Understanding the effect of indoor air pollution on pneumonia in children under 5 in low- and middle-income countries: a systematic review of evidence

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Abstract

Exposure to indoor air pollution increases the risk of pneumonia in children, accounting for about a million deaths globally. This study investigates the individual effect of solid fuel, carbon monoxide (CO), black carbon (BC) and particulate matter (PM) _2.5 on pneumonia in children under 5 in low- and middle-income countries. A systematic review was conducted to identify peer-reviewed and grey full-text documents without restrictions to study design, language or year of publication using nine databases (Embase, PubMed, EBSCO/CINAHL, Scopus, Web of Knowledge, WHO Library Database (WHOLIS), Integrated Regional Information Networks (IRIN), the World Meteorological Organization (WMO)-WHO and Intergovernmental Panel on Climate Change (IPCC). Exposure to solid fuel use showed a significant association to childhood pneumonia. Exposure to CO showed no association to childhood pneumonia. PM _2.5 did not show any association when physically measured, whilst eight studies that used solid fuel as a proxy for PM _2.5 all reported significant associations. This review highlights the need to standardise measurement of exposure and outcome variables when investigating the effect of air pollution on pneumonia in children under 5. Future studies should account for BC, PM ₁ and the interaction between indoor and outdoor pollution and its cumulative impact on childhood pneumonia.

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Epidemiology and etiology of childhood pneumonia.

Igor Rudan, Cynthia Boschi-Pinto, Zrinka Biloglav … (2008)

Childhood pneumonia is the leading single cause of mortality in children aged less than 5 years. The incidence in this age group is estimated to be 0.29 episodes per child-year in developing and 0.05 episodes per child-year in developed countries. This translates into about 156 million new episodes each year worldwide, of which 151 million episodes are in the developing world. Most cases occur in India (43 million), China (21 million) and Pakistan (10 million), with additional high numbers in Bangladesh, Indonesia and Nigeria (6 million each). Of all community cases, 7-13% are severe enough to be life-threatening and require hospitalization. Substantial evidence revealed that the leading risk factors contributing to pneumonia incidence are lack of exclusive breastfeeding, undernutrition, indoor air pollution, low birth weight, crowding and lack of measles immunization. Pneumonia is responsible for about 19% of all deaths in children aged less than 5 years, of which more than 70% take place in sub-Saharan Africa and south-east Asia. Although based on limited available evidence, recent studies have identified Streptococcus pneumoniae, Haemophilus influenzae and respiratory syncytial virus as the main pathogens associated with childhood pneumonia.

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Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis.

Mukesh Dherani, Daniel Pope, Maya Mascarenhas … (2008)

Reduction of indoor air pollution (IAP) exposure from solid fuel use is a potentially important intervention for childhood pneumonia prevention. This review updates a prior meta-analysis and investigates whether risk varies by etiological agent and pneumonia severity among children aged less than 5 years who are exposed to unprocessed solid fuels. Searches were made of electronic databases (including Africa, China and Latin America) without language restriction. Search terms covered all sources of IAP and wide-ranging descriptions of acute lower respiratory infections, including viral and bacterial agents. From 5317 studies in the main electronic databases (plus 307 African and Latin American, and 588 Chinese studies, in separate databases), 25 were included in the review and 24 were suitable for meta-analysis. Due to substantial statistical heterogeneity, random effects models were used. The overall pooled odds ratio was 1.78 (95% confidence interval, CI: 1.45-2.18), almost unchanged at 1.79 (95% CI: 1.26-2.21) after exclusion of studies with low exposure prevalence (< 15%) and one high outlier. There was evidence of publication bias, and the implications for the results are explored. Sensitivity subanalyses assessed the impact of control selection, adjustment for confounding, exposure and outcome assessment, and age, but no strong effects were identified. Evidence on respiratory syncytial virus was conflicting, while risk for severe or fatal pneumonia was similar to or higher than that for all pneumonia. Despite heterogeneity, this analysis demonstrated sufficient consistency to conclude that risk of pneumonia in young children is increased by exposure to unprocessed solid fuels by a factor of 1.8. Greater efforts are now required to implement effective interventions.

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The global burden of respiratory disease-impact on child health.

Heather J Zar, Thomas Ferkol (2014)

Respiratory disease is the major cause of mortality and morbidity worldwide, with infants and young children especially susceptible. The spectrum of disease ranges from acute infections to chronic non-communicable diseases. Five respiratory conditions dominate-acute respiratory infections, chronic obstructive pulmonary disease, asthma, tuberculosis (TB), and lung cancer. Pneumonia remains the predominant cause of childhood mortality, causing nearly 1.3 million deaths each year, most of which are preventable. Asthma is the commonest non-communicable disease in children. Pediatric TB constitutes up to 20% of the TB caseload in high incidence countries. Environmental exposures such as tobacco smoke, indoor air pollution, and poor nutrition are common risk factors for acute and chronic respiratory diseases. Pediatric and adult respiratory disease is closely linked. Early childhood respiratory infection or environmental exposures may lead to chronic disease in adulthood. Childhood immunization can effectively reduce the incidence and severity of childhood pneumonia; childhood immunization is also effective for reducing pneumonia in the elderly. The Forum of International Respiratory Societies (FIRS), representing the major respiratory societies worldwide, has produced a global roadmap of respiratory diseases, Respiratory Disease in the World: Realities of Today-Opportunities for Tomorrow. This highlights the burden of respiratory diseases globally and contains specific recommendations for effective strategies. Greater availability and upscaled implementation of effective strategies for prevention and management of respiratory diseases is needed worldwide to improve global health and diminish the current inequities in health care worldwide.

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Author and article information

Contributors

Enemona Emmanuel Adaji: Emmanuel.Adaji@nottingham.ac.uk

Journal

Journal ID (nlm-ta): Environ Sci Pollut Res Int

Journal ID (iso-abbrev): Environ Sci Pollut Res Int

Title: Environmental Science and Pollution Research International

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0944-1344

ISSN (Electronic): 1614-7499

Publication date (Electronic): 19 December 2018

Publication date PMC-release: 19 December 2018

Publication date (Print): 2019

Volume: 26

Issue: 4

Pages: 3208-3225

Affiliations

[1 ]Division of Epidemiology and Public Health, University of Nottingham, Nottingham City Hospital, Clinical Sciences Building, Hucknall Road, Nottingham, NG5 1PB UK

[2 ]ISNI 0000 0004 1936 8868, GRID grid.4563.4, Faculty of Engineering, , University of Nottingham, ; Nottingham, UK

[3 ]ISNI 0000 0001 2190 4373, GRID grid.7700.0, Climate Change and Human Health Group, Institute for Public Health, , University of Heidelberg, ; Heidelberg, Germany

Author notes

Responsible editor: Philippe Garrigues

Article

Publisher ID: 3769

DOI: 10.1007/s11356-018-3769-1

PMC ID: 6513791

PubMed ID: 30569352

SO-VID: 96fe9d9e-3e8a-417e-99fd-aa7dbfc81a4f

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 30 March 2018

Date accepted : 15 November 2018

Funding

Funded by: University of Nottingham

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ScienceOpen disciplines: General environmental science

Keywords: indoor air pollution,black carbon,particulate matter,carbon monoxide,pneumonia,children under 5,low- and middle-income countries

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ScienceOpen disciplines: General environmental science

Keywords: indoor air pollution, black carbon, particulate matter, carbon monoxide, pneumonia, children under 5, low- and middle-income countries

Understanding the effect of indoor air pollution on pneumonia in children under 5 in low- and middle-income countries: a systematic review of evidence

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Most cited references 47

Epidemiology and etiology of childhood pneumonia.

Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis.

The global burden of respiratory disease-impact on child health.

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