Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA.
Department of Earth System Science, Stanford University, Stanford, California, USA.
Environ Health Perspect. 2023 Mar;131(3):37017. doi: 10.1289/EHP11016. Epub 2023 Mar 29.
Nationwide household transitions to the use of clean-burning cooking fuels are a promising pathway to reducing under-5 lower respiratory infection (LRI) mortality, the leading cause of child mortality globally, but such transitions are rare and evidence supporting an association between increased clean fuel use and improved health is limited.
This study aimed to investigate the association between increased primary clean cooking fuel use and under-5 LRI mortality in Ecuador between 1990 and 2019.
We documented cooking fuel use and cause-coded child mortalities at the canton (county) level in Ecuador from 1990 to 2019 (in four periods, 1988-1992, 1999-2003, 2008-2012, and 2015-2019). We characterized the association between clean fuel use and the rate of under-5 LRI mortalities at the canton level using quasi-Poisson generalized linear and generalized additive models, accounting for potential confounding variables that characterize wealth, urbanization, and child health care and vaccination rates, as well as canton and period fixed effects. We estimated averted under-5 LRI mortalities accrued over 30 y by predicting a counterfactual count of canton-period under-5 LRI mortalities were clean fuel use to not have increased and comparing with predicted canton-period under-5 LRI mortalities from our model and observed data.
From 1990 to 2019, the proportion of households primarily using a clean cooking fuel increased from 59% to 95%, and under-5 LRI mortality fell from 28 to 7 per 100,000 under-5 population. Canton-level clean fuel use was negatively associated with under-5 LRI mortalities in linear and nonlinear models. The nonlinear association suggested a threshold at approximately 60% clean fuel use, above which there was a negative association. Increases in clean fuel use between 1990 and 2019 were associated with an estimated 7,300 averted under-5 LRI mortalities (95% confidence interval: 2,600, 12,100), accounting for nearly 20% of the declines in under-5 LRI mortality observed in Ecuador over the study period.
Our findings suggest that the widespread household transition from using biomass to clean-burning fuels for cooking reduced under-5 LRI mortalities in Ecuador over the last 30 y. https://doi.org/10.1289/EHP11016.
在全球范围内，家庭普遍转向使用清洁燃烧的烹饪燃料，这是降低 5 岁以下下呼吸道感染（LRI）死亡率（全球儿童死亡的主要原因）的一个很有前景的途径，但这种转变很少见，支持增加清洁燃料使用与改善健康之间存在关联的证据有限。
本研究旨在调查厄瓜多尔 1990 年至 2019 年期间，增加主要清洁烹饪燃料使用与 5 岁以下下呼吸道感染死亡率之间的关系。
我们从 1990 年至 2019 年（分为四个时期，1988-1992 年、1999-2003 年、2008-2012 年和 2015-2019 年）记录了厄瓜多尔各县（市）的烹饪燃料使用情况和死因编码儿童死亡情况。我们使用拟泊松广义线性和广义加性模型，在县一级描述清洁燃料使用与下呼吸道感染死亡率之间的关联，考虑了财富、城市化以及儿童保健和疫苗接种率等潜在混杂变量，以及县和时期固定效应。我们通过预测如果清洁燃料使用没有增加，各县时期下呼吸道感染死亡率的理论计数，并将其与我们的模型和观察数据预测的各县时期下呼吸道感染死亡率进行比较，从而估算了 30 年来因使用清洁燃料而避免的 5 岁以下下呼吸道感染死亡人数。
1990 年至 2019 年，主要使用清洁烹饪燃料的家庭比例从 59%增加到 95%，5 岁以下下呼吸道感染死亡率从每 100,000 名 5 岁以下儿童 28 人下降到 7 人。线性和非线性模型均表明，县一级的清洁燃料使用与 5 岁以下下呼吸道感染死亡率呈负相关。非线性关联表明，大约 60%的清洁燃料使用率存在一个阈值，超过该阈值则呈负相关。1990 年至 2019 年清洁燃料使用量的增加与估计的 7300 例 5 岁以下下呼吸道感染死亡人数减少有关（95%置信区间：2600 至 12100），占研究期间厄瓜多尔 5 岁以下下呼吸道感染死亡率下降的近 20%。
我们的研究结果表明，过去 30 年，家庭普遍从使用生物质燃料转向使用清洁燃烧的燃料来烹饪，这降低了厄瓜多尔 5 岁以下下呼吸道感染死亡率。
