Effect of exposure to PM(10) on child health: evidence based on a large-scale survey from 184 cities in India

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/m(3) (PM(10)), on child-health outcomes after adjusting for hygiene practices. METHODS: Health data from the National Family Health Survey-4 (NFHS-4) and PM(10) 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 PM(10). RESULT: Analyses based on 23 954 births found that every 10-unit increase in PM(10) 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 PM(10) on child health regardless of household’s hygienic practices. Effects of PM(10) on child health outcomes remained similar for cities whether or not they were part of the National Clean Air Program (NCAP). CONCLUSION: Exposure to PM(10), 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.