Use of biomass fuel and acute respiratory infections in rural Pakistan

Objective: To evaluate the association between use of biomass fuel and acute respiratory infection (ARI) episodes in children aged ≤5 years in Pakistan. Design: Cross-sectional study. Methods: Cluster sampling was used to select 566 children from 379 households in August-September 2007 in a rural setting in Pakistan. Information was collected on ARI episodes during the previous month and type of fuel used for cooking. Poisson regression with robust variance estimation was used to assess the association between use of biomass fuel and ARI episodes, adjusting for potential confounders. Results: The incidence of ARI was 7 episodes/child/year. In the adjusted model, the incidence of ARI was higher in children living in houses where biomass fuel was used and who accompanied their mothers while cooking compared with children living in houses where fossil fuel was used and who did not accompany their mothers while cooking [rate ratio (RR) 2.6, 95% confidence interval (CI) 1.5-4.5]. Compared with the latter group, the incidence of ARI was also higher in children living in houses where biomass fuel was used but who did not accompany their mothers during cooking (RR 1.5, 95% CI 1.2-1.9), and in children living in houses where fossil fuel was used and who accompanied their mothers while cooking (RR 1.9, 95% CI 1.3-2.8). Conclusion: Use of biomass fuel and presence of a child in the kitchen during cooking were associated with increased incidence of ARI in children aged ≤5 years.