Association Between Urbanicity–Cooking Fuel Type and Acute Respiratory Infection Symptoms Among Children Under Two Years across Ten East African countries.

Introduction: Limited evidence exists on how urbanicity in LMICs and fuel type affect infant ARI risk. 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 included cough and dyspnea in children reported by the mother within the past 2 weeks. 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 infants. Cough prevalence ranged from 13 (Mozambique) to 44% (Uganda), and dyspnea from 3% (Tanzania) to 21% (Uganda). Most households (96%) used unclean fuels, and 79% were rural. Compared with 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 odds were higher 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 2 in households using unclean fuel, whether rural or urban, experienced more cough and dyspnea than those using clean fuel. Promoting clean fuel and early health care could reduce ARI symptoms in LMICs.