Biodigester Cookstove Interventions and Child Diarrhea in Semirural Nepal: A Causal Analysis of Daily Observations,Environmental Health Perspectives

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Biodigester Cookstove Interventions and Child Diarrhea in Semirural Nepal: A Causal Analysis of Daily Observations
Environmental Health Perspectives ( IF 10.1 ) Pub Date : 2022-1-5 , DOI: 10.1289/ehp9468
Heather K Amato ₁ , Caitlin Hemlock ₂ , Kristin L Andrejko ₂ , Anna R Smith ₁ , Nima S Hejazi ₃ , Alan E Hubbard ₃ , Sharat C Verma ₄ , Ramesh K Adhikari ₅ , Dhiraj Pokhrel ₆ , Kirk Smith ₁ , Jay P Graham ₁ , Amod Pokhrel ₁

Affiliation

Abstract

Background:

Hundreds of thousands of biodigesters have been constructed in Nepal. These household-level systems use human and animal waste to produce clean-burning biogas used for cooking, which can reduce household air pollution from woodburning cookstoves and prevent respiratory illnesses. The biodigesters, typically operated by female caregivers, require the handling of animal waste, which may increase domestic fecal contamination, exposure to diarrheal pathogens, and the risk of enteric infections, especially among young children.

Objective:

We estimated the effect of daily reported biogas cookstove use on incident diarrhea among children $less than 5 years$ old in the Kavrepalanchok District of Nepal. Secondarily, we assessed effect measure modification and statistical interaction of individual- and household-level covariates (child sex, child age, birth order, exclusive breastfeeding, proof of vaccination, roof type, sanitation, drinking water treatment, food insecurity) as well as recent 14-d acute lower respiratory infection (ALRI) and season.

Methods:

We analyzed 300,133 person-days for 539 children in an observational prospective cohort study to estimate the average effect of biogas stove use on incident diarrhea using cross-validated targeted maximum likelihood estimation (CV-TMLE).

Results:

Households reported using biogas cookstoves in the past 3 d for 23% of observed person-days. The adjusted relative risk of diarrhea for children exposed to biogas cookstove use was 1.31 (95% confidence interval (CI): 1.00, 1.71) compared to unexposed children. The estimated effect of biogas stove use on diarrhea was stronger among breastfed children (2.09; 95% CI: 1.35, 3.25) than for nonbreastfed children and stronger during the dry season (2.03; 95% CI: 1.17, 3.53) than in the wet season. Among children exposed to biogas cookstove use, those with a recent ALRI had the highest mean risk of diarrhea, estimated at 4.53 events (95% CI: 1.03, 8.04) per 1,000 person-days.

Discussion:

This analysis provides new evidence that child diarrhea may be an unintended health risk of biogas cookstove use. Additional studies are needed to identify exposure pathways of fecal pathogen contamination associated with biodigesters to improve the safety of these widely distributed public health interventions. https://doi.org/10.1289/EHP9468

中文翻译：

尼泊尔半农村地区的生物消化器炉灶干预措施和儿童腹泻：每日观察的因果分析

抽象的

背景：

尼泊尔已建造了数十万个生物沼气池。这些家庭级系统利用人类和动物的排泄物来生产用于烹饪的清洁燃烧沼气，这可以减少燃木炉灶造成的家庭空气污染并预防呼吸道疾病。生物消化器通常由女性护理人员操作，需要处理动物粪便，这可能会增加家庭粪便污染、接触腹泻病原体以及肠道感染的风险，尤其是幼儿。

客观的：

我们估计了每日报告的沼气炉使用对儿童腹泻事件的影响 $< 5 y$ 老在尼泊尔 Kavrepalanchok 区。其次，我们评估了个人和家庭层面协变量（儿童性别、儿童年龄、出生顺序、纯母乳喂养、疫苗接种证明、屋顶类型、卫生设施、饮用水处理、粮食不安全）的效果测量修正和统计交互作用，以及最近 14 天的急性下呼吸道感染 (ALRI) 和季节。

方法：

我们在一项观察性前瞻性队列研究中分析了 539 名儿童的 300,133 人日，使用交叉验证的目标最大似然估计 (CV-TMLE) 来估计使用沼气炉对腹泻事件的平均影响。

结果：

据观察，有 23% 的家庭在过去 3 天内使用过沼气炉灶。与未接触沼气炉灶的儿童相比，调整后的腹泻相对风险为 1.31（95% 置信区间 (CI)：1.00，1.71）。据估计，母乳喂养儿童使用沼气炉对腹泻的影响（2.09；95% CI：1.35，3.25）比非母乳喂养儿童更强，旱季（2.03；95% CI：1.17，3.53）比雨季更强。季节。在接触沼气炉使用的儿童中，最近患有 ALRI 的儿童腹泻的平均风险最高，估计为每 1,000 人日 4.53 起事件（95% CI：1.03，8.04）。