The relationship between biomass fuels smoke and growth stunting in the children under 5 years old in Nepal: findings from 2011 Nepal Demographic Health Survey

Abstract

Background: Children who live in households using biomass fuel for cooking are often exposed to high concentrations of indoor air pollution. This study examined the potential association of biomass fuel smoke with stunting among children under age 5 in Nepal. Methods: A cross sectional study, analyzing secondary data from 2011 Nepal Demographic Health Survey (NDHS), was conducted. Child stunting was ascertained by measuring the height for age of children under age 5. Bivariate analysis was applied to describe the children characteristics and calculate unadjusted associations between children’s stunting and biomass fuel use and other potential risk factors for stunting. Drawing on bivariate analysis results, five logistic models were constructed to calculate the effects of potential confounders on that of biomass fuels smoke. An additional sixth model was constructed to examine effect of the household wealth index on biomass fuels smoke effect and other covariates in the fifth model mentioned above (Model 5). Results: Children with exposure to biomass fuel smoke showed considerably higher prevalence of stunting (84.6%) compared to children with no exposure (84.6% compared to 15.4%, p value=0.0001). It remained significant even after controlling for potential confounding such as child, mother, environment and geodemographic factors (OR =1.50, 95% CI: 1.04-2.18). In addition, mother’s tobacco smoking appeared to be significant prognostic factor for child stunting after controlling with child and mother factors (OR=1.58, 95% CI: 1.06-2.35). Controlling for the household wealth index in model six reduced the effect of biomass fuels smoke on stunting (OR=1.13, 95% CI=0.72-1.76). Stunting was strongly positively associated with lower wealth. Conclusion: The findings show that there is strong positive association between exposure to biomass fuel smoke and stunting in children under age 5 in Nepal. Furthermore, findings from the sixth model strongly suggested that the distal risk factor poverty is the first and foremost risk factor for child stunting in Nepal, and underlies the observed association of stunting and biomass fuel use. Implementing improved stoves and cleaner fuels is recommended, as is providing increased economic opportunity.