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Abstract
Introduction Air pollution is increasingly becoming a serious global public health concern. Prior studies examining the effect of air pollution on health have ignored the role of households’ hygienic practices and socioeconomic condition, which are key determinants of the health status of a country like India. This study examines the effects of air pollution, measured in levels of particulate matters of size below 10 µg/m3 (PM10), on child-health outcomes after adjusting for hygiene practices.
Methods Health data from the National Family Health Survey-4 (NFHS-4) and PM10 levels provided by the Central Pollution Control Board were matched for 184 Indian towns/cities. Child health outcomes included neonatal mortality, post-neonatal mortality, premature births, children with symptoms of acute respiratory infections (ARI) and low birth weight. Multilevel mixed-effects models were used to estimate the risk associated with exposure to PM10.
Result Analyses based on 23 954 births found that every 10-unit increase in PM10 level, increased the risk of neonatal mortality by 6% (adjusted RR (95% CI): 1.02 (1.02 to 1.09)), and the odds of symptoms of ARI among children by 7% (adjusted OR (95% CI): 1.07 (1.03 to 1.12)), and premature births by 8% (adjusted OR (95% CI): 1.08 (1.03 to 1.12)). There was no statistically significant difference in the effect of PM10 on child health regardless of household’s hygienic practices. Effects of PM10 on child health outcomes remained similar for cities whether or not they were part of the National Clean Air Program (NCAP).
Conclusion Exposure to PM10, regardless of hygienic practices, increases the risk of adverse child health outcomes. Study findings suggest that the focus of mitigating the effects of air pollution should be beyond the towns/cities identified under NCAP. Given the increasing industrialisation and urbanisation, a systemic, coherent approach is required to address the issue of air pollution in India.
- child health
- environmental health
- hygiene
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Footnotes
Handling editor Valery Ridde
Twitter @BidhuMahapatra, @monikawalia06
Contributors BM: Conceptualisation, writing, analysis and Interpretation. MW: Writing, analysis and interpretation. WA: Writing and interpretation. NS: Writing and interpretation.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available in a public, open access repository. Data on air pollution is available under the open data platform of Government of India: Historical Daily Ambient Air Quality Data (database on the Internet). National Data Sharing and Accessibility Policy (NDSAP) 2017. Available from: https://data.gov.in/search/site?query=Historical+Daily+Ambient+Air+Quality+Data. The Demographic and Health Survey data is available at https://dhsprogram.com/data/available-datasets.cfm.