Effects of Household Air Pollution From Solid Fuel Use and Environmental Tobacco Smoke on Child Health Outcomes in Indonesia

Objective: We assessed the combined effect of household air pollution from solid fuel use and from environmental tobacco smoke and child health outcomes in Indonesia. Methods: Survey subjects self-reported solid fuel use, frequency of indoor smoking, and health outcomes in children. We then evaluated the effect of a combined exposure using multivariate logistic regression. Results: Children exposed to high levels of pollution from solid fuel use had an increased risk of low birth weight, neonatal death, infant death, and acute lower respiratory infection. Exposure to environmental tobacco smoke increased the risk of acute lower respiratory infection. The combined effect of both pollution sources outweighed the independent risk of each exposure alone. Conclusions: Solid fuel use and environmental tobacco smoke independently increased the risk and child health outcomes and the combined exposure showed the additive effect.