Solid Biomass Fuel Use and Respiratory Health Among Women and Children in South Asian Countries: A Systematic Review and Meta-Analysis

The use of biofuels for cooking in households has been associated with an increased risk of respiratory infections, particularly among women and children. However, there remains a dearth of systematic evidence regarding the respiratory health impacts of biofuel use in South Asian countries. This review aimed to compare the prevalence of respiratory infections among women and children under five years old in households using unimproved cooking fuels versus those using improved alternatives. Articles were systematically retrieved from the PubMed, Embase, and Web of Science databases. Pooled prevalence estimates were calculated through meta-analysis utilizing the random-effects model. From a pool of 4,190 identified articles, 86 full-text articles were scrutinized, leading to the inclusion of 36 studies. Analysis revealed a notably higher prevalence of respiratory infections among individuals utilizing unimproved cooking fuels, with 23.3% prevalence among women compared to 8% among users of improved fuels. Women using unimproved fuels also exhibited higher rates of acute respiratory infections (29.2%) and chronic respiratory infections (17.1%) compared to those using improved fuels (11.2% and 5.3%, respectively). Likewise, children in households using unimproved fuels demonstrated a significantly higher prevalence of acute respiratory infections (26.4%) compared to those using improved fuels (11.8%). These findings underscore the urgent imperative to advocate for the adoption of improved cooking fuels and technologies in South Asian countries to mitigate the burden of respiratory infections.