Biofuel Smoke and Child Anemia in 29 Developing Countries: A Multilevel Analysis

PURPOSE: In this study we examined the effect of biofuel smoke exposure at the national and child levels on child anemia. METHODS: Data are from Demographic and Health Surveys conducted between 2003 and 2007. The respondents were women (15-49 years) and their children (0-59 months) (n = 117,454) in 29 developing countries. RESULTS: In multinomial logistic regression models, both moderate and high exposure to biofuel smoke at the country level are associated with moderate/severe anemia (odds ratio [OR], 2.36; 95% confidence interval [95% CI], 1.28-4.36 vs OR, 2.80; 95% CI, 1.37-5.72) after adjusting for covariates. Exposure to biofuel smoke at home is associated with mild anemia (OR, 1.07; 95% CI, 1.01-1.13), and there are interactions between biofuel smoke exposure and child age in months on mild anemia (OR, 1.004; 95% CI, 1.002-1.006) and moderate/severe anemia (OR, 1.006; 95% CI, 1.004-1.008). There are also interactions between biofuel smoke exposure at home and diarrhea on mild anemia (OR, 1.22; 95% CI, 1.10-1.34) and on moderate/severe anemia (OR, 1.11; 95% CI, 1.01-1.22); and fever on moderate/severe anemia (OR, 1.33; 95% CI, 1.22-1.45). CONCLUSIONS: Given the increasing number of people relying on biofuels in developing countries, policies and programs are necessary to protect children from being exposed to this harmful smoke at home.