Household air pollution from solid fuels and its association with diarrhoea among children under five in Pakistan: evidence from PDHS

Pakistan has the highest child diarrhoea mortality in South Asia, but the impact of household air pollution from polluting cooking fuels remains understudied. This study explores the association between exposure to such fuels and the odds of diarrhoea in children under five, using PDHS 2017-18 data. Diarrhoea prevalence was based on maternal self-reports of episodes in the past two weeks. Household air pollution exposure was measured using the household's primary cooking fuel. Multivariable logistic regression models were applied, adjusting for socioeconomic, child, maternal, nutritional, and water, sanitation, and hygiene factors. Among 11,947 children included, diarrhoea was reported in 2107 (17.6%). In the fully adjusted model, exposure to polluting cooking fuels was associated with higher odds of diarrhoea (OR: 1.13, 95% CI: 1.03-1.25, P-value = 0.013). Fuel-specific analysis showed that children in households using animal dung had the highest odds of diarrhoea (OR: 1.41, 95% CI: 1.06-1.84, P-value = 0.015). Subgroup analyses showed the strongest association among infants under 1 year, children with stunting, and those born to uneducated mothers. This study found that cooking with solid fuels increases childhood diarrhoea in Pakistan. Transitioning to clean fuels is crucial for public health in Pakistan and similar countries to reduce this burden.