Association between household fuel types and undernutrition status of adults and children under 5 years in 14 low and middle income countries
Polluting biomass fuel use has adverse effects on human health, but there are limited studies exploring the association between biomass fuel use and undernutrition in adult and child population. The study aims to investigate the association between biomass fuel use and undernutrition status of adults and children under 5 years of age in low and middle income countries (LMICs) Data were from the Demographic and Health Surveys in 14 LMICs. The main exposure variable was type of fuel the household mainly used for cooking. Linear regression models and Modified Poisson regression models with robust error variance in consideration of complex survey design were used to estimate the association between type of fuel used for cooking and the outcomes of interest. Personal and household data were collected by questionnaire, and anthropometry data were collected by measurement with a standardised protocol. A total of 532 987 households were included in the analysis, and the majority of households (63.9% used high polluting fuels. For women, use of high polluting fuels lead to a 0.66 kg m 2 (95% CI: 0.74, 0.58) decrease in BMI and a 10% (95% CI: 7% 13% higher risk of underweight. For men, high polluting fuels lead to a 0.63 kg m 2 (95% CI: 0.88, 0.38) decrease in BMI and a 11% (95% CI: 5% 18% higher risk of underweight. For children, high polluting fuels resulted in a 0.16 (95% CI: 0.20, 0.11) 0.17 (95% CI: 0.22, 0.11) and 0.09 (95% CI: 0.14, 0.04) unit decrease in weight for age, height for age, and weight for height z scores, respectively; high polluting fuel use can lead to a 10% (95% CI: 3% 18% higher risk of underweight and a 13% (95% CI: 7% 19% higher risk of stunting, respectively. Effective interventions should be adopted by policymakers to accelerate the transition of polluting fuels to cleaner energy in LMICs.