Breathe In Clean Air To avoid Childhood Pneumonia

Pneumonia is a serious disorder affecting children even in their very early stages of life. Like other acute respiratory infections, pneumonia targets the world’s most vulnerable children as it occurs when a child’s still-developing defence system is weakened. Malnutrition, crowded housing, smoking, and polluted air have all been linked to higher incidences of pneumonia, the leading global killer of children under five. The Acute Respiratory Infections (ARI) Atlas confirms that indoor air pollution significantly increases the incidence of pneumonia. The risk depends on how toxic the pollutants are, how long and at what concentration the exposure occurs and the adequacy of ventilation.

Children are particularly vulnerable because (i) their lungs, respiratory defences and immune systems are not fully developed (ii) they breathe more in proportion to their body size and (iii) they are likely to spend more time in polluted home environments. Out of the total annual child mortality of 1.96 million from pneumonia, an estimated 871,500 deaths are caused by indoor air pollution associated with cooking/heating with wood, animal dung, charcoal and other biomass fuels, which are used by half the world’s population for cooking—most of them belonging to the developing countries, like India where wood/coal burning stoves are used by 826 million people. Death toll from Acute Respiratory Infections (ARI) among Indians is also very high--higher than all deaths from HIV/AIDS, malaria and TB combined. In 2008, 371605 children under 5 succumbed to pneumonia in India.

According to Dr Ajay Misra, Managing Director of Nelson Hospital of Paediatrics and Neonatal Medicine Lucknow, the chief sources of indoor air pollution in Indian homes are cooking fuel, insects, and tobacco smoke. The smoke emanating from the chulha (cook stove) in village homes permeates the air in and near the house, and affects the lungs. Even living in posh houses behind closed doors and windows, with no proper ventilation and flow of clean air, poses a danger.

Tobacco is another significant source of indoor pollution and nearly 50% of the world’s children being exposed to tobacco smoke in their daily lives. Tobacco use releases particulates and chemical toxins in the air and smoking indoors endangers the smoker as well as those present at home. Smoking impairs the lung functions of a child. So the risk of respiratory tract infections linked to second hand smoke is heightened in children. A child is twice as likely to be hospitalised with an ARI if a parent smokes. Tobacco use by 241 million Indians also contributes to ARI mortality.

Dr Gourdas Choudhuri, Professor and Head, Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, is very emphatic in saying that, “One of the most preventable factors (of childhood pneumonia) is passive smoking. Pneumonia occurs due to overcrowding in small homes with poor ventilation. The problem is further aggravated if one or both of the parents smoke. Passive smoking makes children more prone to chest and pulmonary infections. Smoking does nobody any good, and fathers especially need to be made aware to be more responsible towards their children’s health. The other issue is of pollution—the fumes and dust in the air which children breathe. These particles will aggravate pneumonia causing bacteria and virus if they are around. Overcrowding allows pathogens to spread rapidly, especially when ventilation is inadequate and sanitation is poor. There is a need of a lot of awareness in mothers about picking up pneumonia at an early stage.”

Professor (Dr) Rama Kant, an eminent surgeon and former Head of the Department of Surgery at Chhatrapati Shahuji Maharaj Medical University (erstwhile King George’s Medical College), Lucknow is passionately involved with social and public health issues. He is a recipient of the World Health Organization (WHO) Director-General’s Award for his contribution in tobacco control (2005) and is the President-elect of Association of Surgeons of India (ASI). He firmly believes that tobacco consumption is playing havoc with the lives of children as well as adults. According to him, “There is an already established link between smoking and poverty. So children living in hutments and slums are more affected by the pollution of tobacco smoke which contains over 4000 chemicals, many of which are not only carcinogenic, but also reduce the child’s immunity. These children are already malnourished, and deprived of proper ventilation and sunlight. On top of this, right from the time they are inside the mother’s womb, they are exposed to the hazards of tobacco smoke, thus making them easy targets for pneumonia.”

In the opinion of Prof (Dr) Rama Kant, “An important and worthwhile intervention is that facilities for tobacco cessation should be made available to people who are ready to quit smoking. Thanks to the efforts made by the government and NGOs, people are now more aware about the health hazards of tobacco. But they do not know where to go as facilities for tobacco cessation are very meagre in our country. Unless we have continuously available cessation facilities that can help people quit, many of the tobacco control efforts will go waste. The WHO did start such clinics, but gradually they are closing down due to paucity of funds and government indifference to manage them. So I want to emphasize two things—people need to be aware that smoking should be controlled and never done inside homes, and secondly, cessation facilities will go a long way in preventing children from suffering from pneumonia related deaths. We have a jumbo system of public health system consisting of a large number of doctors, paramedics and other staff. But their services are underutilised, especially in the rural areas. So cessation facilities can be integrated with and piggy back on the existing public healthcare services.”

Dr Ajay Misra also agrees that “Tobacco smoke is a major cause of respiratory diseases in India and is associated with pneumonia in adults. Second hand smoke does affect the children’s lungs, and reduces their immunity, making them more vulnerable to pneumonia. In order to reduce mortality from pneumonia, it is important to educate the public about prevention strategies—good diet, proper cleanliness and a good environment.”

Improvements in health care, nutrition and the environment are interventions that can significantly reduce the incidence of childhood pneumonia. Access to cleaner fuels for cooking and heating can drastically improve the situation. In India, the ‘national biomass cook stoves initiative’ launched in 2009, targets to distribute low emission stoves in rural areas, and make them accessible to 87% of Indian households over the next 10 years, resulting in 240,000 fewer deaths from ARIs in children. Improving ventilation in houses and enforcing tobacco control policies, so that there is no second hand smoke in the house, will go a long way in preventing childhood pneumonia.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. Email:, website: