Exposure to pollutants for household cooking and lighting and pediatric post-discharge mortality following a severe infection in Uganda

Background: Particulate matter from household air pollution (HAP) is linked to half of all lower respiratory infection deaths among children under 5 years of age. In rural Uganda, similar number of children die 6-months post discharge as during hospitalization for severe infections. However, it is unclear whether exposure to HAP contributes to poor health and death after discharge. We investigated the association between cooking and household lighting practices and mortality 6-months post-discharge among children under 5 years of age treated for severe infection in rural Uganda. Methods: We conducted a secondary analysis of data from observational cohort studies, conducted between July 2017 to July 2021, among 6,955 children 0 to 5 years admitted to one of six Ugandan hospitals for a severe infectious illness. Clinical signs and symptoms, sociodemographic variables, and mortality up to 6-months post-discharge was collected for all participants, and follow-up rates were >95%. Exposure variables included type of cooking fuel used, location of cooking (e.g. indoors, outdoors), and primary source of household lighting. We assessed post-discharge mortality using simple and multivariate Poisson regression. Results: The unadjusted risk ratio of 6-month post-discharge mortality by dual or single exposure to pollutant fuel sources for cooking indoors and household lighting, when compared to minimal exposure, was 1.57 (95%CI 1.17, 2.11) and 1.20 (95%CI 0.94, 1.54), respectively. Adjusting for age, sex, distance to hospital, maternal education, and maternal HIV status, the adjusted risk ratios for dual and single exposure became 1.30 (95%CI 0.96, 1.76] and 1.08 (95%CI 0.84, 1.38). There was no significant interaction between exposure and age, sex, maternal education, or anemia status. Results: This analysis did not find a statistically significant association between HAP and 6-month post-discharge mortality. However, HAP cannot be ruled out as a contributor in this population where malnutrition, comorbidities and sociodemographic vulnerabilities are common. Data Collection Methods: All data were collected at the point of care using encrypted study tablets and these data were then uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses systematically collected data on clinical, social and demographic variables. Following discharge, field officers contacted caregivers at 2 and 4 months by phone, and in-person at 6 months, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for children who had died following discharge. Data Processing Methods: A proxy exposure variable was created to classify whether each participant was exposed to a pollutant fuel source. This was stratified into three exposure levels. Ethics Declaration: These studies were approved by the Mbarara University of Science and Technology Research Ethics Committee (15/10–16, 27-Jan-2017), and the University of British Columbia–Children and Women’s Health Centre of British Columbia Research Ethics Board (H16–02679, 09-May-2017). Study Protocol & Supplementary Materials: Smart Discharges to improve post-discharge health outcomes in children: A prospective before-after study with staggered implementation

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