Impact of household air pollution on under 5 mortalities and ARI in sub saharan africa: evidence from demographic and health survey 2010-2020.

Household air pollution (HAP) is a major environmental health risk globally and is strongly associated with adverse child health outcomes, including neonatal, infant, and under-five mortality. Household environmental conditions such as water source, sanitation, cooking fuel type, and housing materials (roofing and walling) influence exposure levels and subsequent health risks. While there is robust global evidence linking HAP to poor child health outcomes, evidence from Sub-Saharan Africa (SSA) remains comparatively limited, despite the region bearing a disproportionately high burden of solid fuel use and child mortality. This gap constrains a comprehensive understanding of the magnitude and contextual drivers of HAP-related risks among children in SSA. We investigated the association between HAP due to household environmental variables (source of water, sanitation, type of cooking fuel, roofing materials, walling material etc.) and selected child health outcomes (neonatal, infant, ARI and under five mortality) in 32 Sub-Saharan Africa (SSA) countries. In all we analyzed Demographic and Health Survey (DHS) data from 362,072 children under the age of five, applying complex survey design features including stratification, clustering, and sampling weights. HAP exposure was defined using quantile distribution and summarized into Household Air Pollution Index through principal component analysis, categorized as "unexposed", "moderate exposure" and "high exposure". Associations were estimated using Poisson regression models with a robust variance adjusting for confounding variables and survey design effects. Approximately two-thirds (65%) children under-five were exposed to HAP, with the highest exposures in Central (71%) and West Africa (67%). Over the study decade, mortality rates were under five (92 per 1000 live births), infants (52 per 1000 live births), and neonatal (28 per 1000 live births). Exposure to HAP was associated with increased risk of under-five mortality (aRR: 1.3; 95% CI: 1.19, 1.46; p = 0.001) and infant mortality (aRR: 1.4; 95% CI: 1.28, 1.60; p = 0.001). Children with high exposure to HAP had a higher mortality risk than the unexposed (aRR: 1.10; 95% CI: 0.91-1.33; p = 0.032). Our findings demonstrate that HAP significantly contributes to infants, ARI and under five mortalities in SSA. Given the heavy reliance on solid fuels in low-resource settings, urgent government action is needed to reduce solid fuel use, improve household sanitation, expand access to clean water, and reconsider housing materials to protect child health.