Household solid fuel exposure and linear growth faltering in rural Indian children

Abstract

Introduction: Stunting affects approximately one-quarter of children globally. This study aims to examine how exposure to Household Air Pollution (HAP) from solid fuel use contributes to growth faltering among children.

Materials and methods: The study utilized data from the National Family Health Survey (NFHS-5, 2019–21) and included 185,721 rural children aged 0–59 months. Bivariate and multivariable logistic regression analyses were performed to evaluate the association between household cooking fuel and childhood stunting, with findings reported as 95% Confidence Intervals (CIs). A mediation analysis was further undertaken to examine the potential mediating role of child morbidity.

Results: Using clean fuels was inversely associated with stunting; the odds of stunting were 62% and 54% lower among children in households using only clean fuels compared to those exposed to solid fuels. Based on the adjusted multivariable logistic regression, clean cooking fuel was significantly associated with a decreased prevalence of stunting (β = − 0.029, p = 0.050). Mediation analysis indicated significant effects of cooking fuel on stunting for the controlled direct effect (CDE = 0.972, p = 0.050) and natural direct effect (NDE = 0.973, p = 0.044) but not for the natural indirect effect via morbidity (NIE = 1.000, p = 0.893). The marginal total effect (MTE=0.973, p = 0.044) supported a small but significant protective association of child stunting with clean cooking fuel.

Conclusion: The findings suggest that reducing exposure to household air pollution through clean cooking fuels, alongside broader socio-economic interventions, may contribute to lowering childhood stunting in India