Fuel type use and risk of respiratory symptoms: A cohort study of infants in the Northern region of Ghana

Highlights: • Few studies exist about fuel types and risk of respiratory symptoms in infants despite high usage by women in Northern Ghana • Questionnaires were used to collect baseline, exposure to fuel types and respiratory symptoms data. • Cooking with charcoal and firewood were associated with respiratory symptoms in infants between three and seven months old. • Use of LPG and electricity for cooking could decrease respiratory symptoms among infants Little evidence exists about the association between fuel type use and risk of respiratory symptoms among infants; we aimed to evaluate this hypothesis through a cohort study in the Northern Region of Ghana. The study was carried out from April 2018 to May 2019. We recruited 28 weeks old pregnant women at selected hospitals and prospectively followed them at birth in the hospital ward to register their newborns and at homes when the baby had attained 3 to 7 months to collect data on respiratory symptoms of infants. A logistic regression model was used to investigate the odds of respiratory symptoms in infants. Exactly 1270 infants completed the study; the average age of women was 27.1 years and standard deviation of 5.1. The study found that infants of mothers who cooked with charcoal and those with firewood had increased odds of having cough with cold 4.10 (95% CI, 2.21–7.61) and 3.95 (95% CI, 2.06–7.58), increased odds of congestion, phlegm with cold by 3.89 (95% CI, 1.73–8.79) and 3.45 (95% CI, 1.44–8.26), increased odds of wheezing 4–14 days or nights by 1.68 (95% CI, 0.72–3.91) and 3.37 (95% CI, 1.41–8.04) and increased odds of seeking medical treatments in a health facility for chest illness by 3.97 (95% CI, 1.31–12.02) and 6.67 (95% CI, 2.14–20.77) in comparison with liquid petroleum gas respectively. Some significant predictors of respiratory infections were maternal malaria, hospitalisations of an infant after birth, residence, cooking location, composite breastfeeding, sharing of a bedroom with infant and air-conditioner or fan in the living room. Our findings indicate increased odds of infant respiratory symptoms in households using solid fuel in Ghana. Although our observational design precludes ascribing any causal relationships, our results are consistent with other studies suggesting clean fuel use during pregnancy and infancy may benefit this vulnerable age group.