Indoor air pollution and its impact on child health outcomes in India

Indoor air pollution from the use of solid cooking fuels is a major public health concern in India, particularly affecting child health. This study aims to examine the impact of cooking fuel type (solid vs. clean) on infant mortality rate (IMR), neonatal mortality rate (NMR), acute respiratory infections (ARI), and low birth weight (LBW) in children across various socio-demographic and economic backgrounds in India. This cross-sectional study utilized data from the fifth round of the National Family Health Survey (NFHS-5) conducted in 2019–21. Bivariate analysis was used to estimate the prevalence of ARI, LBW, IMR, and NMR by cooking fuel type and background characteristics. Multivariate logistic regression was applied to assess the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for ARI, LBW, IMR, and NMR outcomes associated with solid fuel use. ArcGIS was used for mapping analysis. Using nationally representative data from the National Family Health Survey (NFHS-5), this study analyzed children under five years of age across households using solid fuels (dung, wood, coal, and charcoal) and clean fuels (LPG, electricity, and ovens). A substantial proportion of children resided in solid fuel–using households, particularly in rural and socioeconomically disadvantaged settings. Children exposed to solid fuels had significantly higher odds of neonatal and infant mortality compared to those using clean fuels (IMR: OR = 1.55, 95% CI 1.26–1.85; NMR: OR = 1.65, 95% CI 1.23–1.95). The prevalence of acute respiratory infection and low birth weight was consistently higher among solid fuel–using households across most socio-demographic groups. Low birth weight was particularly prevalent among adolescent mothers aged 15–19 years, women with no formal education, poorer wealth quintiles, and rural residents. Female children exhibited a higher prevalence of low birth weight than males in both fuel categories. Maternal education emerged as a strong protective factor, while states with higher reliance on solid fuels, such as Bihar and Uttar Pradesh, showed markedly poorer child health outcomes. Solid fuel use for cooking is a significant risk factor for increased infant and neonatal mortality, respiratory illness, and low birth weight in India. Accelerating the transition to clean cooking fuels, particularly among rural and socioeconomically disadvantaged populations, is crucial for improving child survival and health in India.