RESUMO
Background: In India, household air pollution (HAP) is one of the leading riskfactors contributing to the national burden of disease. Estimates indicate that 7.6%of all deaths in children aged under 5 years in the country can be attributed to HAP.This analysis attempts to establish the association between HAP and neonatalmortality rate (NMR).Methods: Secondary data from the Annual Health Survey, conducted in 284districts of nine large states covering 1 404 337 live births, were analysed. Thesurvey was carried out from July 2010 to March 2011 (reference period: January2007 to December 2009). The primary outcome was NMR. The key exposurewas the use of firewood/crop residues/cow dung as fuel. The covariates were:sociodemographic factors (place of residence, literacy status of mothers,proportion of women aged less than 18 years who were married, wealth index);health-system factors (three or more antenatal care visits made during pregnancy;institutional deliveries; proportion of neonates with a stay in the institution forless than 24 h; percentage of neonates who received a check-up within 24 h ofbirth); and behavioural factors (initiation of breast feeding within 1 h). Descriptiveanalysis, with district as the unit of analysis, was performed for rural and urbanareas. Bivariate and multivariable linear regression analysis was carried out toinvestigate the association between HAP and NMR.Results: The mean rural NMR was 42.4/1000 live births (standard deviation [SD]= 11.4/1000) and urban NMR was 33.1/1000 live births (SD=12.6/1000). Theproportion of households with HAP was 92.2% in rural areas, compared to 40.8%in urban areas, and the difference was statistically significant (P < 0.001). HAPwas found to be strongly associated with NMR after adjustment (β = 0.22; 95%confidence interval [CI] = 0.09 to 0.35) for urban and rural areas combined. Forrural areas separately, the association was significant (β = 0.30; 95% CI = 0.13 to0.45) after adjustment. In univariable analysis, the analysis showed a significantassociation in urban areas (β = 0.23; 95% CI = 0.12 to 2.34) but failed to demonstratean association in multivariable analysis (β = 0.001; 95% CI = –0.15 to 0.15).Conclusion: Secondary data from district level indicate that HAP is associatedwith NMR in rural areas, but not in urban areas in India.
