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A Systematic Review and Appraisal of Epidemiological Studies on Household Fuel Use and Its Health Effects Using Demographic and Health Surveys

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  • Daniel B. Odo

    (School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
    College of Health Sciences, Arsi University, Oromia, Asella P.O. Box 193, Ethiopia)

  • Ian A. Yang

    (Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Chermside, QLD 4032, Australia
    UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane QLD 4032, Australia)

  • Luke D. Knibbs

    (School of Public Health, The University of Queensland, Herston, QLD 4006, Australia)

Abstract

The domestic combustion of polluting fuels is associated with an estimated 3 million premature deaths each year and contributes to climate change. In many low- and middle-income countries (LMICs), valid and representative estimates of people exposed to household air pollution (HAP) are scarce. The Demographic and Health Survey (DHS) is an important and consistent source of data on household fuel use for cooking and has facilitated studies of health effects. However, the body of research based on DHS data has not been systematically identified, nor its strengths and limitations critically assessed as a whole. We aimed to systematically review epidemiological studies using DHS data that considered cooking fuel type as the main exposure, including the assessment of the extent and key drivers of bias. Following PRISMA guidelines, we searched PubMed, Web of Science, Scopus and the DHS publication portal. We assessed the quality and risk of bias (RoB) of studies using a novel tool. Of 2748 records remaining after removing duplicates, 63 were read in full. A total of 45 out of 63 studies were included in our review, spanning 11 different health outcomes and representing 50 unique analyses. In total, 41 of 45 (91%) studies analysed health outcomes in children <5 years of age, including respiratory infections ( n = 17), death (all-cause) ( n = 14), low birthweight ( n = 5), stunting and anaemia ( n = 5). Inconsistencies were observed between studies in how cooking fuels were classified into relatively high- and low-polluting. Overall, 36/50 (80%) studies reported statistically significant adverse associations between polluting fuels and health outcomes. In total, 18/50 (36%) of the analyses were scored as having moderate RoB, while 16/50 (32%) analyses were scored as having serious or critical RoB. Although HAP exposure assessment is not the main focus of the DHS, it is the main, often only, source of information in many LMICs. An appreciable proportion of studies using it to analyse the association between cooking fuel use and health have potential for high RoB, mostly related to confounder control, exposure assessment and misclassification, and outcome ascertainment. Based on our findings, we provide some suggestions for ways in which revising the information collected by the DHS could make it even more amenable to studies of household fuel use and health, and reduce the RoB, without being onerous to collect and analyse.

Suggested Citation

  • Daniel B. Odo & Ian A. Yang & Luke D. Knibbs, 2021. "A Systematic Review and Appraisal of Epidemiological Studies on Household Fuel Use and Its Health Effects Using Demographic and Health Surveys," IJERPH, MDPI, vol. 18(4), pages 1-31, February.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:4:p:1411-:d:492510
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    References listed on IDEAS

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    1. Juwel Rana & Jalal Uddin & Richard Peltier & Youssef Oulhote, 2019. "Associations between Indoor Air Pollution and Acute Respiratory Infections among Under-Five Children in Afghanistan: Do SES and Sex Matter?," IJERPH, MDPI, vol. 16(16), pages 1-13, August.
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    Cited by:

    1. Zubaidah Al-Janabi & Katherine E. Woolley & G. Neil Thomas & Suzanne E. Bartington, 2021. "A Cross-Sectional Analysis of the Association between Domestic Cooking Energy Source Type and Respiratory Infections among Children Aged under Five Years: Evidence from Demographic and Household Surve," IJERPH, MDPI, vol. 18(16), pages 1-17, August.
    2. Joshua Epuitai & Katherine E. Woolley & Suzanne E. Bartington & G. Neil Thomas, 2022. "Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data," IJERPH, MDPI, vol. 19(7), pages 1-14, April.

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