Impact of Household Air Pollution on Under-five Child Mortality and Nutrition in Rural Punjab, Pakistan

Abstract

Owing to socioeconomic challenges, most households in Pakistan depend on unsafe energy sources for cooking, heating, and lighting. Household air pollution (HAP), primarily caused due to dirty fuel usage, results in morbidity and mortality, especially among infants. The study focuses on the impact of unclean fuel usage, a proxy for HAP, on under-five child mortality and malnutrition in rural Punjab, Pakistan. Alternatively, we use father’s smoking as a proxy for HAP to see its impact on child health. For this research, the proposed data is taken from the Multiple Indicator Cluster Survey (MICS) 2017-18 for Punjab, Pakistan. While using fuel choice as a proxy for HAP, the two-stage least squares (2SLS) regression analysis – using forest cover (Global Forest Watch) and number of cattle owned by household as instrument variables – aids in overcoming the endogeneity problem. Furthermore, we use binary logistic regressions to determine the impact of father’s smoking on child health. The study presents a number of findings. First and foremost, HAP, with fuel choice as proxy, has a positive and significant impact on under-five mortality, infant mortality, neonatal mortality, under-five stunting, and under-five underweight. Second, HAP, with father’s smoking as proxy, significantly increases the odds of under-five mortality (OR = 1.31*** [CI = 1.10-1.56]), infant mortality (OR = 1.30*** [CI = 1.08-1.55]), neonatal mortality (OR = 1.38*** [CI = 1.13-1.69]), under-five stunting (OR = 1.38*** [CI = 1.09-1.75]), and under-five underweight (OR = 1.28** [CI = 1.04-1.58]). However, no significant association was found between household air pollution and wasting in children under the age of five. Eventually, the study calls for action: Pakistan's energy, environment, and healthcare policy should concentrate on raising awareness of the risks associated with solid fuel usage and ensuring feasibility of clean energy in rural Punjab.