence in this population sample. Assuming these associations are causal, about 12% of stillbirths in India could be prevented by providing access to cleaner cooking fuel.
多项研究表明，生物质烹饪燃料与早产、低出生体重和新生儿后死亡等不良妊娠结局有关，但很少有研究将烹饪燃料与其他与死产相关的因素分开来研究与这些结局的关联。
我们分析了印度 2003-2004 年第二次全国家庭健康调查（District Level Household Survey-II）中 188917 名 15-49 岁已婚妇女的数据，以调查家庭使用烹饪燃料（液化石油气/电、煤油、生物质）与死产风险之间的关系。使用泊松回归和稳健标准差，在控制了几个潜在混杂因素（社会人口学和产妇健康特征）后，获得了患病率比（PR）。
泊松回归和稳健标准差模型中与死产发生显著相关的危险因素有：母亲和父亲的文化程度、照明燃料和烹饪燃料的使用、孕次、既往流产史、是否接受产前检查、上次怀孕年龄>35 岁、分娩并发症、出血并发症、胎儿和其他并发症、早产和家庭分娩。在控制这些因素的影响后，使用柴火（PR 1.24；95%CI：1.08-1.41，p=0.003）或煤油（PR 1.36；95%CI：1.10-1.67，p=0.004）做饭的妇女比使用液化石油气/电做饭的妇女更容易发生死产。与电灯照明相比，使用煤油灯也与死产有关（PR 1.15；95%CI：1.06-1.25，p=0.001）。在印度，柴火作为烹饪燃料导致死产的人群归因风险为 11%，煤油烹饪的人群归因风险为 1%。
在该人群样本中，生物质和煤油烹饪燃料与死产的发生有关。假设这些关联是因果关系，通过提供更清洁的烹饪燃料，印度约 12%的死产可以得到预防。
