Household air pollution is associated with disease severity in Ugandan children hospitalized with hypoxemic pneumonia

Ayla Ahmed; Sehaj Sandhu; Sophie Namasopo; Juliet Nabwire; Qaasim Mian; Andrea L. Conroy; Jackson Amone; Charles Olaro; Robert O. Opoka; Michael T. Hawkes

doi:10.1371/journal.pone.0348277

Household air pollution is associated with disease severity in Ugandan children hospitalized with hypoxemic pneumonia

Ayla Ahmed
, Sehaj Sandhu
, Sophie Namasopo
, Juliet Nabwire
, Qaasim Mian
, Andrea L. Conroy
, Jackson Amone
, Charles Olaro
, Robert O. Opoka
, Michael T. Hawkes

Research output: Contribution to journal › Article › peer-review

Abstract

Background Household air pollution (HAP) due to biomass fuel use is a risk factor for childhood pneumonia, a leading cause of under-five mortality globally. This study examined the relationship between HAP and disease severity in Ugandan children hospitalized with hypoxemic pneumonia. Methods We conducted a retrospective case-control study across 20 Ugandan hospitals. PM_2.5 exposure was estimated using caregiver-reported fuel use, cooking duration, kitchen structure, and ventilation. Pneumonia severity was assessed clinically, and associations were analyzed using non-parametric tests. Results We included 735 children (median age 9 months, 42% female) hospitalized with hypoxemic pneumonia. Most households used firewood (84%) or charcoal (16%) for cooking. Other HAP sources included cigarette smoke (17%) and open-flame lighting (17%). The median estimated personal PM_2.5 exposure was 145 µg/m³ (IQR 79–270), and 732 children (99.6%) exceeded the recommended WHO limit of 15 µg/m^3. Chronic HAP-related symptoms included cough (57%), red eyes (41%), rhinorrhea (38%), difficulty breathing (22%), and wheeze (6.5%). Higher PM2.5 exposure was significantly associated with more frequent red eyes (p=0.0073), rhinorrhea (p=0.016), and difficulty breathing (p<0.0001). The median SICK score was 3.9 (IQR 3.4–5.0). Higher scores correlated with higher PM_2.5 exposure (τ=0.15, p<0.0001) and increased mortality risk (p=0.0024). Higher PM_2.5 exposure was also linked to WHO danger signs, lower SpO₂ at admission, longer duration of oxygen therapy, and greater total oxygen volume administered over the hospital admission (p<0.05 for all). Conclusion Household PM_2.5 exposure from biomass combustion is associated with greater pneumonia severity in hospitalized children under five. Reducing household air pollution through cleaner fuels, better ventilation, and behavioral changes may improve outcomes for a leading cause of child mortality globally.

Original language	English (US)
Article number	e0348277
Journal	PLoS ONE
Volume	21
Issue number	5 May
DOIs	https://doi.org/10.1371/journal.pone.0348277
Publication status	Published - May 2026
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1371/journal.pone.0348277

Cite this

@article{708d86b59879430fb39e22293f2d4ebd,

title = "Household air pollution is associated with disease severity in Ugandan children hospitalized with hypoxemic pneumonia",

abstract = "Background Household air pollution (HAP) due to biomass fuel use is a risk factor for childhood pneumonia, a leading cause of under-five mortality globally. This study examined the relationship between HAP and disease severity in Ugandan children hospitalized with hypoxemic pneumonia. Methods We conducted a retrospective case-control study across 20 Ugandan hospitals. PM2.5 exposure was estimated using caregiver-reported fuel use, cooking duration, kitchen structure, and ventilation. Pneumonia severity was assessed clinically, and associations were analyzed using non-parametric tests. Results We included 735 children (median age 9 months, 42\% female) hospitalized with hypoxemic pneumonia. Most households used firewood (84\%) or charcoal (16\%) for cooking. Other HAP sources included cigarette smoke (17\%) and open-flame lighting (17\%). The median estimated personal PM2.5 exposure was 145 µg/m3 (IQR 79–270), and 732 children (99.6\%) exceeded the recommended WHO limit of 15 µg/m3. Chronic HAP-related symptoms included cough (57\%), red eyes (41\%), rhinorrhea (38\%), difficulty breathing (22\%), and wheeze (6.5\%). Higher PM2.5 exposure was significantly associated with more frequent red eyes (p=0.0073), rhinorrhea (p=0.016), and difficulty breathing (p<0.0001). The median SICK score was 3.9 (IQR 3.4–5.0). Higher scores correlated with higher PM2.5 exposure (τ=0.15, p<0.0001) and increased mortality risk (p=0.0024). Higher PM2.5 exposure was also linked to WHO danger signs, lower SpO2 at admission, longer duration of oxygen therapy, and greater total oxygen volume administered over the hospital admission (p<0.05 for all). Conclusion Household PM2.5 exposure from biomass combustion is associated with greater pneumonia severity in hospitalized children under five. Reducing household air pollution through cleaner fuels, better ventilation, and behavioral changes may improve outcomes for a leading cause of child mortality globally.",

author = "Ayla Ahmed and Sehaj Sandhu and Sophie Namasopo and Juliet Nabwire and Qaasim Mian and Conroy, \{Andrea L.\} and Jackson Amone and Charles Olaro and Opoka, \{Robert O.\} and Hawkes, \{Michael T.\}",

note = "Publisher Copyright: {\textcopyright} 2026 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2026",

month = may,

doi = "10.1371/journal.pone.0348277",

language = "English (US)",

volume = "21",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "5 May",

}

TY - JOUR

T1 - Household air pollution is associated with disease severity in Ugandan children hospitalized with hypoxemic pneumonia

AU - Ahmed, Ayla

AU - Sandhu, Sehaj

AU - Namasopo, Sophie

AU - Nabwire, Juliet

AU - Mian, Qaasim

AU - Conroy, Andrea L.

AU - Amone, Jackson

AU - Olaro, Charles

AU - Opoka, Robert O.

AU - Hawkes, Michael T.

N1 - Publisher Copyright: © 2026 Ahmed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2026/5

Y1 - 2026/5

N2 - Background Household air pollution (HAP) due to biomass fuel use is a risk factor for childhood pneumonia, a leading cause of under-five mortality globally. This study examined the relationship between HAP and disease severity in Ugandan children hospitalized with hypoxemic pneumonia. Methods We conducted a retrospective case-control study across 20 Ugandan hospitals. PM2.5 exposure was estimated using caregiver-reported fuel use, cooking duration, kitchen structure, and ventilation. Pneumonia severity was assessed clinically, and associations were analyzed using non-parametric tests. Results We included 735 children (median age 9 months, 42% female) hospitalized with hypoxemic pneumonia. Most households used firewood (84%) or charcoal (16%) for cooking. Other HAP sources included cigarette smoke (17%) and open-flame lighting (17%). The median estimated personal PM2.5 exposure was 145 µg/m3 (IQR 79–270), and 732 children (99.6%) exceeded the recommended WHO limit of 15 µg/m3. Chronic HAP-related symptoms included cough (57%), red eyes (41%), rhinorrhea (38%), difficulty breathing (22%), and wheeze (6.5%). Higher PM2.5 exposure was significantly associated with more frequent red eyes (p=0.0073), rhinorrhea (p=0.016), and difficulty breathing (p<0.0001). The median SICK score was 3.9 (IQR 3.4–5.0). Higher scores correlated with higher PM2.5 exposure (τ=0.15, p<0.0001) and increased mortality risk (p=0.0024). Higher PM2.5 exposure was also linked to WHO danger signs, lower SpO2 at admission, longer duration of oxygen therapy, and greater total oxygen volume administered over the hospital admission (p<0.05 for all). Conclusion Household PM2.5 exposure from biomass combustion is associated with greater pneumonia severity in hospitalized children under five. Reducing household air pollution through cleaner fuels, better ventilation, and behavioral changes may improve outcomes for a leading cause of child mortality globally.

AB - Background Household air pollution (HAP) due to biomass fuel use is a risk factor for childhood pneumonia, a leading cause of under-five mortality globally. This study examined the relationship between HAP and disease severity in Ugandan children hospitalized with hypoxemic pneumonia. Methods We conducted a retrospective case-control study across 20 Ugandan hospitals. PM2.5 exposure was estimated using caregiver-reported fuel use, cooking duration, kitchen structure, and ventilation. Pneumonia severity was assessed clinically, and associations were analyzed using non-parametric tests. Results We included 735 children (median age 9 months, 42% female) hospitalized with hypoxemic pneumonia. Most households used firewood (84%) or charcoal (16%) for cooking. Other HAP sources included cigarette smoke (17%) and open-flame lighting (17%). The median estimated personal PM2.5 exposure was 145 µg/m3 (IQR 79–270), and 732 children (99.6%) exceeded the recommended WHO limit of 15 µg/m3. Chronic HAP-related symptoms included cough (57%), red eyes (41%), rhinorrhea (38%), difficulty breathing (22%), and wheeze (6.5%). Higher PM2.5 exposure was significantly associated with more frequent red eyes (p=0.0073), rhinorrhea (p=0.016), and difficulty breathing (p<0.0001). The median SICK score was 3.9 (IQR 3.4–5.0). Higher scores correlated with higher PM2.5 exposure (τ=0.15, p<0.0001) and increased mortality risk (p=0.0024). Higher PM2.5 exposure was also linked to WHO danger signs, lower SpO2 at admission, longer duration of oxygen therapy, and greater total oxygen volume administered over the hospital admission (p<0.05 for all). Conclusion Household PM2.5 exposure from biomass combustion is associated with greater pneumonia severity in hospitalized children under five. Reducing household air pollution through cleaner fuels, better ventilation, and behavioral changes may improve outcomes for a leading cause of child mortality globally.

UR - https://www.scopus.com/pages/publications/105038386035

U2 - 10.1371/journal.pone.0348277

DO - 10.1371/journal.pone.0348277

M3 - Article

AN - SCOPUS:105038386035

SN - 1932-6203

VL - 21

JO - PLoS ONE

JF - PLoS ONE

IS - 5 May

M1 - e0348277

ER -

Household air pollution is associated with disease severity in Ugandan children hospitalized with hypoxemic pneumonia

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