Vol.:(0123456789) 1 3 Matern Child Health J DOI 10.1007/s10995-017-2355-3 Potential Impacts of Modifiable Behavioral and Environmental Exposures on Reducing Burden of Under-five Mortality Associated with Household Air Pollution in Nepal Sabrina Naz 1  · Andrew Page 1  · Kingsley Emwinyore Agho 2   © Springer Science+Business Media, LLC 2017 never breastfed for all age-groups of children. PIF esti- mates, assuming a 63% of reduction of HAP based on pre- viously published interventions in Nepal, suggested that a burden of 40% of neonatal and 33% of under-five mortality cases associated with an indoor kitchen using polluting fuel could be avoidable. Conclusion Improved infrastructure and behavioral interventions could help reduce the pollu- tion from cooking fuel in the household resulting in further reduction in under-five mortality in Nepal. Keywords Household air pollution · Cooking fuel · Under-five mortality · Attributable risk · Nepal Significance What is already known on this subject? Acute respiratory infection is a leading cause of child death in Nepal and widespread use of solid fuels in Nepal remains a key pre- ventable exposure and source of public health burden. What this study adds? This study provides national esti- mates of the impact of household air pollution from use of cooking fuel on under-five mortality in Nepal. Findings show important differences in risk of under-five accord- ing to breastfeeding behaviour in mothers and location of kitchen (cooking inside or in a separate structure), factors which are amenable to behavioral interventions. Estimates of avoidable burden of household air pollution suggest that approximately half of under-five mortality cases in Nepal could be avoided by separating children from the cooking area. Abstract Objectives Household air pollution (HAP) is one of the leading causes of respiratory illness and deaths among young children in low and lower-middle income countries. This study examines for the first time trends in the association between HAP from cooking fuel and under-five mortality and measures the potential impact of interventions to reduce HAP using Nepal Demographic and Health Survey datasets (2001–2011). Methods A total of 17,780 living children across four age-groups (neona- tal 0–28 days, post-neonatal 1–11 months, child 12–59 months and under-five 0–59 months) were included and multi-level logistic regression models were used for analy- ses. Population attributable fractions of key risk factors and potential impact fractions assessing the impact of previous interventions to reduce exposure prevalence were also cal- culated. Results Use of cooking fuel was associated with total under-five mortality (OR 2.19, 95% CI 1.37–3.51, P = 0.001) in Nepal, with stronger associations evident for sub-group analyses of neonatal mortality (OR 2.67, 95% CI 1.47–4.82, P = 0.001). Higher association was found in rural areas and for households without a separate kitchen using polluting fuel for cooking, and in women who had Electronic supplementary material The online version of this article (doi:10.1007/s10995-017-2355-3) contains supplementary material, which is available to authorized users. * Sabrina Naz sabrinanaz@gmail.com; 18125072@student.westernsydney.edu.au 1 Translational Health Research Institute, School of Medicine, Western Sydney University, Building 3, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia 2 School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia