Household use of biomass fuel is associated with childhood wheeze and eczema: a cross sectional study of rural communities in Kandy, Sri Lanka

Background: The majority of households in low- and middle-income countries (LMICs) rely on biomass fuel for cooking. Studies investigating the association between early life exposure to household air pollution and health outcomes in children in LMICs have been limited. In this study we aimed to investigate the effects of biomass fuel for cooking and different types of stoves on wheeze and allergies in children of rural Sri Lankan communities. Methods: A cross-sectional study was conducted on 452 children aged 5 years and younger in Kandy, Sri Lanka. A questionnaire was administered to mothers of the children to collect information on exposures, outcomes and covariates. The associations between biomass fuel and outcomes of wheeze and allergies were analysed using logistic regression models while adjusting for potential confounders. Results: Use of biomass fuel for cooking was associated with increased risk of childhood wheeze (aOR=2.38; 95% CI 1.08-5.27) and childhood eczema (aOR=4.49; 95% CI 1.40-14.38) compared with households that used clean fuel (LPG, electricity and/or bio gas). Among households that used biomass fuel, use of traditional biomass stoves was associated with a higher risk of childhood wheeze (aOR=3.24; 95% CI 1.28-8.20), allergic rhinitis (aOR=3.08; 95% CI 1.34-7.04) and childhood eczema (aOR=7.96; 95% CI 2.35-26.93) compared with households that used clean stoves (gas or electric). Conclusion: Children living in households that used biomass fuel, especially traditional biomass cookstoves, were at a higher risk of wheeze and allergic outcomes. Reducing use of biomass fuel for cooking and access to affordable clean energy sources may help to improve health of rural LMICs through reduction of air pollution.