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Background/AimSeveral studies have demonstrated associations between household air pollution (HAP) and child undernutrition, but the extent to which this relationship varies across the outcome distribution and according to socioeconomic status (SES) is unknown. We aimed to address this using data from Nepal Demographic and Health Survey (NDHS).
MethodsWe used child anthropometry data for 9,914 children aged 0-59 months from the 2006, 2011, and 2016 NDHS. Sex-stratified quantile regression (QR) analysis was performed to identify the relationship between the markers of HAP and child nutritional status, which is indicated by z scores for height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ). The SES was based on the composite of education, household wealth, and occupation. We used QR plots to visually examine the effect of HAP across the entire outcome distribution for each SES group.
ResultsIn the adjusted model, the negative association between HAP and HAZ was stronger at the lower end of HAZ distribution in both sexes. For example, the estimate for female children at the 10^th quantile was −0.39 (95% confidence interval (CI) = −0.65, −0.13), decreasing to −0.26 (95% CI = −0.52, 0.01) at the 90^th quantile. The QR plots showed a pattern of stronger association in low SES group and at the lower end of HAZ distribution, particularly among female children. For example, female children from low SES group, HAP was associated with a 0.81unit decrease (95% CI = 1.51, 0.11) in HAZ at the 10^th quantile, whereas it was associated with a 0.49 unit decrease (95% CI = 0.69, 0.28) for high SES group in the same quantile. The strength of evidence for socioeconomic inequalities for WAZ and WHZ was weak.
ConclusionsWe observed evidence for a pattern of stronger effect of HAP in lower SES group, particularly among female children and at the lower end of the HAZ.