Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design, Setting, and Data Source
2.2. Study Population
2.3. Modifications to the Wealth Index
2.4. Exposure Variables
2.5. Outcome Variables
2.6. Covariates
2.7. Data Analysis
2.8. Ethical Approval and Authorisation
3. Results
3.1. Descriptive Statistics
3.2. Association between Type of Biomass Cooking Fuels with LBW
3.3. Sensitivity Analyses
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Birthweight < 2500 g N (%) | Birthweight ≥ 2500 g N (%) | ||
---|---|---|---|
N = 986 | N = 9281 | p-Value | |
Cooking fuel | 0.062 | ||
Wood | 720 (73.3) | 6393 (69.3) | |
Other polluting fuels | 262 (26.7) | 2831 (30.7) | |
Missing (%) | 4 (0.4) | 56 (0.6) | |
Cooking location | 0.942 | ||
In the house | 100 (10.2) | 967 (10.4) | |
In a separate building | 622 (63.1) | 5774 (62.3) | |
Outdoors | 264 (26.8) | 2521 (27.2) | |
Missing (%) | 264 (26.8) | 0 (0.0) | |
Household smoking | 0.863 | ||
Yes | 862 (87.5) | 8137 (87.7) | |
No | 124 (12.5) | 1144 (12.3) | |
Type of place of residence | 0.293 | ||
Urban | 247 (25.0) | 2522 (27.2) | |
Rural | 739 (75.0) | 6759 (72.8) | |
Region | 0.096 | ||
Central | 277 (28.1) | 2719 (29.3) | |
East | 250 (25.3) | 2354 (25.4) | |
North | 259 (26.3) | 2071 (22.3) | |
West | 200 (20.3) | 2137 (23.0) | |
Electricity | 0.011 | ||
Yes | 700 (74.3) | 6169 (69.0) | |
No | 243 (25.7) | 2772 (31.0) | |
Missing (%) | 43 (4.4) | 339 (3.7) | |
Number of household members (listed) | 0.568 | ||
Median (IQR) | 6.0 (4.0, 8.0) | 5.0 (4.0, 7.0) | |
Combined wealth index | 0.003 | ||
Low | 248 (25.1) | 1851 (19.9) | |
Second | 193 (19.6) | 1662 (17.9) | |
Middle | 182 (18.4) | 1632 (17.6) | |
Fourth | 158 (16.1) | 1804 (19.4) | |
Highest | 205 (20.8) | 2332 (25.1) | |
Maternal characteristics | |||
Respondent’s current age | <0.001 | ||
Median (IQR) | 26.0 (22.0, 32.0) | 27.0 (23.0, 32.0) | |
Mother’s education | 0.010 | ||
No education/Primary | 697 (70.7) | 6072 (65.4) | |
Secondary/higher | 289 (29.3) | 3208 (34.6) | |
Mother’s BMI (kg/m2) | 0.223 | ||
<18.5 | 19 (6.2) | 253 (8.3) | |
≥18.5 | 296 (93.8) | 2795 (91.7) | |
Missing (%) | 670 (68.0) | 6233 (67.2) |
Variable | Birthweight < 2500 g N (%) | Birthweight ≥ 2500 g N (%) | |
---|---|---|---|
N = 986 | N = 9281 | p-Value | |
Parity | 0.327 | ||
Once | 170 (17.2) | 1466 (15.8) | |
More than once | 816 (82.8) | 7814 (84.2) | |
Birth order number | |||
Median (IQR) | 2.0 (1.0, 5.0) | 3.0 (2.0, 5.0) | |
Sex of child | <0.001 | ||
Male | 438 (44.4) | 4761 (51.3) | |
Female | 548 (55.6) | 4520 (48.7) | |
Birth Interval | 0.576 | ||
≤24 months | 824 (83.5) | 7681 (82.8) | |
>24 months | 162 (16.5) | 1599 (17.2) | |
Duration of pregnancy | <0.001 | ||
Pre-term | 274 (27.8) | 1184 (12.8) | |
Term | 711 (72.2) | 8097 (87.2) | |
Timing of first ANC visits | 0.066 | ||
<5 months gestation | 387 (65.1) | 3896 (60.8) | |
≥5 months gestation | 207 (34.9) | 2509 (39.2) | |
Missing (%) | 391 (39.7) | 2875 (31.0) | |
Number of ANC visits | 0.003 | ||
<4 | 252 (41.4) | 2206 (34.3) | |
≥4 | 357 (58.6) | 4225 (65.7) | |
Missing (%) | 377 (38.3) | 2849 (30.7) | |
Place of delivery | 0.131 | ||
Health facility | 906 (92.5) | 8655 (93.9) | |
Home | 73 (7.5) | 561 (6.1) | |
Missing (%) | 7 (0.7) | 64 (0.7) | |
Delivery by caesarean section | 0.763 | ||
No | 895 (91.4) | 8479 (91.8) | |
Yes | 84 (8.6) | 760 (8.2) | |
Missing (%) | 7 (0.7) | 42 (0.4) | |
Iron supplementation | 0.131 | ||
No | 66 (10.8) | 562 (8.7) | |
Yes | 545 (89.2) | 5906 (91.3) | |
Missing (%) | 375 (38.0) | 2812 (30.3) | |
Sulphadoxine-pyrimethamine | 0.014 | ||
Yes | 467 (76.8) | 5251 (81.4) | |
No | 141 (23.2) | 1199 (18.6) | |
Missing (%) | 378 (38.4) | 2831 (30.5) | |
Deworming | 0.021 | ||
Yes | 364 (59.7) | 4179 (65.2) | |
No | 246 (40.3) | 2226 (34.8) | |
Missing (%) | 376 (38.1) | 2876 (31.0) |
Unadjusted Analysis | Adjusted Analysis (N = 9863) | |||||
---|---|---|---|---|---|---|
UOR | 95% CI | p-Value | AOR | 95% CI | p-Value | |
Household Characteristics | ||||||
Cooking fuel | ||||||
Wood | Ref. | Ref. | ||||
Other polluting fuels | 0.82 | (0.67, 1.00) | 0.053 | 0.94 | (0.72, 1.22) | 0.646 |
Cooking location | ||||||
In the house | Ref. | Ref. | ||||
In a separate building | 1.04 | (0.75, 1.43) | 0.818 | 0.99 | (0.71, 1.36) | 0.928 |
Outdoors | 1.01 | (0.71, 1.43) | 0.959 | 0.94 | (0.67, 1.30) | 0.691 |
Household smoking | ||||||
Yes | Ref. | Ref. | ||||
No | 1.02 | (0.82, 1.27) | 0.863 | 0.92 | (0.73, 1.15) | 0.470 |
Type of place of residence | ||||||
Urban | Ref. | |||||
Rural | 1.12 | (0.91, 1.37) | 0.294 | 0.90 | (0.70, 1.15) | 0.400 |
Region | ||||||
Central | Ref. | Ref. | ||||
East | 1.04 | (0.83, 1.30) | 0.726 | 0.76 | (0.59, 0.98) | 0.035 |
North | 1.23 | (0.98, 1.54) | 0.076 | 0.75 | (0.57, 0.99) | 0.042 |
West | 0.92 | (0.71, 1.19) | 0.525 | 0.82 | (0.62, 1.06) | 0.134 |
Electricity | ||||||
Yes | Ref. | Ref. | ||||
No | 1.30 | (1.06, 1.58) | 0.011 | 0.94 | (0.73, 1.22) | 0.655 |
Number of household members (listed) | ||||||
1.01 | (0.99, 1.04) | 0.418 | 1.03 | (1.00, 1.07) | 0.027 | |
Combined wealth index | ||||||
Low | Ref. | Ref. | ||||
Second | 0.87 | (0.70, 1.08) | 0.214 | 0.92 | (0.71, 1.18) | 0.500 |
Middle | 0.83 | (0.66, 1.04) | 0.108 | 0.89 | (0.67, 1.19) | 0.435 |
Fourth | 0.66 | (0.51, 0.84) | 0.001 | 0.69 | (0.50, 0.96) | 0.027 |
Highest | 0.66 | (0.50, 0.85) | 0.002 | 0.73 | (0.50, 1.08) | 0.120 |
Maternal characteristics | ||||||
Respondent’s current age | ||||||
0.98 | (0.97, 0.99) | 0.001 | 0.99 | (0.97, 1.01) | 0.403 | |
Mother’s education | ||||||
No education/Primary only | Ref. | Ref. | ||||
Secondary only/higher | 0.78 | (0.65, 0.94) | 0.010 | 0.80 | (0.64, 1.00) | 0.050 |
Mother’s BMI (Kg/m2) | ||||||
<18.5 | Ref. | |||||
≥18.5 | 1.37 | (0.82, 2.29) | 0.225 | |||
Birth characteristics | ||||||
Parity | ||||||
Once | Ref. | Ref. | ||||
More than once | 0.90 | (0.73, 1.11) | 0.327 | 1.18 | (0.89, 1.55) | 0.249 |
Birth order number | ||||||
0.95 | (0.92, 0.99) | 0.008 | 0.96 | (0.90, 1.02) | 0.164 | |
Sex of child | ||||||
Male | Ref. | Ref. | ||||
Female | 1.32 | (1.13, 1.53) | <0.001 | 1.32 | (1.13, 1.55) | 0.001 |
Birth Interval | ||||||
≤24 months | Ref. | Ref. | ||||
>24 months | 0.95 | (0.78, 1.15) | 0.576 | 0.95 | (0.77, 1.16) | 0.597 |
Duration of pregnancy | ||||||
Pre-term | Ref. | Ref. | ||||
term | 0.38 | (0.31, 0.46) | <0.001 | 0.39 | (0.31, 0.49) | <0.001 |
Timing of first ANC visits | ||||||
<5 months gestation | Ref. | |||||
≥5 months gestation | 0.83 | (0.68, 1.01) | 0.066 | |||
Number of ANC visits | ||||||
<4 times | Ref. | |||||
≥4 times | 0.74 | (0.61, 0.90) | 0.003 | |||
Place of delivery | ||||||
Health facility | Ref. | Ref. | ||||
Home | 1.25 | (0.94, 1.67) | 0.131 | 1.21 | (0.90, 1.62) | 0.211 |
Delivery by caesarean section | ||||||
No | Ref. | Ref. | ||||
Yes | 1.05 | (0.78, 1.41) | 0.763 | 1.16 | (0.87, 1.56) | 0.313 |
Iron supplementation | ||||||
No | Ref. | |||||
Yes | 0.78 | (0.57, 1.08) | 0.132 | |||
Sulphadoxine-pyrimethamine | ||||||
Yes | Ref. | |||||
No | 1.32 | (1.06, 1.65) | 0.014 | |||
Deworming | ||||||
Yes | Ref. | |||||
No | 1.27 | (1.04, 1.55) | 0.021 |
AOR | 95% CI | p-Value | |
---|---|---|---|
Place of residence | |||
Urban (N = 2274) | 1.09 | (0.65, 1.83) | 0.745 |
Rural (N = 7589) | 0.85 | (0.61, 1.18) | 0.322 |
Cooking location | |||
Indoor (N = 7190) | 1.04 | (0.77, 1.42) | 0.786 |
Outdoor (N = 2682) | 0.77 | (0.49, 1.19) | 0.235 |
Adjusting for normal maternal BMI | |||
BMI ≤ 18 (N = 2655) | 0.92 | (0.59, 1.44) | 0.726 |
Adjusting for all confounders | |||
N = 2167 | 0.78 | (0.46, 1.31) | 0.348 |
Birthweight as a continuous variable | |||
N = 9863 | 29.43 | (−38.15, 97.01) | 0.393 |
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Epuitai, J.; Woolley, K.E.; Bartington, S.E.; Thomas, G.N. Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data. Int. J. Environ. Res. Public Health 2022, 19, 4377. https://doi.org/10.3390/ijerph19074377
Epuitai J, Woolley KE, Bartington SE, Thomas GN. Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data. International Journal of Environmental Research and Public Health. 2022; 19(7):4377. https://doi.org/10.3390/ijerph19074377
Chicago/Turabian StyleEpuitai, Joshua, Katherine E. Woolley, Suzanne E. Bartington, and G. Neil Thomas. 2022. "Association between Wood and Other Biomass Fuels and Risk of Low Birthweight in Uganda: A Cross-Sectional Analysis of 2016 Uganda Demographic and Health Survey Data" International Journal of Environmental Research and Public Health 19, no. 7: 4377. https://doi.org/10.3390/ijerph19074377