Association between urbanicity–cooking fuel type and self-reported respiratory symptoms as a proxy for acute respiratory infection symptoms among children under two years across ten East African countries

Abstract

Abstract Introduction Evidence remains limited on how urbanicity modifies the relationship between household cooking fuel type and respiratory symptoms in young children in low- and middle-income countries (LMICs). This study examined the prevalence of cough and dyspnea across ten East African countries and the associations of these symptoms with fuel type and residence among children aged under two years. Methods Pooled Demographic and Health Survey data (2015–2023) from mother–child pairs across ten East African countries were analyzed. Outcomes were maternal reports of cough and dyspnea in the past two weeks as a proxy to ARI. The exposure was a four-category of cooking fuel type and residence (urban-clean vs. rural-clean, urban-unclean, rural-unclean). Multivariable logistic regression was adjusted for child, maternal, and household characteristics. Results There were 38,849 mother-child pairs. Cough prevalence ranged from 13 (Mozambique) to 44% (Uganda), and dyspnea from 3% (Tanzania) to 21% (Uganda). Most households used unclean fuels (96%), and 79% were rural. Compared with children in urban–clean households, the adjusted odds of cough were higher in urban–unclean (aOR = 1.36; 95% CI:1.06–1.74) and rural–unclean households (aOR = 1.40; 95% CI:1.09–1.81). Dyspnea was more likely in urban–unclean (aOR = 2.21; 95% CI:1.46–3.74) and in rural–unclean households (aOR = 3.08; 95% CI:1.89–5.01). Children aged 12–23 months had higher odds of cough (aOR = 1.16; 95% CI: 1.09–1.22) than those 0–11 months. Conclusions Children under two years living in households using unclean fuels had a higher likelihood of respiratory symptoms, regardless of urban or rural residence. These findings suggest that both fuel use and living context may shape exposure patterns in early childhood.