Impact of air pollution on stunting among children in Africa

BACKGROUND: Undernutrition is a global public health crisis, causing nearly half of deaths for children under age 5 years. Little is known regarding the impact of air pollution in-utero and early childhood on health outcomes related to undernutrition. The aim of our study is to evaluate the association of prenatal and early-life exposure to PM(2.5) and child malnutrition as captured by the height-for-age z-score (HAZ), and stunting in 32 countries in Africa. We also evaluated critical windows of susceptibility during pregnancy to each environmental risk. METHODS: We linked nationally representative anthropometric data from 58 Demographic and Health Surveys (DHS) (n = 264,207 children < 5 years of age) with the average in-utero PM(2.5) concentrations derived from satellite imagery. We then estimated associations between PM(2.5) and stunting and HAZ after controlling for child, mother and household factors, and trends in time and seasonality. RESULTS: We observed lower HAZ and increased stunting with higher in-utero PM(2.5) exposure, with statistically significant associations observed for stunting (OR: 1.016 (95% CI: 1.002, 1.030), for a 10 μg/m(3) increase). The associations observed were robust to various model specifications. Wald tests revealed that sex, wealth quintile and urban/rural were not significant effect modifiers of these associations. When evaluating associations between trimester-specific PM(2.5) levels, we observed that associations between PM(2.5) and stunting was the largest. CONCLUSIONS: This is one of the first studies for the African continent to investigate in-utero and early-life exposure to PM(2.5) is an important marker of childhood undernutrition. Our results highlight that PM(2.5) concentrations need to be urgently mitigated to help address undernutrition in children on the continent. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12940-022-00943-y.