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How sustainable household environment and knowledge of healthy practices relate to childhood morbidity in South Asia: analysis of survey data from Bangladesh, Nepal and Pakistan
  1. Md Masud Hasan1,
  2. Alice Richardson2
  1. 1 Faculty of Education, Science, Technology and Mathematics, University of Canberra, Canberra, Australia
  2. 2 National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
  1. Correspondence to Dr Alice Richardson; Alice.Richardson{at}


Objectives Prevalence of diarrhoea and acute respiratory infection (ARI) is considerably high among South Asian children. The objective of this study is to compare the associations of sustainable household environment and knowledge of healthy practices with episodes of these diseases among the children in the region.

Design The study analysed the latest, nationally representative and cross-sectional Demographic and Health Survey data.

Setting Data from three countries were analysed: Bangladesh, Nepal and Pakistan.

Participants Women aged between 12 and 49 years living in selected households provided information on 23 940 of their children under the age of 5 years.

Primary outcomes measures The morbidity status of the children was recorded with respect to episodes of diarrhoea and/or ARI in the 2 weeks preceding data collection.

Results Consuming unhygienic drinking water increased the risks of childhood diarrhoea, and use of solid fuel for indoor cooking increased the risk of ARI, across all three countries investigated. However, far more significant were the effects of mother’s education, with incomplete primary education leading to an odds of diarrhoea approaching twice that of a mother with secondary education or higher (OR 1.70 in Bangladesh, 95% CI 1.16 to 2.49).

Conclusions Results from the current research underline the importance of developing and implementing integrated strategic plans for mothers and children in the countries investigated. Promoting hygienic water and sanitation facilities can help reduce the prevalence of childhood diarrhoea. Replacing indoor solid fuel cooking arrangements with cleaner fuel or more airy conditions can help reduce the prevalence of ARI. However, these strategies need to be integrated with education for women to raise the likelihood that reduced risks are actually realised.

  • Public health &lt
  • Infectious Diseases
  • Community child health &lt
  • Paediatrics
  • Public Health
  • Statistics and Research Methods

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors MMH conceptualised the study and developed the methodology. Data interpretation was undertaken by both authors and they are responsible for the drafting of the final manuscript.

  • Competing interests None declared.

  • Patient consent Secondary analysis of publicly available, de-identified data involved, and so no consent sought.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon request from the Demographic and Health Survey Program (

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with 'BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected theseerrors and the correct publishers have been inserted into the references.

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