Independent and combined effects of maternal smoking and solid fuel on infant and child mortality in sub‐Saharan Africa

• Published in: Tropical medicine & international health 2016-12, Vol.21 (12), p.1572-1582
• Main Authors: Akinyemi, Joshua O., Adedini, Sunday A., Wandera, Stephen O., Odimegwu, Clifford O.
• Format: Article
• Language: English
• Subjects: Adult; Africa South of the Sahara - epidemiology; Afrique subsaharienne; Air Pollution - adverse effects; características del hogar; caractéristiques des ménages; Child Mortality; Child, Preschool; childhood mortality; combustible solide; combustible sólido; Cooking - methods; Demography; Environmental Exposure - adverse effects; facteurs socioéconomiques; factores socioeconómicos; Family Characteristics; Health Surveys; household characteristics; Humans; Infant; Infant Death - etiology; Infant Mortality; Infant, Newborn; Maternal & child health; maternal smoking; mortalidad infantil; mortalité infantile; Mothers; Proportional Hazards Models; Smoking; Smoking - adverse effects; socio‐economic factors; solid fuel; sub‐Saharan Africa; tabagisme maternel; tabaquismo materno; Tobacco Smoke Pollution - adverse effects; África subsahariana
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.12779

Objective To estimate the independent and combined risks of infant and child mortality associated with maternal smoking and use of solid fuel in sub‐Saharan Africa. Methods Pooled weighted data on 143 602 under‐five children in the most recent demographic and health surveys for 15 sub‐Saharan African countries were analysed. The synthetic cohort life table technique and Cox proportional hazard models were employed to investigate the effect of maternal smoking and solid cooking fuel on infant (age 0–11 months) and child (age 12–59 months) mortality. Socio‐economic and other confounding variables were included as controls. Results The distribution of the main explanatory variable in households was as follows: smoking + solid fuel – 4.6%; smoking + non‐solid fuel – 0.22%; no smoking + solid fuel – 86.9%; and no smoking + non‐solid fuel – 8.2%. The highest infant mortality rate was recorded among children exposed to maternal smoking + solid fuel (72 per 1000 live births); the child mortality rate was estimated to be 54 per 1000 for this group. In full multivariate models, the risk of infant death was 71% higher among those exposed to maternal smoking + solid fuel (HR = 1.71, CI: 1.29–2.28). For ages 12 to 59 months, the risk of death was 99% higher (HR = 1.99, CI: 1.28–3.08). Conclusions Combined exposures to cigarette smoke and solid fuel increase the risks of infant and child mortality. Mothers of under‐five children need to be educated about the danger of smoking while innovative approaches are needed to reduce the mortality risks associated with solid cooking fuel. Objectif Estimer les risques indépendants et combinés de la mortalité infantile et des nourrissons, associés au tabagisme maternel et à l'utilisation de combustibles solides en Afrique subsaharienne. Méthodes Les données pondérées et poolées de 143.602 enfants de moins de cinq ans dans les plus récentes enquêtes démographiques et de santé de 15 pays d'Afrique subsaharienne ont été analysées. La technique de la table de mortalité de cohorte synthétique et les modèles de risques proportionnels de Cox ont été utilisés pour étudier l'effet du tabagisme maternel et des combustibles de cuisine solides sur la mortalité des nourrissons (âge 0‐11 mois) et des enfants (âge 12‐59 mois). Les variables confusionnelles socioéconomiques et autres ont été incluses comme contrôles. Résultats La répartition de la principale variable explicative dans les ménages était: tabagisme + combustible solide: 4,6%; tabagis