03
EXPOSURE TO BIOMASS FUEL SMOKE AND RISK OF CHILD MORBIDITY:
AN ANALYSIS ON SOUTH AND SOUTH-EAST ASIAN COUNTRIESLabhita Das1, K. C. Das2 and Ajit Kumar Jaiswal1
1Ph.D. Scholar, International Institute for Population Studies, Mumbai, India
2Professor, International Institute for Population Studies, Mumbai, India

Email: labhita77@gmail.com

How to cite this paper:
Das Labhita, Das K. C. andJaiswal Ajit Kumar (2023)
Exposure to Biomass Fuel
Smoke and Risk of Child
Morbidity: An Analysis on
South and South-east AsianCountries, Journal of Global
Resources, Vol. 09 (02)DOI:
10.46587/JGR.2023.v09i02.003

Received: 30 April 2023
Reviewed: 15 June 2023
Final Accepted: 25 June 2023

Abstract: Around 03 billion people still cook using biomass
fuels, these cooking practices are hazardous and produce awide range of health-damaging pollutants causing high level
household air pollution. Most of these people using solid
fuels belong to lower wealth quintile household and resides
in low and middle-income countries. The women and young
children who spend most of their time near the domestic
hearth are comparatively more exposed to toxic amount ofhousehold air pollutants every day. The current study
compares the scenario of child respiratory health; assessing
the occurrence of ARI and cough among children aged
under five in South and Southeast Asian countries. The
current study is comprised of analysis of Demographic
Health Survey data for Afghanistan, India, Nepal, Cambodia,
Bangladesh and Philippines. A comparative study was
conducted between the selected countries. The differences
in categorical variables were tested using Pearson’s χ2
Statistics, since both treatment and outcome variable in the
study are binomial, a simultaneous equation was used
(probit regression model). The results indicated that there isan increased likelihood of occurrence of ARI and coughamong children aged under five belonging to the households
using solid fuel in the selected South and Southeast Asian
countries.
Keywords: Asia, ARI, Child Morbidity, Cough, DHS Data,
Indoor Air Pollution, Smoke

21

Introduction
Household air pollution (HAP) is usually measured indoors and arises from domestic activities
of cooking, heating, and lighting. Around 2.6 billion people still cook using biomass fuels (suchas firewood, agricultural wastes, charcoal, coal and cow dung) and kerosene is usually themost common fuel for inefficient stoves (1). Most of these people using solid fuels are fromlower wealth quintiles and resides in low and middle-income countries (2). These cooking
practices are hazardous and produce a wide range of health-damaging pollutants causing highlevel household air pollution; some small soot particles are produced that penetrate deep into
the lungs (3). Indoor smoke can be 100 times higher than acceptable levels for fine particles
in poorly ventilated dwellings (4). The women and young children who spend most of their timenear the domestic hearth are comparatively more exposed to a toxic amount of HAP every day(5)(6). Household air pollution (HAP) is a severe health risk factor which is intrinsically linked
to poverty (7). The Global Burden of Disease Study indicated that household air pollution
attributed almost 3.5 million deaths worldwide in 2010 (8). The number further increased to 3.8
million caused by the inefficient use of solid fuels and kerosene for cooking in 2015 (9).
Solid fuel can have serious adverse consequences on health as well as on theenvironment, and also on economic development (10)(11). Around 2.8 million children facedeath prematurely each year because of exposure to indoor air pollution from solid fuelconcerning health (12). These fuels produce smoke, often used in an inefficient stove or open
fire with incomplete combustion, and results in a huge amount of indoor air pollution whensmoke is poorly vented (13). Biomass fuels (derived from plant sources) or coal combustion
results in the release of products of incomplete combustion such as particulate matter (PM)and carbon monoxide (14). Furthermore, solid fuel is commonly used in homes with poor orabsent chimney ventilation of smoke. An estimate given by the International Energy Agency(IEA 2006) indicates that the lack of new policies will increase this figure to 2.7 in 2030 due topopulation growth (15).
DATA AND METHODOLOGY
Data Sources
The data source used was the Demographic and Health Survey (DHS). Recent available
Standard DHS-VIII data of selected eight countries of South and Southeast Asia region havebeen taken. DHS are nationally-representative household surveys that provide data for a wide
range of monitoring and impact evaluation indicators in the areas of population, health, andnutrition.
Sample Size
The present study considers information from currently married women aged 15-49 years of
selected South and Southeast Asian countries using recent DHS data of the respective
countries. The Afghanistan data set comprises 1, 25,715 women, Bangladesh 43,772 women,
India 13,15,617 women Cambodia 33,290 women, Myanmar 22,989 women; Nepal 26,028
women and Philippines 1,51,703 women.
Child Morbidity
With reference to available data from different countries the occurrence of diseases, four
categories, i.e., fever, cough, acute respiratory infections (ARI) and diarrhea were taken into
consideration to compute child morbidity.
Data Analysis
Differences in categorical variables were tested using Pearson’s χ2 (chi-square) statistic, i.e.,
to understand the association between indoor air Pollution and morbidities among children.
Since both treatment and outcome variable in this case are binomial, a simultaneous equation
has been used, i.e., probit regression model in order to consider the effect of Indoor air
Pollution along with other variables. In the binary probit model the event of occurrence of thediseases i. e. fever, diarrhea, ARI and cough, has been taken as 01, and non-occurrence ofthe event has been taken as 0.
22

The relationship between specific variables and the outcome probability is interpreted by themeans of marginal effect, which accounts for the partial change in the probability. The marginal
effect associated with continuous explanatory variables (x) on the probability P (Yi= 1| X),
holding the other variables constant. The marginal effect provides insight into how the
explanatory variables shift the probability of risk of the morbidities. Using the command“margins” in Stata 16.0 software marginal effects has been calculated for each variable holding
other variables constant at their sample mean values.
RESULTS
Prevalence of Disease among the Children in the Selected Countries
Table 1 shows the prevalence of childhood morbidity in selected countries. Three major
patterns of childhood morbidity that were experienced in the two weeks preceding the survey
were examined: diarrhea, fever, ARI and cough. These four diseases have been identified as
main morbidities among children under the age of five.
Fever
In Nepal, 4.22 percent of the fever cases in children are from the households which aredependent on solid fuels. The scenario of Afghanistan depicts a similar picture where children
from 7.59 percent of household using solid fuel suffered from fever. Total prevalence of feveris 6.88 percent among children in Bangladesh. In Cambodia, 6.15 percent of children sufferedfrom fever in the solid fuel using households. Percentage of children suffering from feveramong the solid fuel using households in Myanmar, Philippines, and India are 3.55 percent,4.30 percent, 3.37 percent, and 2.65 percent respectively.
Diarrhea
1.49 percent of children from the solid fuel using household in Nepal suffered from Diarrhea;
in Afghanistan, it is 7.40 percent. In Bangladesh, it is 1.0 percent who belonged to thehousehold using solid fuel for cooking. Cambodia showed 2.84 percent of diarrhea cases. In
Myanmar, the calculated percentage of diarrhea suffering children from solid fuel using houses
were 2.42 percent. Philippines and India also showed a very high prevalence of diarrhea
among children in the solid fuel using households.
Acute Respiratory Infections (ARI)
Indoor air pollution has a significant effect on ARIs; the evidence was found in Nepal where
0.59 percent of children having ARIs were from solid fuel using households. 3.66 percent ofchildren born in the households using solid-fuel suffered ARI in Afghanistan. For Bangladesh
the percentage is 1.01 percent. 1.21 percent children in Cambodia suffered ARI in the solidfuel using households. In Myanmar, Philippines and India the percentage of children sufferingfrom ARI are 0.71 percent, 0.42 percent and 0.58 percent, respectively.
Cough
The highest prevalence of cough in the solid fuel using households was found in Afghanistan
which is around 6 percent while minimum prevalence is seen in India with 2.13 percent. 4.25
percent of children in Nepal from the households using solid fuel had cough. In Afghanistan,
6.32 percent of children suffered ARI who belonged to the households using solid-fuel. In
Bangladesh and Cambodia also the percentages were high i.e., 5.98 percent and 4.75 percent
respectively. The percentage of children suffering from cough in Myanmar, Philippines andIndia were 3.40 percent, 5.27 percent and 2.24 percent respectively.
Results of Marginal Effect from Probit Regression Analysis:
Fever
Table 2 shows the result of marginal probabilities from the probit regression analysis of feverwith respect to its related covariates. Since the Coefficients of a probit regression model is notdirectly interpretable, the marginal probabilities are calculated to see the effect of various
categories of independent variables on the outcome variable. When we see the probabilities
across different countries, a clear picture of variations can be seen. For the type of fuel used
for cooking in the household, among 7 selected countries, Afghanistan showed the highest
probability of occurrence of fever among solid fuel user with a probability value of 0.065 andleast probability of occurrence was seen in India (0.024). Among solid-fuel using households’
23highest probability of occurrence of fever was seen in Afghanistan (0.067) and India occupied
the extreme bottom with a probability of 0.026. Even after consuming safe drinking waterprobability of occurrence of fever was seen to be highest in Afghanistan and Bangladesh witha probability 0.66. In unsafe drinking water, the probability was highest in Bangladesh (0.075),
and least probability was seen in India (0.023). Where there were no toilet facilities, highest
probability of occurrence of fever was seen in Afghanistan (0.079). In all the three categories(no toilet, flush toilet, and pit & others) India occupied the bottom with probabilities ofoccurrence 0.027, 0.024 and 0.024 respectively. The results remain unchanged wheninteraction effect of fuel used for cooking and source of drinking water was seen for
Afghanistan. Nepal occupied the top position in terms of probabilities of occurrence of fever,and lowest probability was seen in India.
Diarrhea
In table 3 Afghanistan showed the highest probability of occurrence of Diarrhea i.e., 0.071
percent whereas Nepal shows the lowest probability (0.012). Now, when we see the scenario
for solid fuel usage, Afghanistan again occupied the top position on the list with a probabilityof 0.072 whereas Bangladesh shows the least (0.008). The Scenario for the people who use
safe drinking water, Afghanistan topped the list with the highest probability of getting diarrhea
as compared to other counterparts, whereas Bangladesh is at the bottom. For, unsafe use ofdrinking water, again Afghanistan is at the top of the list with a probability of 0.072 whereas
Nepal stands at the bottom. It can clearly see that the probabilities for all the countries cameout to be highly significant. People who cook food outside the home, Afghanistan, andBangladesh shows the highest probabilities i.e., 0.065 and 0.007 respectively. For the
Education levels of the mother, in all four sub-categories of education (Illiterate, primary,secondary and higher education) Afghanistan shows the highest probability of occurrence of
diarrhea followed by Myanmar whereas Bangladesh shows the least probabilities ofoccurrence of diarrhea among all the countries selected for the study. For poor, middle andrich wealth quintile of the population, Afghanistan shows the highest probabilities i.e., 6.7
percent, 7.6 percent and 7.5 percent respectively in all the three categories. For the categories
of parity and birth interval, the overall scenario does not change at all when we try to see theinteraction effect of “fuel” and “water source used” on diarrhea. In these study for the selected
countries, we can clearly put forward our conclusion that Afghanistan has the highest chanceof getting diarrhea followed by Myanmar, and Bangladesh occupies the bottom indicating abetter health scenario as compared to all other countries.
ARI (Acute Respiratory Infections)
Table 4 shows the result of marginal probabilities from the probit regression model of the binary
outcome variable ARI (Acute Respiratory Infections) with respect to different covariates. From
the different types of fuel used for cooking in the household, solid fuel using households in
Afghanistan shows 0.03 probability, followed by Cambodia & Myanmar. When we see in termsof education of the mother, children born to illiterate mothers of Afghanistan have the highest
probabilities of suffering from ARI. For, the interaction effect of fuel used for cooking andsources of drinking water, the probability of occurrence of ARI for the children of Afghanistan
is the highest in all the four categories.
Cough
In table 5 result of marginal effect of probit regression model for occurrence of cough arepresented, it was observed from the analysis that the children of Nepal have the highest
probability of suffering cough in both non-solid and solid fuel using households withprobabilities 0.049 and 0.058 respectively. When interaction effect of fuel used for cooking andsource of drinking water was seen the interaction effect of both “safe” and “unsafe” drinking
with solid fuel showed the highest probability of occurrence of Cough in Nepal and least
probability was seen in India. The effect of fuel used for cooking and source of drinking water
also shows the similar results.
Discussion
Under five mortality and morbidities are dependent on many factors including various maternaland socioeconomic factors (16) (17).The outcome of this study shows that the use of biomass
fuel for cooking has a significant effect on occurrence of diseases among the under five24

children. Studies on indoor air pollution typically focuses on the specific pollutants like PM(particulate matter) and CO (carbon monoxide) which can cause morphologic and biochemicalchanges after penetrating deep into the lungs. In the biomass fuel using households the mean
24 hour PM level is 300–3,000 µg/m3, but can reach up to 30,000 µg/m3, which is much higher
than the acceptable range of PM level in the air (18). CO when inhaled can cause systemic
effect on one’s biology by biding with the hemoglobin and produces carboxyhemoglobin, which
can reduces the oxygen delivery to the vital tissues (19). This can be a reason to cause
illnesses among the children where CO is ambient in the air produced while burning any solid
fuel. Another study in India found that there is a significant association between solid biomass
fuel use in the households and respiratory symptoms and severity of the disease among thechildren from those households (20). A study in Nairobi also found the increased risk of Asthma
when the study population was exposed to wood smoke (21). Another study showed that there
was significant trend of higher infant mortality among the households that uses solid biomass
fuel in greater proportions (22). These studies contribute to the base of effect of household air
pollution caused by burning biomass-fuel on child health. But these results might not beadequate to assess any unique relationship. A review of published evidence revealed that
there is an increased risk of lower respiratory infection in children with the use of biomass fuel(23). Another study found that among the households using solid fuel there is a significantly
increased risk of cough and earache (22). One more study had reported that burning biomass
fuel in developing countries is linked to respiratory symptoms and chronic respiratory diseases
in children (18). The major limitation of this study is its cross-sectional design, which does notaccount for past exposure to biomass fuel smoke also the duration of exposure. Since the data
were collected retrospectively there is potential risk of recall bias influencing the results.
Strength of this study was the diversity of data. The analysis was made for six South andSoutheast Asian countries. In Conclusion, the result of this study suggests that exposure tobiomass fuel smoke is associated with increased risk of morbidity among children. The findings
have important policy implications which includes the need for a public information campaign
to increase awareness about the risks of biomass fuel smoke exposure.
It was observed from the analysis that there is a significant effect of household air pollution
caused by solid fuel use on occurrence of certain diseases among the children under the ageof five. Biomass fuel smoke has significant effect on the occurrence of all the four categoriesof the diseases in the study i.e. fever, cough, acute respiratory infections and diarrhea.
Interaction
Table 01: Percentages of selected morbidities among under-five children by type of fuel use in
selected South and Southeast Asian Countries
Morbidities
Fever
Non-solid Fuel
Solid Fuel
Total
Diarrhoea
Non-solid Fuel
Solid Fuel
Total
ARI
Non-solid Fuel
Solid Fuel
Total
Cough
Non-solid Fuel
Solid Fuel
Total

Nepal
%
P-value
4.47
0.00
4.22
4.28

Afghanistan%
P-value
7.64
0.00
7.59
7.61

Bangladesh% P-value
6.73
0.00
6.88
6.85

Cambodia%P-value
7.08
0.00
6.15
6.29

Myanmar%P-value
2.75
0.00
3.55
3.40

Philippines% P-value
3.00
0.00
4.30
3.73

India
% P-value
2.17
0.00
2.65
2.47

1.35
1.49
1.45

0.00

8.05
7.40
7.60

0.00

1.31
1
1.04

0.00

2.99
2.84
2.86

0.00

1.28
2.42
2.22

0.00

0.98
1.66
1.36

0.00

1.46
1.91
1.74

0.00

0.28
0.59
0.51

0.00

2.60
3.66
3.34

0.00

0.8
1.01
0.98

0.00

1.42
1.21
1.24

0.00

0.54
0.71
0.68

0.00

0.24
0.42
0.34

0.00

0.43
0.58
0.52

0.00

4.25
4.25
4.30

0.00

5.92
6.32
6.20

0.00

5.86
5.98
5.97

0.00

5.71
4.75
4.89

0.00

3.66
3.40
3.45

0.00

3.76
5.27
4.61

0.00

1.94
2.24
2.13

0.00

25

Table 02: Marginal effect of Selected Variables on Fever among under-Five Children in South and South-east
Asian Countries
Variables

Nepal

Afghanistan

Bangladesh

Cambodia

MyanmarPhilippines

India

0.027***(0.003)

0.065***(0.002)

0.062***(0.006)

0.052***(0.005)

0.04***(0.006)

0.033***(0.003)

0.024***(0.00)

Solid fuel0.041***(0.002)
Source of water
Safe
0.038***(0.002)
Unsafe0.03***(0.005)
Toilet facility
No facility
0.061***(0.005)
Flush0.034***(0.002)
Pit and Others
0.034***(0.003)
Place to cook
Outside house
0.039***(0.003)
Inside house
0.037***(0.002)
Wall material
Kachcha
0.039***(0.006)
Semi Pucca
0.037***(0.002)
Pucca
0.038***(0.004)
Floor material
Kachcha
0.053***(0.007)
Pucca
0.031***(0.004)
Semi Pucca
0.039***(0.002)
Roof material
Kachcha
0.035***(0.004)
Semi Pucca
0.047***(0.005)
Pucca
0.035***(0.002)
Educational attainment of the mother
Illiterate
0.025***(0.002)
Primary
0.056***(0.005)
Secondary
0.06***(0.006)
Higher
0.067***(0.011)
WealthPoor
0.04***(0.003)
Middle0.036***(0.003)
Rich
0.035***(0.004)
Maternal age at birth
20 years and below
0.025***(0.003)
21-30 years
0.035***(0.002)
30 years & above
0.064***(0.006 )ParityTwo and below
0.087***(0.006)
Third and above
0.026***(0.001)
Birth interval
One year0.028***(0.003)
Two to Three Years
0.033***(0.003)
Four and above Years
0.047***(0.003)
Interaction of fuel with water source
0.028***(0.003)
Non-solid fuel with Safe
Non-solid fuel with Unsafe
0.014**(0.007)
0.042***(0.002)
Solid fuel with Safe
Solid fuel with Unsafe
0.035***(0.006)

0.067***(0.001)

0.067***(0.002)

0.058***(0.002)

0.044***(0.002)

0.044***(0.002)

0.026***(0.00)

0.066***(0.001)
0.068***(0.001)

0.066***(0.002)
0.075***(0.01)

0.044***(0.002)
0.042***(0.003)

0.04***(0.001)
0.044***(0.002)

0.026***(0.00)
0.023***(0.00)

0.079***(0.003)
0.063***(0.003)
0.065***(0.001)

0.073***(0.009)
0.064***(0.005)
0.066***(0.002)

0.065***(0.003)
0.049***(0.003)
0.049***(0.009)

0.051***(0.005)
0.035***(0.007)
0.042***(0.002)

0.053***(0.005)
0.039***(0.001)
0.04***(0.003)

0.027***(0.00)
0.024***(0.00)
0.024***(0.00)

0.056***(0.001)
0.073***(0.001)

0.063***(0.002)
0.081***(0.005)

0.045***(0.002)
0.071***(0.003)

0.036***(0.003)
0.047***(0.002)

0.034***(0.002)
0.043***(0.001)

0.025***(0.00)
0.026***(0.00)

0.061***(0.005)
0.067***(0.001)
0.063***(0.003)

0.053***(0.004)
0.072***(0.005)
0.067***(0.002)

0.118***(0.033)
0.058***(0.003)
0.056***(0.002)

0.041*(0.022)
0.042***(0.002)
0.052***(0.005)

0.039***(0.002)
0.042***(0.002)

0.022***(0.00)
0.028***(0.00)
0.025***(0.00)

0.093***(0.005)
0.063***(0.001)
0.07***(0.001)

0.067***(0.002)
0.064***(0.005)

0.057***(0.005)
0.056***(0.002)

0.211*(0.121)
0.044***(0.007)
0.043***(0.002)

0.038***(0.002)
0.044***(0.002)

0.03***(0.001)
0.024***(0.00)
0.026***(0.00)

0.075***(0.002)
0.064***(0.001)
0.076***(0.007)

0.074***(0.013)
0.054***(0.005)
0.068***(0.002)

0.066***(0.007)
0.042***(0.003)
0.062***(0.002)

0.039***(0.003)
0.045***(0.011)
0.046***(0.002)

0.045***(0.004)
0.049***(0.008)
0.04***(0.001)

0.026***(0.001)
0.028***(0.00)
0.021***(0.00)

0.065***(0.001)
0.093***(0.004)
0.077***(0.005)
0.044***(0.007)

0.039***(0.002)
0.065***(0.003)
0.106***(0.004)
0.075***(0.009)

0.044***(0.003)
0.061***(0.002)
0.062***(0.004)

0.035***(0.003)
0.042***(0.002)
0.059***(0.005)
0.037***(0.011)

0.019***(0.004)
0.031***(0.002)
0.048***(0.002)
0.044***(0.003)

0.018***(0.00)
0.029***(0.00)
0.036***(0.00)
0.037***(0.001)

0.063***(0.001)
0.068***(0.002)
0.07***(0.002)

0.084***(0.004)
0.066***(0.004)
0.049***(0.003)

0.058***(0.003)
0.06***(0.004)
0.054***(0.004)

0.065***(0.004)
0.025***(0.003)
0.025***(0.003)

0.047***(0.002)
0.037***(0.003)
0.028***(0.003)

0.032***(0.00)
0.026***(0.00)
0.017***(0.00)

0.034***(0.002)
0.065***(0.001)
0.089***(0.002)

0.036***(0.002)
0.068***(0.002)
0.112***(0.006)

0.038***(0.005)
0.051***(0.002)
0.075***(0.004)

0.02***(0.005)
0.033***(0.002)
0.064***(0.004)

0.027***(0.003)
0.035***(0.001)
0.054***(0.002)

0.01***(0.00)
0.026***(0.00)
0.04***(0.001)

0.254***(0.008)
0.06***(0.001)

0.148***(0.006)
0.047***(0.001)

0.138***(0.006)
0.041***(0.002)

0.095***(0.007)
0.035***(0.002)

0.097***(0.005)
0.032***(0.001)

0.053***(0.001)
0.019***(0.00)

0.056***(0.001)
0.066***(0.001)
0.088***(0.002)

0.054***(0.003)
0.053***(0.003)
0.074***(0.002)

0.038***(0.003)
0.049***(0.003)
0.07***(0.003)

0.036***(0.003)
0.034***(0.003)
0.05***(0.003)

0.031***(0.002)
0.039***(0.002)
0.05***(0.002)

0.024***(0.00)
0.025***(0.00)
0.028***(0.00)

0.066***(0.002)
0.063***(0.003)
0.065***(0.001)
0.069***(0.002)

0.062***(0.006)
0.064 (0.041)
0.066***(0.002)
0.076***(0.009)

0.041***(0.008)
0.038***(0.007)
0.044***(0.002)
0.043***(0.003)

0.034***(0.004)
0.032***(0.003)
0.042***(0.002)
0.048***(0.003)

0.024***(0.00)
0.023***(0.001)
0.027***(0.00)
0.024***(0.001)

Type of fuelNon-solid fuelNote: For the countries where data was not available for the variable under study was left empty.
Significance level *p < 0.1. **p < 0.05. ***p < 0.01

26

Table 03: Marginal effect of Selected Variables on Occurrence of Diarrhea Among Under-Five Children in South andSouth-east Asian Countries
Variables

Nepal

Afghanistan

Bangladesh

Cambodia

MyanmarPhilippines

India

0.012***(0.002)
0.014***(0.001)

0.071***(0.002)
0.072***(0.001)

0.008***(0.001)

0.023***(0.003)
0.026***(0.001)

0.022***(0.005)
0.029***(0.002)

0.016***(0.002)
0.016***(0.001)

0.017***(0.00)
0.018***(0.00)

Safe

0.014***(0.001)

0.071***(0.001)

0.008***(0.001)

0.028***(0.002)

0.015***(0.001)

0.018***(0.00)

Unsafe0.01***(0.003)

0.072***(0.001)

0.028***(0.003)

0.017***(0.001)

0.016***(0.00)

No facility

0.026***(0.004)

0.088***(0.003)

0.012***(0.004)

0.031***(0.002)

0.028***(0.004)

0.02***(0.003)

0.02***(0.00)

Flush

0.011***(0.001)

0.063***(0.003)

0.009***(0.002)

0.021***(0.002)

0.021***(0.006)

0.015***(0.001)

0.016***(0.00)

Pit and Others

0.013***(0.002)

0.07***(0.001)

0.008***(0.001)

0.024***(0.007)

0.028***(0.002)

0.016***(0.002)

0.016***(0.00)

Outside house

0.012***(0.001)

0.065***(0.001)

0.007***(0.001)

0.021***(0.001)

0.022***(0.002)

0.015***(0.001)

0.017***(0.00)

Inside house

0.015***(0.001)

0.076***(0.001)

0.014***(0.002)

0.031***(0.002)

0.031***(0.002)

0.016***(0.001)

0.018***(0.00)

Kachcha

0.015***(0.004)

0.069***(0.005)

0.004***(0.001)

0.056**(0.024)

0.061**(0.028)

Semi Pucca

0.014***(0.001)

0.072***(0.001)

0.011***(0.002)

0.023***(0.002)

0.026***(0.001)

0.015***(0.001)

0.02***(0.00)

Pucca

0.012***(0.003)

0.073***(0.003)

0.008***(0.001)

0.027***(0.001)

0.039***(0.005)

0.016***(0.001)

0.017***(0.00)

Kachcha

0.015***(0.004)

0.087***(0.004)

Pucca

0.011***(0.002)

0.072***(0.001)

0.008***(0.001)

0.026***(0.004)

0.029***(0.006)

0.015***(0.001)

0.017***(0.00)

Semi Pucca

0.014***(0.001)

0.07***(0.001)

0.01***(0.003)

0.026***(0.001)

0.028***(0.001)

0.016***(0.001)

0.018***(0.00)

Kachcha

0.009***(0.002)

0.086***(0.002)

0.01**(0.004)

0.031***(0.005)

0.023***(0.002)

0.018***(0.002)

0.02***(0.001)

Semi Pucca

0.016***(0.003)

0.068***(0.001)

0.009***(0.002)

0.019***(0.002)

0.028***(0.01)

0.023***(0.005)

0.02***(0.00)

Pucca

0.014***(0.001)

0.055***(0.006)

0.008***(0.001)

0.028***(0.001)

0.031***(0.002)

0.015***(0.001)

0.014***(0.00)

Educational attainment of the mother
Illiterate
0.011***(0.001)

0.07***(0.001)

0.005***(0.001)

0.022***(0.002)

0.022***(0.003)

0.006***(0.002)

0.013***(0.00)

Primary0.019***(0.003)

0.104***(0.005)

0.009***(0.001)

0.026***(0.002)

0.026***(0.002)

0.015***(0.001)

0.021***(0.00)

Secondary

0.019***(0.003)

0.087***(0.005)

0.012***(0.002)

0.029***(0.003)

0.04***(0.004)

0.017***(0.001)

0.024***(0.00)

Higher

0.015***(0.005)

0.06***(0.008)

0.014***(0.004)

0.026***(0.01)

0.016***(0.002)

0.025***(0.001)

Poor

0.013***(0.002)

0.067***(0.001)

0.014***(0.002)

0.03***(0.002)

0.044***(0.003)

0.019***(0.001)

0.023***(0.00)

Middle0.015***(0.002)

0.076***(0.002)

0.008***(0.002)

0.02***(0.003)

0.021***(0.003)

0.013***(0.002)

0.017***(0.00)

Rich

0.014***(0.003)

0.075***(0.002)

0.005***(0.001)

0.022***(0.002)

0.012***(0.002)

0.009***(0.001)

0.012***(0.00)

20 years and below

0.012***(0.002)

0.039***(0.002)

0.005***(0.001)

0.022***(0.004)

0.016***(0.005)

0.013***(0.002)

0.007***(0.00)

21-30 years

0.012***(0.001)

0.071***(0.001)

0.009***(0.001)

0.023***(0.001)

0.022***(0.002)

0.013***(0.001)

0.018***(0.00)

30 years & above

0.025***(0.004)

0.092***(0.002)

0.01***(0.002)

0.033***(0.003)

0.039***(0.003)

0.021***(0.002)

0.026***(0.001)

Two and below

0.031***(0.004)

0.27***(0.008)

0.018***(0.002)

0.071***(0.005)

0.069***(0.006)

0.04***(0.003)

0.041***(0.001)

Third and above

0.01***(0.001)

0.065***(0.001)

0.006***(0.001)

0.017***(0.001)

0.022***(0.001)

0.012***(0.001)

0.013***(0.00)

One year0.01***(0.002)

0.061***(0.001)

0.006***(0.001)

0.019***(0.002)

0.024***(0.003)

0.013***(0.001)

0.017***(0.00)

Two to Three Years

0.013***(0.002)

0.071***(0.001)

0.008***(0.001)

0.023***(0.002)

0.023***(0.003)

0.014***(0.001)

0.018***(0.00)

Four and above Years

0.016***(0.002)

0.094***(0.002)

0.01***(0.001)

0.031***(0.002)

0.031***(0.002)

0.019***(0.001)

0.018***(0.00)

0.008***(0.002)

0.028***(0.007)

0.016***(0.003)

0.017***(0.00)

0.01***(0.004)

0.015***(0.002)

0.016***(0.001)

Type of fuelNon-solid fuelSolid fuelSource of water

Toilet facility

Place to cook

Wall material
0.016***(0.00)

Floor material
0.022***(0.001)

Roof material

WealthMaternal age at birth

ParityBirth intervalInteraction of fuel with water source
Non-solid fuel with Safe

0.013***(0.003)

0.072***(0.002)

Non-solid fuel with Unsafe

0.008(0.006)

0.068***(0.004)

Solid fuel with Safe

0.014***(0.001)

0.071***(0.001)

0.008***(0.001)

0.028***(0.002)

0.015***(0.001)

0.019***(0.00)

Solid fuel with Unsafe

0.011***(0.004)

0.073***(0.002)

0.013***(0.004)

0.03***(0.003)

0.018***(0.002)

0.016***(0.00)

Note: For the countries where data was not available for the variable under study was left empty.
Significance level *p < 0.1. **p < 0.05. ***p < 0.01

27

Table 04: Marginal effect of selected variables on occurrence of ARI among Under-Five Children in South andSouth-east Asian Countries
Variables

Nepal

Afghanistan

Bangladesh

Cambodia

MyanmarPhilippines

India

0.015***(0.003)

0.015***(0.004)

0.003***(0.001)

0.005***(0.00)

0.012***(0.001)

0.012***(0.001)

0.004***(0.00)

0.006***(0.00)

0.013***(0.001)

0.004***(0.00)

0.006***(0.00)

0.012***(0.002)

0.004***(0.001)

0.005***(0.00)

Type of fuelNon-solid fuelSolid fuel0.024***(0.001)
0.005***(0.001)

0.03***(0.001)

0.009***(0.001)

0.005***(0.001)

0.027***(0.001)

0.009***(0.001)

Source of water
Safe
Unsafe0.032***(0.001)

Toilet facility
No facility

0.005***(0.002)

0.035***(0.002)

0.017***(0.004)

0.014***(0.001)

0.012***(0.003)

0.008***(0.002)

0.006***(0.00)

Flush

0.004***(0.001)

0.028***(0.002)

0.008***(0.002)

0.011***(0.001)

0.01**(0.004)

0.003***(0.00)

0.005***(0.00)

Pit and Others

0.006***(0.001)

0.028***(0.001)

0.009***(0.001)

0.007**(0.003)

0.013***(0.001)

0.005***(0.001)

0.006***(0.00)

Outside house

0.006***(0.001)

0.025***(0.001)

0.008***(0.001)

0.01***(0.001)

0.009***(0.001)

0.004***(0.001)

0.005***(0.00)

Inside house

0.004***(0.001)

0.031***(0.001)

0.015***(0.002)

0.014***(0.001)

0.015***(0.001)

0.004***(0.00)

0.006***(0.00)

Kachcha

0.005**(0.002)

0.03***(0.003)

0.009***(0.002)

0.013(0.013)

Semi Pucca

0.005***(0.001)

0.029***(0.001)

0.008***(0.002)

0.015***(0.002)

0.012***(0.001)

0.004***(0.001)

0.006***(0.00)

Pucca

0.006***(0.002)

0.026***(0.002)

0.009***(0.001)

0.011***(0.001)

0.017***(0.003)

0.004***(0.001)

0.005***(0.00)

Kachcha0.007**(0.003)

0.034***(0.003)

Pucca

0.003***(0.001)

0.026***(0.001)

0.008***(0.001)

0.01***(0.002)

0.008***(0.003)

0.004***(0.001)

0.005***(0.00)

Semi Pucca

0.005***(0.001)

0.033***(0.001)

0.012***(0.003)

0.013***(0.001)

0.013***(0.001)

0.004***(0.001)

0.006***(0.00)

Kachcha

0.003***(0.001)

0.028***(0.001)

0.014**(0.006)

0.023***(0.004)

0.01***(0.001)

0.006***(0.001)

0.006***(0.00)

Semi Pucca

0.01***(0.003)

0.029***(0.001)

0.007***(0.002)

0.01***(0.001)

0.009*(0.005)

0.006**(0.003)

0.006***(0.00)

Pucca

0.004***(0.001)

0.034***(0.005)

0.009***(0.001)

0.012***(0.001)

0.015***(0.001)

0.004***(0.00)

0.004***(0.00)

Place to cook

Wall material
0.005***(0.00)

Floor material
0.007***(0.00)

Roof material

Educational attainment of the mother
Illiterate

0.003***(0.001)

0.028***(0.001)

0.005***(0.001)

0.008***(0.001)

0.009***(0.002)

0.004***(0.001)

0.004***(0.00)

Primary0.009***(0.002)

0.042***(0.003)

0.011***(0.001)

0.015***(0.001)

0.01***(0.001)

0.004***(0.001)

0.007***(0.00)

Secondary

0.007***(0.002)

0.034***(0.003)

0.013***(0.002)

0.011***(0.002)

0.025***(0.003)

0.003***(0.001)

0.008***(0.00)

Higher

0.006*(0.003)

0.016***(0.004)

0.008***(0.003)

0.01*(0.006)

0.016**(0.008)

Poor

0.007***(0.002)

0.029***(0.001)

0.014***(0.002)

0.013***(0.001)

0.023***(0.003)

0.004***(0.001)

0.007***(0.00)

Middle0.005***(0.001)

0.027***(0.001)

0.008***(0.002)

0.013***(0.002)

0.006***(0.002)

0.003***(0.001)

0.006***(0.00)

Rich

0.003**(0.001)

0.031***(0.001)

0.005***(0.001)

0.011***(0.002)

0.005***(0.001)

0.004***(0.001)

0.004***(0.00)

Maternal age atbirth
20 years and below

0.002**(0.001)

0.015***(0.001)

0.005***(0.001)

0.008***(0.003)

0.007**(0.003)

0.003**(0.001)

0.003***(0.00)

21-30 years

0.005***(0.001)

0.028***(0.001)

0.008***(0.001)

0.01***(0.001)

0.008***(0.001)

0.003***(0.00)

0.005***(0.00)

30 years & above

0.008***(0.002)

0.039***(0.001)

0.019***(0.003)

0.018***(0.002)

0.02***(0.002)

0.006***(0.001)

0.009***(0.00)

Two and below

0.01***(0.002)

0.105***(0.006)

0.021***(0.002)

0.033***(0.003)

0.018***(0.003)

0.01***(0.002)

0.012***(0.00)

Third and above

0.004***(0.001)

0.026***(0.001)

0.006***(0.001)

0.008***(0.001)

0.012***(0.001)

0.003***(0.00)

0.004***(0.00)

One year0.004***(0.001)

0.024***(0.001)

0.007***(0.001)

0.007***(0.001)

0.011***(0.002)

0.003***(0.001)

0.005***(0.00)

Two to Three Years

0.003***(0.001)

0.029***(0.001)

0.007***(0.001)

0.012***(0.001)

0.011***(0.002)

0.005***(0.001)

0.006***(0.00)

Four and above
0.006***(0.001)
Years
Interactionof fuel with water source

0.038***(0.001)

0.01***(0.001)

0.015***(0.001)

0.014***(0.001)

0.004***(0.001)

0.006***(0.00)

Non-solid fuel with
Safe
Non-solid fuel with
UnsafeSolidfuel with Safe

0.004***(0.001)

0.023***(0.001)

0.007***(0.002)

0.018***(0.006)

0.003***(0.001)

0.005***(0.00)

0.005***(0.001)

0.024***(0.002)
0.028***(0.001)

0.009***(0.001)

0.01**(0.004)
0.012***(0.001)

0.003***(0.001)
0.005***(0.001)

0.005***(0.001)
0.006***(0.00)

Solid fuel with Unsafe

0.007**(0.003)

0.034***(0.001)

0.009***(0.003)

0.013***(0.002)

0.004***(0.001)

0.005***(0.00)

0.009***(0.001)

WealthParityBirth interval

Note: For the countries where data was not available for the variable under study was left empty.
Significance level *p < 0.1. **p < 0.05. ***p < 0.01

28

Table 05: Marginal Effect of Selected Variables on Cough among Under-Five Children in South and South-east AsianCountries
Variables

Nepal

Afghanistan

Bangladesh

Cambodia

MyanmarPhilippines

India

Non-solid fuel0.02***(0.002)

0.047***(0.002)

0.049***(0.005)

0.046***(0.005)

0.05***(0.007)

0.041***(0.003)

0.021***(0.00)

Solid fuel0.042***(0.002)

0.055***(0.001)

0.058***(0.002)

0.042***(0.002)

0.048***(0.002)

0.053***(0.002)

0.023***(0.00)

Safe

0.037***(0.002)

0.052***(0.001)

0.057***(0.001)

0.047***(0.002)

0.047***(0.002)

0.022***(0.00)

Unsafe0.028***(0.005)

0.054***(0.001)

0.055***(0.008)

0.049***(0.003)

0.053***(0.002)

0.022***(0.00)

No facility

0.064***(0.006)

0.069***(0.002)

0.069***(0.009)

0.049***(0.003)

0.053***(0.005)

0.067***(0.005)

0.023***(0.00)

Flush

0.031***(0.002)

0.05***(0.003)

0.061***(0.005)

0.037***(0.002)

0.043***(0.008)

0.049***(0.002)

0.021***(0.00)

Pit and Others

0.032***(0.003)

0.05***(0.001)

0.056***(0.002)

0.038***(0.008)

0.047***(0.002)

0.042***(0.003)

0.023***(0.00)

Outside house

0.035***(0.002)

0.046***(0.001)

0.054***(0.002)

0.035***(0.002)

0.04***(0.003)

0.043***(0.002)

0.022***(0.00)

Inside house

0.037***(0.002)

0.057***(0.001)

0.072***(0.004)

0.052***(0.002)

0.052***(0.002)

0.052***(0.001)

0.022***(0.00)

Kachcha

0.039***(0.006)

0.053***(0.004)

0.048***(0.004)

0.052**(0.025)

0.03***(0.02)

Semi Pucca

0.037***(0.002)

0.053***(0.001)

0.061***(0.004)

0.046***(0.003)

0.049***(0.002)

0.051***(0.002)

0.024***(0.00)

Pucca

0.033***(0.004)

0.055***(0.003)

0.057***(0.002)

0.041***(0.002)

0.043***(0.005)

0.048***(0.002)

0.022***(0.00)

Kachcha

0.049***(0.007)

0.061***(0.004)

Pucca

0.029***(0.004)

0.049***(0.001)

0.057***(0.002)

0.042***(0.004)

0.043***(0.007)

0.047***(0.002)

0.021***(0.00)

Semi Pucca

0.038***(0.002)

0.057***(0.001)

0.057***(0.005)

0.043***(0.002)

0.048***(0.002)

0.052***(0.002)

0.023***(0.00)

Kachcha

0.031***(0.004)

0.057***(0.002)

0.06***(0.011)

0.06***(0.007)

0.038***(0.003)

0.061***(0.004)

0.024***(0.001)

Semi Pucca

0.048***(0.005)

0.052***(0.001)

0.046***(0.005)

0.031***(0.002)

0.057***(0.013)

0.06***(0.008)

0.024***(0.00)

Pucca

0.033***(0.002)

0.059***(0.007)

0.058***(0.002)

0.046***(0.002)

0.054***(0.003)

0.048***(0.001)

0.02***(0.00)

Type of fuelSource of water

Toilet facility

Place to cook

Wall material
0.02***(0.00)

Floor material
0.11***(0.1)

0.026***(0.001)

Roof material

Educational attainment of the mother
Illiterate

0.025***(0.002)

0.052***(0.001)

0.035***(0.002)

0.03***(0.003)

0.039***(0.003)

0.031***(0.005)

0.015***(0.00)

Primary

0.047***(0.004)

0.07***(0.004)

0.057***(0.003)

0.045***(0.002)

0.042***(0.002)

0.04***(0.002)

0.026***(0.00)

Secondary

0.059***(0.006)

0.062***(0.004)

0.087***(0.004)

0.05***(0.004)

0.073***(0.005)

0.058***(0.002)

0.033***(0.00)

Higher

0.076***(0.012)

0.033***(0.006)

0.068***(0.008)

0.027***(0.009)

0.057***(0.013)

0.049***(0.003)

0.034***(0.001)

Poor

0.034***(0.003)

0.051***(0.001)

0.073***(0.003)

0.045***(0.003)

0.071***(0.004)

0.056***(0.002)

0.029***(0.00)

Middle0.033***(0.003)

0.051***(0.002)

0.056***(0.004)

0.049***(0.004)

0.032***(0.003)

0.041***(0.003)

0.022***(0.00)

Rich

0.042***(0.005)

0.057***(0.002)

0.043***(0.003)

0.038***(0.003)

0.029***(0.003)

0.037***(0.003)

0.015***(0.00)

20 years and below

0.023***(0.003)

0.027***(0.001)

0.035***(0.002)

0.027***(0.005)

0.024***(0.006)

0.031***(0.004)

0.01***(0.00)

21-30 years

0.035***(0.002)

0.052***(0.001)

0.057***(0.002)

0.037***(0.002)

0.034***(0.002)

0.043***(0.001)

0.022***(0.00)

30 years & above

0.056***(0.005)

0.07***(0.002)

0.093***(0.005)

0.059***(0.003)

0.074***(0.004)

0.067***(0.003)

0.036***(0.001)

Two and below

0.081***(0.006)

0.194***(0.007)

0.124***(0.005)

0.106***(0.006)

0.1***(0.007)

0.12***(0.006)

0.047***(0.001)

Third and above

0.026***(0.001)

0.048***(0.001)

0.041***(0.001)

0.03***(0.001)

0.039***(0.002)

0.039***(0.001)

0.016***(0.00)

One year0.029***(0.003)

0.044***(0.001)

0.044***(0.003)

0.028***(0.002)

0.041***(0.004)

0.041***(0.002)

0.021***(0.00)

Two to Three Years

0.029***(0.002)

0.052***(0.001)

0.046***(0.003)

0.039***(0.003)

0.044***(0.004)

0.049***(0.002)

0.022***(0.00)

Four and above Years

0.046***(0.003)

0.072***(0.002)

0.065***(0.002)

0.051***(0.002)

0.052***(0.003)

0.057***(0.002)

0.024***(0.00)

WealthMaternal age at birth

ParityBirth intervalInteraction of fuel with water source
Non-solid fuel with Safe

0.021***(0.003)

0.048***(0.002)

0.05***(0.005)

0.05***(0.008)

0.039***(0.004)

0.021***(0.00)

Non-solid fuel with Unsafe

0.013**(0.006)

0.046***(0.003)

0.028(0.026)

0.05***(0.009)

0.044***(0.004)

0.022***(0.001)

Solid fuel with Safe

0.043***(0.002)

0.053***(0.001)

0.058***(0.002)

0.047***(0.002)

0.051***(0.002)

0.023***(0.00)

Solid fuel with Unsafe

0.035***(0.007)

0.057***(0.001)

0.059***(0.009)

0.049***(0.004)

0.056***(0.003)

0.022***(0.001)

Note: For the countries where data was not available for the variable under study was left empty.
Significance level *p < 0.1. **p < 0.05. ***p < 0.01

References
1. Leary J., M. Leach, S. Batchelor, N. Scott, and E. Brown (2021) Battery-supported eCooking: A
transformative opportunity for 2.6 billion people who still cook with biomass, Energy Policy, vol. 159,
p. 112619.
2. Rana J., J. Uddin, R. Peltier, and Y. Oulhote (2019) Associations between indoor air pollution andacute respiratory infections among under-five children in Afghanistan: do SES and sex matter?, Int.
J. Environ. Res. Public Health, vol. 16, no. 16, p. 2910.
3. Smith K. R. (2006) Health impacts of household fuelwood use in developing countries, UNASYLVAFAO-, vol. 57, no. 2, p. 41.

29

4. Smith K. R. (2002) Indoor air pollution in developing countries: recommendations for research,
Indoor Air, vol. 12, no. 3, pp. 198–207.
5. Po J. Y. T., J. M. Fitz Gerald, and C. Carlsten (2011) Respiratory disease associated with solid
biomass fuel exposure in rural women and children: systematic review and meta-analysis, Thorax,
vol. 66, no. 3, pp. 232–239
6. Po J. Y. T., N. Shahidi, J. Fitzgerald, and C. Arlsten (2009) Respiratory disease associated withsolid biomass fuel exposure in rural women and children: a systematic review and meta-analysis,
Am J Respir Crit Care Med, vol. 179, p. A4740, 2009.
7. Mortimer K., S. B. Gordon, S. K. Jindal, R. A. Accinelli, J. Balmes, and W. J. Martin II, (2012)
Household air pollution is a major avoidable risk factor for cardiorespiratory disease, Chest, vol.
142, no. 5, pp. 1308–1315.
8. Smith K. R. et al., (2014) Millions dead: how do we know and what does it mean? Methods used in
the comparative risk assessment of household air pollution, Annu. Rev. Public Health, vol. 35, pp.
185–206.
9. Balmes J. R. (2019) Household air pollution from domestic combustion of solid fuels and health, J.
Allergy Clin. Immunol., vol. 143, no. 6, pp. 1979–1987.
10. Rehfuess E. A., N. G. Bruce, and K. R. Smith (2017) Solid fuel use: health effect.
11. Garba I. and R. Bellingham (2021) Energy poverty: Estimating the impact of solid cooking fuels on
GDP per capita in developing countries-Case of sub-Saharan Africa, Energy, vol. 221, p. 119770.
12. IEA S. (2017) International Energy Agency, 2016, Key World Energy Stat. ed.
13. Agrawal S. and S. Yamamoto (2015) Effect of indoor air pollution from biomass and solid fuelcombustion on symptoms of preeclampsia/eclampsia in Indian women, Indoor Air, vol. 25, no. 3,
pp. 341–352.
14. Křůmal K., P. Mikuška, J. Horák, F. Hopan, and L. Kuboňová (2021) Influence of boiler output andtype on gaseous and particulate emissions from the combustion of coal for residential heating,Chemosphere, vol. 278, p. 130402
15. Biro F. l. (2009) World energy outlook 2006, Int. Energy Agency
16. Das L. and A. Mishra (2018) Impact of maternal age and birth spacing on mortality of children inindia, IJSSER, vol. 07, pp. 3555-3563.
17. Jaiswal A. K., H. Chaurasia, and L. Das (2021) What better is the Culmination of Food thanNutrition?, Emerg. Challenges Agric. Food Sci. Vol. 1, pp. 75–79
18. Bruce N., R. Perez-Padilla, and R. Albalak (2000) Indoor air pollution in developing countries: amajor environmental and public health challenge, Bull. World Health Organ., vol. 78, pp. 1078–1092
19. Townsend C. L. and R. L. Maynard (2002) Effects on health of prolonged exposure to low
concentrations of carbon monoxide, Occup. Environ. Med., vol. 59, no. 10, pp. 708–711
20. Padhi B. K. and P. K. Padhy (2008) Domestic fuels, indoor air pollution, and children’s health: thecase of rural India, Ann. N. Y. Acad. Sci., vol. 1140, no. 1, pp. 209–217
21. Mohamed N. J. Odhiambo, J. Nyamwaya, and R. Menzies, (1995) Home environment and asthma
in Kenyan schoolchildren: a case-control study, Thorax, vol. 50, no. 1, pp. 74–78.
22. S. T. Rinne, E. J. Rodas, M. L. Rinne, J. M. Simpson, and L. T. Glickman (2007) Use of biomass
fuel is associated with infant mortality and child health in trend analysis, Am. J. Trop. Med. Hyg.,
vol. 76, no. 3, pp. 585–591
23. K. R. Smith, J. M. Samet, I. Romieu, and N. Bruce, “Indoor air pollution in developing countries andacute lower respiratory infections in children,” Thorax, vol. 55, no. 6, pp. 518–532, 2000.

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