Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005-2016 Ethiopian Demographic Health Survey data.

Background: Globally, acute respiratory infections are among the leading causes of under-five child mortality, especially in lower-income countries; it is associated with indoor exposure to toxic pollutants from solid biomass fuel. In Ethiopia, 90% of the population utilizes solid biomass fuel; respiratory illness is a leading health problem. However, there is a paucity of nationally representative data on the association of household cooking place and respiratory infections. Besides, evidence on the variability in the infection based on the data collected at different times is limited. Therefore, this study is intended to assess the association of food cooking place with acute respiratory infections and the variability in households and surveys.

Methods: The current analysis is based on the Ethiopian Demographic and Health Survey data collected in 2005, 2011, and 2016 and obtained via online registration. The association of food cooking place with acute respiratory infection was assessed using multilevel modeling after categorizing all factors into child level and survey level, controlling them in a full model. The analyses accounted for a complex survey design using a Stata command "svy."

Result: A total of 30,895 under-five children were included in this study, of which 3677 (11.9%) children had an acute respiratory infection, with 12.7% in 2005, 11.9% in 2011, and 11.1% in 2016. The risk of having an infection in under-five children in households that cooked food outdoors was 44% lower (AOR = 0.56, 95% CI = 0.40, 0.75) compared to those households that cooked the food inside the house. There was a statistically significant difference among the children among surveys to have an acute respiratory infection.

Conclusion: The risk of having children with acute respiratory infection is lower in the households of cooking food outdoor compared to indoor. The infection difference in different surveys suggests progress in the practices in either food cooking places or the fuel types used that minimize food cooking places location or the fuel types used that minimizes the risk. But, the infection is still high; therefore, measures promoting indoor cooking in a well-ventilated environment with alternative energy sources should take place.