Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK.
School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.
Malar J. 2022 Apr 27;21(1):133. doi: 10.1186/s12936-022-04152-3.
Smoke from solid biomass cooking is often stated to reduce household mosquito levels and, therefore, malarial transmission. However, household air pollution (HAP) from solid biomass cooking is estimated to be responsible for 1.67 times more deaths in children aged under 5 years compared to malaria globally. This cross-sectional study investigates the association between malaria and (i) cleaner fuel usage; (ii) wood compared to charcoal fuel; and, (iii) household cooking location, among children aged under 5 years in sub-Saharan Africa (SSA).
Population-based data was obtained from Demographic and Health Surveys (DHS) for 85,263 children within 17 malaria-endemic sub-Saharan countries who were who were tested for malaria with a malarial rapid diagnostic test (RDT) or microscopy. To assess the independent association between malarial diagnosis (positive, negative), fuel type and cooking location (outdoor, indoor, attached to house), multivariable logistic regression was used, controlling for individual, household and contextual confounding factors.
Household use of solid biomass fuels and kerosene cooking fuels was associated with a 57% increase in the odds ratio of malarial infection after adjusting for confounding factors (RDT adjusted odds ratio (AOR):1.57 [1.30-1.91]; Microscopy AOR: 1.58 [1.23-2.04]) compared to cooking with cleaner fuels. A similar effect was observed when comparing wood to charcoal among solid biomass fuel users (RDT AOR: 1.77 [1.54-2.04]; Microscopy AOR: 1.21 [1.08-1.37]). Cooking in a separate building was associated with a 26% reduction in the odds of malarial infection (RDT AOR: 0.74 [0.66-0.83]; Microscopy AOR: 0.75 [0.67-0.84]) compared to indoor cooking; however no association was observed with outdoor cooking. Similar effects were observed within a sub-analysis of malarial mesoendemic areas only.
Cleaner fuels and outdoor cooking practices associated with reduced smoke exposure were not observed to have an adverse effect upon malarial infection among children under 5 years in SSA. Further mixed-methods research will be required to further strengthen the evidence base concerning this risk paradigm and to support appropriate public health messaging in this context.
固体生物质燃烧产生的烟雾常被认为可以降低家庭蚊虫数量，从而减少疟疾传播。然而，据估计，与疟疾相比，固体生物质燃烧产生的室内空气污染（HAP）导致全球 5 岁以下儿童死亡的人数多 1.67 倍。本横断面研究调查了在撒哈拉以南非洲（SSA） 5 岁以下儿童中，疟疾与（i）使用清洁燃料；（ii）与木炭相比使用木材燃料；以及（iii）家庭烹饪地点之间的关联。
从 17 个疟疾流行的撒哈拉以南非洲国家的人口为基础的全国性数据，从人口与健康调查（DHS）中获得了 85263 名 5 岁以下儿童的数据，这些儿童接受了疟疾快速诊断检测（RDT）或显微镜检查以检测疟疾。为了评估疟疾诊断（阳性、阴性）、燃料类型和烹饪地点（室外、室内、附属于房屋）之间的独立关联，使用多变量逻辑回归来控制个体、家庭和背景混杂因素。
在调整混杂因素后，与使用清洁燃料相比，使用固体生物质燃料和煤油烹饪燃料与疟疾感染的几率增加 57%相关（RDT 调整后的比值比（AOR）：1.57 [1.30-1.91]；显微镜 AOR：1.58 [1.23-2.04]）。与使用固体生物质燃料的人群相比，使用木材与木炭相比，也观察到类似的效果（RDT AOR：1.77 [1.54-2.04]；显微镜 AOR：1.21 [1.08-1.37]）。与室内烹饪相比，在单独的建筑物中烹饪与疟疾感染几率降低 26%相关（RDT AOR：0.74 [0.66-0.83]；显微镜 AOR：0.75 [0.67-0.84]）；但是，室外烹饪则没有关联。在仅对疟疾中流行地区的亚分析中也观察到类似的效果。
在 SSA，5 岁以下儿童中，与减少烟雾暴露相关的清洁燃料和户外烹饪做法并没有被观察到对疟疾感染产生不利影响。需要进一步开展混合方法研究，以进一步加强这一风险模式的证据基础，并为这一背景下的适当公共卫生宣传提供支持。
