Fractured effects of solid fuel use in early child development: analyses of urban and rural territories in Ghana

摘要

Background: About 41% of households globally, mainly in developing countries, rely on solid fuels for cooking with consequences for health outcomes in populations. In Ghana, more than 77% of the population depends on biomass fuels for cooking and heating. Previous studies posit that solid fuel use (SFU) in Ghana has had adverse effects on child health outcomes, stillbirth, and pregnancy. Yet these studies have not considered the effect on early child development (ECD), nor how SFU' potential effects vary across rural and urban areas. Objective: To investigate the potential effect of SFU on ECD, and whether it varies across rural and urban territories in Ghana. Methods: Using the 2011-2012 Ghana's Multiple Indicator Cluster Surveys - UNICEF (N = 2972 3-4 years children). A standardized global ECD index (ECDI) was calculated. A two-multilevel logistic regression model conditioning on household characteristics (second level), and individual-level covariates, corresponding to child and mother's characteristics (first level) were used to estimate the association between SFU and ECDI. Results: After adjustment for covariates, SFU was associated higher odds of not being developmentally on track (Odds ratio [OR]= 2.6; 95% confidence interval, Cl:1.2, 5.6) compared to non SFU in all children of Ghana. This association was significantly different between rural and urban children, with an OR of 3.8 (95% Cl:1.2, 12.3) in rural areas, compared with an OR of 1.5 (95% CI: 0.5, 4.1) in urban areas. Discussion: The use of solid fuels is an independent predictor of a children's early development in rural Ghana, however this association in urban territories was not observed. This may point to specific characteristics of rural kids that play a synergistic role with solid fuel use. Policy efforts which tackle solid fuel use should be mindful of these differences. More research is needed to assess what rural characteristics are drive this association.