Household cooking fuels, symptoms compatible with pneumonia and inequalities in care seeking among children under five in the Republic of the Congo: a nationally representative survey analysis

Objectives: To examine the association between household cooking fuels and symptoms compatible with pneumonia, and socioeconomic inequalities in care seeking, among children under five in the Republic of the Congo. Methods: Secondary analysis of the 2014-2015 Multiple Indicator Cluster Survey, the most recent national survey with available microdata on respiratory symptoms (9,159 children aged 0-59 months), using survey-weighted logistic regression. Results: The weighted prevalence of caretaker-reported cough with fast or difficult breathing due to a chest problem was 5.9% (95% CI 5.3-6.6). Compared with electricity or gas, cooking with solid fuels (adjusted odds ratio [aOR] 2.23, 1.34-3.73) or kerosene (aOR 2.63, 1.38-5.01) was associated with higher odds of symptoms, independently of wealth, education and residence (E-values 3.9 and 4.7). Only 28.2% (23.1-33.9) of children with symptoms were taken to a health facility or provider, from 17.8% in the poorest to 61.1% in the richest quintile (aOR 4.10, 1.96-8.57 for the three richest versus the two poorest quintiles). Conclusions: Poorer Congolese children combine greater exposure to polluting cooking fuels and less access to care. Clean cooking policies should be combined with removal of financial barriers to care for sick children.