india

Updated: Nov 13, 2019 01:42 IST

Air pollution is the second biggest risk factor for child deaths from pneumonia in India after wasting, according to a new report released on Tuesday by Unicef and the non-profit Save the Children.

Pneumonia killed an estimated 126, 535 children under the age of five in India in 2017 – 14 children every hour – of which 27% were attributable to outdoor air pollution and 22% to indoor air pollution, according to the report titled Fighting For Breath – Call to Action.

“Air pollution is responsible for one in four deaths of children due to respiratory ailments; it is a very important factor. When it comes to pneumonia, earlier we would talk about indoor air pollution and replacing chullahs, now outdoor air pollution is also very bad. It makes the lungs susceptible to all kinds of respiratory infections. It is akin to pouring oil in the fire,” said Dr Narendra Arora, a public health expert on respiratory ailments in children and executive director of INCLEN trust.

While the link between air pollution and respiratory infections is known, this report specifically quantifies the risk of pneumonia from exposure to both indoor and outdoor air pollution.

Owing to a huge population, India reported the second highest pneumonia-related child mortality 2018 in terms of absolute numbers. However, with a mortality rate of 5.2 children per 1,000 live births, India is one of the better performers among the 30 “high burden” countries. This includes 22 countries with the highest absolute number of pneumonia deaths and top 14 countries with the highest pneumonia mortality rates.

“The average annual rate of reduction in pneumonia mortality between 2000 and 2018 was 7%. At the same rate, India is expected to reach the 2025 GAPPD (Global Action Plan for Pneumonia and Diarrhoea) target in 2026,” the report said.

Only three of the 30 high-burden countries – Bangladesh, Indonesia, and China – are on track to achieve the deadline.

Pneumonia – the biggest infectious killer

Between 2000 and 2018, there has been a 54% reduction in deaths due to pneumonia in children under the age of five, yet it remains the world’s leading infectious killer of children. The disease claims the lives of more than 800,000 children under the age of five every year or more than 2,000 every day.

After pneumonia, diarrhoea was the biggest killer with 437,000 deaths in 2018.

“Ten or 15 years ago, pneumonia and diarrhoea were the biggest challenges for children in India, especially during the first month after birth. Since then, the deaths due to diarrhoea has gone down mainly due to improved sanitation and hygiene, access to better quality potable water, availability of Oral Rehydration Solution (ORS), and for the last few years, the use of rotavirus vaccine that prevents deaths due to severe viral diarrhoea. Similar developments haven’t happened when it comes to pneumonia,” said Dr Arora.

Pneumonia deaths can be brought down by improving the nutrition status of children, expanding the coverage of pneumococcal vaccine, ensuring antibiotic treatment is completed, and making oxygen and IV fluids are available to manage severe cases at the lowest level of health care.

“The treatment is simple and inexpensive. The challenge is the accessibility of a healthcare facility in some parts of the country and health-seeking behaviour among people. The World Health Organisation has given a clinical case definition of pneumonia to help identify the cases even without diagnostics in high burden countries. The health care workers can count the respiratory rate and check whether the child is experiencing difficulty breathing to diagnose pneumonia. Now, the healthcare workers have also been empowered to give some antibiotic treatment,” said Dr SK Kabra, professor of paediatric pulmonology at All India Institute of Medical Sciences.

Health seeking behaviour is also important for timely treatment.

“What we see is people trying home remedies when the child develops symptoms initially, then they go to a local quack, and reach a hospital only when the child has complications. Parents need to be made aware that cough with rapid respiration, fever and cold needs to be treated by a doctor immediately,” he said.

“Now the availability of antibiotics is not such an issue. But, health-seeking behaviour is. A study we did in Kerala and Tamil Nadu showed that for every death due to pneumonia in children, 20 to 25 got admitted seeking care. In North India, only 1 to 1.5 children were taken to hospitals for every death. There is a need for aggressive social mobilisation,” said Dr Arora.

Poorest are the worst affected

Child deaths from pneumonia are concentrated in the world’s poorest countries and within these countries it is the most deprived and marginalised children who suffer the most, according to the report.

“Children from the poorest families living in low- and middle-income countries are nearly twice as likely to die before their fifth birthday as children from wealthier families, because of social and economic inequalities and poor access to basic, good-quality health services through the poorer provision or out-of-pocket costs. They are further disadvantaged by high rates of malnutrition, co-infections with other diseases, exposure to polluted air, and limited access to safe water, sanitation and hygiene,” the report states,” the report said.

In India, childhood deaths more common in poor with 72 deaths per 1,000 live births in the poorest households as compared to 23 deaths per 1,000 in richest households.