Biofuel Smoke and Child Anemia in 29 Developing Countries: A Multilevel Analysis

Purpose In this study we examined the effect of biofuel smoke exposure at the national and child levels on child anemia. Methods Data are from Demographic and Health Surveys conducted between 2003 and 2007. The respondents were women (15−49 years) and their children (0−59 months) (n = 117,454) in 29 developing countries. Results In multinomial logistic regression models, both moderate and high exposure to biofuel smoke at the country level are associated with moderate/severe anemia (odds ratio [OR], 2.36; 95% confidence interval [95% CI], 1.28−4.36 vs OR, 2.80; 95% CI, 1.37−5.72) after adjusting for covariates. Exposure to biofuel smoke at home is associated with mild anemia (OR, 1.07; 95% CI, 1.01−1.13), and there are interactions between biofuel smoke exposure and child age in months on mild anemia (OR, 1.004; 95% CI, 1.002−1.006) and moderate/severe anemia (OR, 1.006; 95% CI, 1.004−1.008). There are also interactions between biofuel smoke exposure at home and diarrhea on mild anemia (OR, 1.22; 95% CI, 1.10−1.34) and on moderate/severe anemia (OR, 1.11; 95% CI, 1.01−1.22); and fever on moderate/severe anemia (OR, 1.33; 95% CI, 1.22−1.45). Conclusions Given the increasing number of people relying on biofuels in developing countries, policies and programs are necessary to protect children from being exposed to this harmful smoke at home.