Environmental Burden Can Weigh Down Your Child's Health

Environmental burden is a threat to children and a risk factor for both acute and chronic respiratory diseases. While second-hand tobacco smoke and certain other pollutants are known risk factors for acute respiratory infections indoor air pollution from biomass fuel is also one of the major contributors to the global killer of children i.e. pneumonia. In fact, in developing countries, indoor pollution increases the risk of pneumonia by about 38%.

According to World Health Organization (WHO), nearly half of the deaths among children under five years old from acute lower respiratory infections (ALRI) are due to particulate matter inhaled from indoor air pollution from household solid fuels. Among these deaths, 44% are due to pneumonia.

Around 3 billion people still cook and heat their homes using solid fuels in open fires and leaky stoves. About 2.7 billion burn biomass (wood, animal dung, crop waste) and a further 0.4 billion use coal. Most are poor, and live in developing countries. Such cooking and heating produces high levels of indoor air pollution with a range of health-damaging pollutants. In poorly ventilated dwellings, indoor smoke can be 100 times higher than acceptable levels for small particles. More than 1 million people die every year from chronic obstructive respiratory diseases (COPD) that develop due to exposure to such indoor air pollution. It is particularly high among women and young children, who spend a lot of time near the domestic hearth.

Dr. Vijaya Mohan, Senior Pediatrician, Vivekananda Polyclinic and Institute of Medical Sciences, said that "In the villages cooking may lead to indoor pollution as they cook on 'chulha' and this leads to carbon dioxide emission. And in the cities lifestyle things like carpets and inadequate ventilation may predispose the child to respiratory infections."

Urban indoor pollution may also occur due to limited spacing plan, use of synthetic materials for building and furnishing, use of chemical products, and presence of mites and cockroaches in the house. Dampness, overcrowding, and small particulate matter/pollutants present in indoor smoke inflame the airways and lungs, impairing the immune response and reducing the oxygen-carrying capacity of the blood. They are the most common reasons for causing pneumonia and associated mortality in young children. About 20% of all deaths in children under 5 years are due to Acute Lower Respiratory Infections, 90% of which are due to pneumonia.

Passive smoking is another reason for the increased incidence of ARI in children. There is no safe level of exposure to secondhand smoke and children are exposed to it more than adults. Not only is a child's body still developing physically, but her breathing rate is also faster than that of adults. The immature immune systems and narrow airways of infants and young children make them more susceptible. Every year, an estimated 150,000 to 300,000 children under 18 months of age get pneumonia or bronchitis from breathing secondhand tobacco smoke. Research has shown that children, who grow up in a smoky household, where one or both parents smoke, are likely to have twice the amount of respiratory and lung disorders as compared to children in non smoky households. Also, mothers who smoke may contribute to inadequate breast milk production.

According to Dr.Jyotsna Mehta, Senior Gynecologist and Obstetrician at Sahani and City Hospital: “In urban societies that we are dealing with, smoking has become rampant. We promote patients to quit smoking. It should be strictly avoided during the pregnancy. It must be ensured that the child does not ever become a passive smoker, whether in the womb or outside it."

Unfortunately, finding an affordable solution for controlling indoor air pollution by reducing smoke exposure, reducing fuel costs, and attaining sustainability is a complex and evolving process. The WHO is preparing new indoor air quality guidelines for household fuel combustion.  Introducing cleaner fuel, better ventilation by enlarging windows, and adding smoke hoods over the cooking area are interventions that can reduce pneumonia risk. Changing to full-scale cleaner household fuel could lower pneumonia incidence by 50%. The WHO has also launched a Framework Convention on Tobacco Control (WHO-FCTC) for further driving the need for clearer guidance on protection from second hand smoke. Children should be especially kept away from smoke. Smoke may not directly cause pneumonia, but it certainly leads to some ciliary dysfunction which may actually cause predisposition to the colonization of bacteria and viruses and make children more susceptible to pneumonia. The major interventions can be a switch at the household level to cleaner gaseous or liquid fuels; better combustion ventilation through high-quality biomass stoves; and strict self control on indoor smoking—all in the interest of our children’s health.

In the words of Dr YC Govil, Professor of Paediatrics in Chhatrapati Shahuji Maharaj Medical University (erstwhile King George’s Medical College Lucknow): “The biggest intervention that can be done is education. No measure is better than awareness and for that people need to be educated about the havoc which tobacco and fuel smoke can wreak on innocent infants and children, exposing them to pneumonia related complications, (which may even be fatal) for no fault of theirs.”

Shikha Srivastava - CNS