Naz Sabrina, Page Andrew, Agho Kingsley Emwinyore
1Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia.
2School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia.
Glob Health Res Policy. 2018 Jan 18;3:4. doi: 10.1186/s41256-018-0059-x. eCollection 2018.
Solid fuel use is the major source of household air pollution (HAP) and accounts for a substantial burden of morbidity and mortality in low and middle income countries. To evaluate and compare childhood mortality attributable to HAP in four South Asian countries.
A series of Demographic and Health Survey (DHS) datasets for Bangladesh, India, Nepal and Pakistan were used for analysis. Estimates of relative risk and exposure prevalence relating to use of cooking fuel and under-five mortality were used to calculate population attributable fractions (PAFs) for each country. Potential impact fractions (PIFs) were also calculated assessing theoretical scenarios based on published interventions aiming to reduce exposure prevalence.
There are an increased risk of under-five mortality in those exposed to cooking fuel compared to those not exposed in the four South Asian countries (OR = 1.30, 95% CI = 1.07-1.57, = 0.007). Combined PAF estimates for South Asia found that 66% (95% CI: 43.1-81.5%) of the 13,290 estimated cases of under-five mortality was attributable to HAP. Joint PIF estimates (assuming achievable reductions in HAP reported in intervention studies conducted in South Asia) indicates 47% of neonatal and 43% of under-five mortality cases associated with HAP could be avoidable in the four South Asian countries studied.
Elimination of exposure to use of cooking fuel in the household targeting valuable intervention strategies (such as cooking in separate kitchen, improved cook stoves) could reduce substantially under-five mortality in South Asian countries.
固体燃料的使用是家庭空气污染（HAP）的主要来源，在低收入和中等收入国家造成了相当大的发病和死亡负担。为了评估和比较四个南亚国家中可归因于家庭空气污染的儿童死亡率。
使用孟加拉国、印度、尼泊尔和巴基斯坦的一系列人口与健康调查（DHS）数据集进行分析。与烹饪燃料使用和五岁以下儿童死亡率相关的相对风险和暴露患病率估计值用于计算每个国家的人群归因分数（PAF）。还计算了潜在影响分数（PIF），以评估基于已发表的旨在降低暴露患病率的干预措施的理论情景。
与未接触烹饪燃料的儿童相比，四个南亚国家中接触烹饪燃料的儿童五岁以下死亡风险增加（OR = 1.30，95%CI = 1.07 - 1.57，P = 0.007）。南亚的综合PAF估计发现，在估计的13290例五岁以下死亡病例中，66%（95%CI：43.1 - 81.5%）可归因于家庭空气污染。联合PIF估计（假设南亚进行的干预研究报告的家庭空气污染可实现减少）表明，在所研究的四个南亚国家中，47%的新生儿死亡病例和43%的五岁以下死亡病例与家庭空气污染相关，这些死亡病例是可以避免的。
针对有价值的干预策略（如在单独的厨房烹饪、改进炉灶）消除家庭中烹饪燃料的使用，可大幅降低南亚国家五岁以下儿童的死亡率。
