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Smoke-inducing Fuel Use and Early Childhood Development: Accounting for Multilevel Heterogeneity in Malnutrition and Respiratory Illness among Bangladeshi Children

Chowdhury R · 27 Aug 2026

Abstract

Abstract Background Household reliance on smoke-producing cooking fuel remains a leading environmental risk factor for child health in low- and middle-income countries. This study assesses the association between smoke-producing fuel adoption and child stunting, wasting, underweight, and Acute Respiratory Infection (ARI) in Bangladesh while accounting for socioeconomic and geographic confounding factors. Methods Using pooled data from five waves of the Bangladesh Demographic and Health Survey (2007–2018), this study examined the relationship between smoke-producing fuel adoption and child health outcomes using Propensity Score Matching (PSM) and multilevel mixed-effects logistic regression. PSM was applied to reduce selection bias in household fuel choice, while multilevel regression accounted for the hierarchical structure of the survey data. Results In the fully adjusted pooled multilevel model, fuel choice was not significantly associated with any outcome, indicating that the observed association between fuel type and child health was largely attributable to confounding by household wealth, maternal education, and geography. However, year-stratified PSM identified a significant positive association between smoke-producing fuel use and stunting and underweight in more recent survey waves (2014–2018), suggesting an independent association with chronic malnutrition beyond socioeconomic confounding. Formal interaction tests found no significant differences by child sex, residence, or wealth. Conclusion Clean fuel transition appears to be a relevant, though not singularly sufficient, component of strategies to reduce chronic child malnutrition in Bangladesh. Such interventions should be pursued alongside investments in household wealth, maternal education, and health infrastructure, incorporating feasible approaches such as subsidy programs and improved cookstoves.