Exposure to pollutants for household cooking and lighting and pediatric post-discharge mortality following a severe infection in Uganda

Abstract

Background: Particulate matter from household air pollution (HAP) is linked to half of all lower respiratory infection deaths among children under 5 years of age. In rural Uganda, similar number of children die 6-months post discharge as during hospitalization for severe infections. However, it is unclear whether exposure to HAP contributes to poor health and death after discharge. We investigated the association between cooking and household lighting practices and mortality 6-months post-discharge among children under 5 years of age treated for severe infection in rural Uganda. Methods: We conducted a secondary analysis of data from observational cohort studies, conducted between July 2017 to July 2021, among 6,955 children 0 to 5 years admitted to one of six Ugandan hospitals for a severe infectious illness. Clinical signs and symptoms, sociodemographic variables, and mortality up to 6-months post-discharge was collected for all participants, and follow-up rates were >95%. Exposure variables included type of cooking fuel used, location of cooking (e.g. indoors, outdoors), and primary source of household lighting. We assessed post-discharge mortality using simple and multivariate Poisson regression. Results: The unadjusted risk ratio of 6-month post-discharge mortality by dual or single exposure to pollutant fuel sources for cooking indoors and household lighting, when compared to minimal exposure, was 1.57 (95%CI 1.17, 2.11) and 1.20 (95%CI 0.94, 1.54), respectively. Adjusting for age, sex, distance to hospital, maternal education, and maternal HIV status, the adjusted risk ratios for dual and single exposure became 1.30 (95%CI 0.96, 1.76] and 1.08 (95%CI 0.84, 1.38). There was no significant interaction between exposure and age, sex, maternal education, or anemia status. Discussion: This analysis did not find a statistically significant association between HAP and 6-month post-discharge mortality. However, HAP cannot be ruled out as a contributor in this population where malnutrition, comorbidities and sociodemographic vulnerabilities are common.