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Original research
Associations between household air pollution and early child development among children aged 36–59months in Bangladesh
  1. Juwel Rana1,2,3,
  2. Patricia Luna-Gutiérrez3,
  3. Syed Emdadul Haque4,
  4. José Ignacio Nazif-Muñoz5,6,
  5. Dipak Kumar Mitra2,
  6. Youssef Oulhote7
  1. 1Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
  2. 2Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
  3. 3Research and Innovation, South Asian Institute for Social Transformation, Dhaka, Bangladesh
  4. 4UChicago Research Bangladesh, The University of Chicago, Chicago, Illinois, USA
  5. 5Programmes d’études et de recherche en toxicomanie, Faculté de Médecine et des Sciences de la Santé, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
  6. 6Department of Environmental Health, T. H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
  7. 7Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
  1. Correspondence to Mr Juwel Rana, Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; juwelranasoc{at}gmail.com

Abstract

Background Household air pollution (HAP) from solid fuel use (SFU) for cooking may impact child health in low-resources countries. This study examined the associations between HAP and early childhood development (ECD) outcomes among children under 5 years of age in Bangladesh and explored potential effect modification by sex and urbanicity.

Methods The study sample consisted of 9395 children aged 36–59 months in the households from the Bangladesh Multiple Indicator Cluster Survey 2019. SFU and levels of exposure to SFU (unexposed, moderately exposed and highly exposed) were used as proxies of HAP exposure. We estimated the covariate-adjusted prevalence ratios (aPRs) and 95% CIs for the associations between HAP and ECD outcomes using multilevel mixed-effects Poisson regression models with a robust variance estimator.

Results 81.4% of children were exposed to SFU, and the prevalence of developmental delay (in Early Childhood Development Index) was 25.3%. Children exposed to SFU were 1.47 times more likely to have developmental delays (95% CI: 1.25, 1.73; p<0.001) compared with children with no SFU exposure. SFU was significantly associated with developmental delay in socioemotional (aPR: 1.17; 95% CI: 1.01, 1.36; p=0.035) and learning-cognitive (aPR: 1.90; 95% CI: 1.39, 2.60; p<0.001) domains. Similarly, children moderately exposed and highly exposed to HAP had higher prevalence of developmental delays than unexposed children. We did not observe effect modification by sex or urbanicity.

Conclusion Public health policies should promote the use of clean cooking fuels and cookstoves to reduce the high burden of HAP exposure in low-resource countries for helping younger children to meet their developmental milestones.

  • CHILD HEALTH
  • ENVIRONMENTAL HEALTH
  • AIR POLLUTION
  • COGNITION

Data availability statement

Data are available upon reasonable request. All data files are publicly available and can be downloaded upon request from the MICS program database: https://mics.unicef.org/surveys. Codes are also available from the corresponding author on reasonable request.

https://doi.org/10.1136/jech-2021-217554

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    Data availability statement

    Data are available upon reasonable request. All data files are publicly available and can be downloaded upon request from the MICS program database: https://mics.unicef.org/surveys. Codes are also available from the corresponding author on reasonable request.

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    Footnotes

    • Twitter @juwelranasoc, @aynumazi

    • Contributors JR and YO conceptualised and designed the study. JR, JIN-M and DKM carried out the analyses. JR, SEH and PLG drafted the initial manuscript. YO supervised the study and revised the manuscript. All authors met the conditions for authorship: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data; drafting the work or revising it critically for important intellectual content; final approval of the version published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JR is the study guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.