Parental smoking and under-five child mortality in Southeast Asia: Evidence from demographic and health surveys

Smoking remains the main cause of preventable early death. However, little is known about the association between parental smoking and child mortality in under-fives in developing countries. This study assesses the association between parental smoking status, smoking amount and smoking frequency with child mortality in under-fives in four Southeast Asian countries (Cambodia, Indonesia, Lao People’s Democratic Republic and Timor Leste). We used the Demographic and Health Survey dataset. The information from couples consisting of fathers and mothers (n = 19,301 couples) in the same household were collected. Under-five child mortality was significantly associated with paternal smoking only (odds ratio (OR) = 1.25, 95% confidence interval (CI): 1.14-1.38), maternal smoking only (OR = 2.40, 95% CI: 1.61-3.59) and both parents smoking (OR = 2.60, 2.08-3.26). Paternal, maternal, both parents’ smoking amount and frequency were also assessed. The estimated association decreased after adjusting for covariates but remained highly significant for smoking in both parents, mothers who smoked 1-10 cigarettes/day, when both parents smoked > 20 cigarettes/day, and in mothers who smoked every day. Future behavioural changes and smoking cessation programmes should engage parents as a catalyst for the reduction of child mortality risk in LMICs in the SEA region.