Long-Term PM(2.5) Exposure Is Associated with Symptoms of Acute Respiratory Infections among Children under Five Years of Age in Kenya, 2014

Introduction: Short-term exposures to air pollutants such as particulate matter (PM) have been associated with increased risk for symptoms of acute respiratory infections (ARIs). Less well understood is how long-term exposures to fine PM (PM [Formula: see text]) might increase risk of ARIs and their symptoms. This research uses georeferenced Demographic Health Survey (DHS) data from Kenya (2014) along with a remote sensing based raster of PM [Formula: see text] concentrations to test associations between PM [Formula: see text] exposure and ARI symptoms in children for up to 12 monthly lags. Methods: Predicted PM [Formula: see text] concentrations were extracted from raster of monthly averages for latitude/longitude locations of survey clusters. These data and other environmental and demographic data were used in a logistic regression model of ARI symptoms within a distributed lag nonlinear modeling framework (DLNM) to test lag associations of PM [Formula: see text] exposure with binary presence/absence of ARI symptoms in the previous two weeks. Results: Out of 7036 children under five for whom data were available, 46.8% reported ARI symptoms in the previous two weeks. Exposure to PM [Formula: see text] within the same month and as an average for the previous 12 months was 18.31 and 22.1 µg/m [Formula: see text] , respectively, far in excess of guidelines set by the World Health Organization. One-year average PM [Formula: see text] exposure was higher for children who experienced ARI symptoms compared with children who did not (22.4 vs. 21.8 µg/m [Formula: see text] p < 0.0001.) Logistic regression models using the DLNM framework indicated that while PM exposure was not significantly associated with ARI symptoms for early lags, exposure to high concentrations of PM [Formula: see text] (90th percentile) was associated with elevated odds for ARI symptoms along a gradient of lag exposure time even when controlling for age, sex, types of cooking fuels, and precipitation. Conclusions: Long-term exposure to high concentrations of PM [Formula: see text] may increase risk for acute respiratory problems in small children. However, more work should be carried out to increase capacity to accurately measure air pollutants in emerging economies such as Kenya.