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Open Access Research article

Child mortality from solid-fuel use in India: a nationally-representative case-control study

Diego G Bassani123*, Prabhat Jha12, Neeraj Dhingra4 and Rajesh Kumar5

Author Affiliations

1 Centre for Global Health Research (CGHR), Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada

2 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

3 Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada

4 Najafgarh Rural Health Training Centre, Ministry of Health, Government of India, New Delhi, India

5 School of Public Health, PGIMER, Chandigarh, India

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BMC Public Health 2010, 10:491  doi:10.1186/1471-2458-10-491

Published: 17 August 2010



Most households in low and middle income countries, including in India, use solid fuels (coal/coke/lignite, firewood, dung, and crop residue) for cooking and heating. Such fuels increase child mortality, chiefly from acute respiratory infection. There are, however, few direct estimates of the impact of solid fuel on child mortality in India.


We compared household solid fuel use in 1998 between 6790 child deaths, from all causes, in the previous year and 609 601 living children living in 1.1 million nationally-representative homes in India. Analyses were stratified by child's gender, age (neonatal, post-neonatal, 1-4 years) and colder versus warmer states. We also examined the association of solid fuel to non-fatal pneumonias.


Solid fuel use was very common (87% in households with child deaths and 77% in households with living children). After adjustment for demographic factors and living conditions, solid-fuel use significantly increase child deaths at ages 1-4 (prevalence ratio (PR) boys: 1.30, 95%CI 1.08-1.56; girls: 1.33, 95%CI 1.12-1.58). More girls than boys died from exposure to solid fuels. Solid fuel use was also associated with non-fatal pneumonia (boys: PR 1.54 95%CI 1.01-2.35; girls: PR 1.94 95%CI 1.13-3.33).


Child mortality risks, from all causes, due to solid fuel exposure were lower than previously, but as exposure was common solid, fuel caused 6% of all deaths at ages 0-4, 20% of deaths at ages 1-4 or 128 000 child deaths in India in 2004. Solid fuel use has declined only modestly in the last decade. Aside from reducing exposure, complementary strategies such as immunization and treatment could also reduce child mortality from acute respiratory infections.