Smoke-free Indoors For Pneumonia Free Lungs

Every 20 seconds, somewhere a child dies from pneumonia. Pneumonia accounts for 20% under 5 child mortality, killing 1.5 million children per year. This loss of life is even more painful because these deaths are preventable with sufficient interventions. The World Health Organization (WHO) lists several environmental factors that increase a child's susceptibility to pneumonia. These are (i) indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung); (ii) living in crowded homes; and (iii) parental smoking. It also suggests that addressing environmental factors such as indoor air pollution, by providing affordable clean indoor stoves and encouraging good hygiene in crowded homes, can reduce the number of children who fall ill with pneumonia.

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. Hence improvements in the living environment to reduce the spread of germs play an important role in pneumonia control.

In 2009, WHO and UNICEF launched the Global Action Plan for the Prevention and Control of Pneumonia (GAPP), to accelerate pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children. Interventions that can protect children from pneumonia include promoting exclusive breastfeeding and hand washing, and reducing indoor air pollution. New technologies can reduce indoor air pollution. These include changes in cooking fuel from traditional fuel wood, animal dung and coal (which are still used in several low income countries) to liquid fuels like kerosene, natural gas, LPG, etc. Relative risk reduction has been observed in specific settings with liquid fuel stoves and improved solid fuel stoves.
Passive smoking is the inhalation of smoke, called second-hand smoke (SHS) or environmental tobacco smoke (ETS), from tobacco products used by others. Exposure to second-hand tobacco smoke causes disease, disability, and death. It also leads to Impaired respiratory function and slowed lung growth. In the United States, second hand smoke has been associated with an estimated 150,000 --300,000 lower respiratory tract infections in infants and children under 18 months of age, resulting in 7,500--15,000 hospitalizations each year.

Dr. S. N. Rastogi, a leading Paediatrician and Child Cardiologist of Lucknow
warns that, “Use of hookah,  bidi, and cigarettes in the house is quite harmful for the child. This is passive smoking as the child inhales the nicotine present in the room which increases the risk of pneumonia. The father /family members of the baby should not smoke in the child's room. The new born baby should be kept in a separate room and less number of people should be allowed to visit and/or handle her. But in India, due to cultural norms, it is very difficult to curb this practice. From the very first day the child is born, he/she is toyed by a lot of people, which is not a good habit. This social custom, which is prevalent even in well educated families, should be stopped. Only the mother and the attendant should be allowed to get close to the child for at least the first six months.”

The environment of the child and the pollution to which he/she is exposed play an important role in predisposing a child to a host of diseases. Dr. S. K. Sehta, Consultant Paediatrician and Neonatologist, Lucknow, emphasizes that, “If the home is well ventilated, sunny and airy, and the number of persons is less i.e. there is no overcrowding, so that the child has a separate and sufficient amount of space, then there is comparatively less chance of cross infection. But, if the child’s surroundings are such that a large number of people are congested in a small room and the environment is polluted with either cooking smoke or tobacco smoke then the chances of infection are high. In such families the chances of chronic bronchitis and tuberculosis is very high which can be transmitted to the child.”

Supporting the correlation between tobacco use and increased incidence of pneumonia, Dr. Neelam Singh, Consultant Obstetrician and Gynaecologist and Chief Functionary of Vatsalya Resource Centre on Health, says that, “Indoor air pollution definitely increases the risk of pneumonia. In rural areas food is cooked on chulhas so a lot of smoke results. Tobacco smoking also plays an important role in causing childhood pneumonia and other respiratory diseases. Tobacco smoking parents are a major cause of indoor air pollution, and children who live in an environment  where parents are tobacco smokers, are under high risk.  As far as possible, the child should be kept in a clean and pollution free environment. Air pollution in urban areas is very high which affects children”

Dr Rastogi also agrees that as the urban population cooks mostly on gas stoves, so the pollution is comparatively less. But in rural areas people still use fuel wood and coal for cooking which causes a lot of indoor air pollution. In rural areas there is also lack of education about hygiene and cleanliness. But in urban areas people are a little more aware and so they are cautious.

 Dr. S. K. Sehta, says that, “In order to reduce indoor air pollution the government is encouraging use of cooking gas. This will reduce indoor air pollution. A law against tobacco smoking has already been enforced which prohibits smoking in community areas where people have gathered. Parents need to understand that when they are smoking indoors their child is exposed to passive smoking. So if they do not smoke at all, it would be wonderful, but at least they should not smoke before their children.”

There is a general consensus amongst the doctors that a clean smoke free environment and no cigarette smoking around the child can reduce indoor air pollution to a large extent. Reduction in other forms of air pollution and other kinds of pollution is highly recommended because ultimately the infection has its source in some form of pollution. Strategies to reduce indoor air pollution should be encouraged, as they are likely to prevent and control pneumonia.

Somya Arora, CNS
(The author is doing her post-graduation in microbiology from Lucknow University and writes on social justice issues for CNS: