Over 100,000 infants in India did not survive a month due to severe air pollution in 2019: Report

The State of Global Air 2020 report said that India has the highest burden of infant deaths due to air pollution followed by 67,900 (Nigeria); 56,500 (Pakistan); 22,900 (Ethiopia) and 1,200 (Democratic Republic of Congo)

Over 116,000 infants in India died within a month after their birth due to exposure to severe air pollution in 2019, according to the State of Global Air 2020 report. US-based Health Effects Institute and Global Burden of Disease released the first such report analysing the impact of high air pollution on infant health on Wednesday. The report said that India had the highest burden of infant deaths due to air pollution followed by Nigeria (67,900), Pakistan (56,500), Ethiopia (22,900), and the Democratic Republic of Congo (1,200).

The analysis is based on a growing body of research and evidence that suggests mothers’ exposure to dirty air during pregnancy is linked to increased risk of infants being born too small and being born too early.(Representational photo.)

It is based on a growing body of research and evidence that suggests mothers’ exposure to polluted air during pregnancy is linked to increased risks to infants weighing under 2,500 grams at birth or those born before 37 weeks of gestation, as opposed to 38 to 40 weeks. Low weight and premature birth are linked to a higher risk of lower respiratory tract infections, diarrhoea, other serious infections as well as brain damage and blood disorders, jaundice that can be potentially fatal.

“Although the biological reasons for this linkage are not fully known, it is thought that air pollution may affect a pregnant woman, her developing foetus, or both through pathways similar to those of tobacco smoking, which is a well-known risk factor for low birth weight and preterm birth,” the report said.

Kalpana Balakrishnan, the director of the Indian Council of Medical Research (ICMR)’s Centre for Advanced Research on Air Quality, Climate and Health, said around 116,000 infant deaths can be prevented if air quality is as per the World Health Organisation’s standards. “That is how the attributable burden is identified. But the number seems large because population risks are often not perceivable because they have tiny risk on an individual level. For example, smoking, anaemia or maternal nutrition are all individual risks that can be dealt with on an individual level. But when it comes to air pollution, a very large population is at risk because of high overall exposure. India also has an underlying prevalence of low birth weight which also makes the risk pronounced.”

Balakrishnan said the evidence from over 70 studies, including that of ICMR in India, show that exposures to household and ambient air pollution are associated with adverse pregnancy outcomes. “India has a long history of addressing multiple risk factors contributing to adverse pregnancy outcomes including maternal nutrition, anaemia, access to antenatal care, to name a few.”

Balakrishnan said the recent evidence shows that air pollution must be included alongside these risk factors to address the burden of low birth weight and preterm births. Clean household energy initiatives offer some strategic near-term opportunities that can be directed at these vulnerable groups, Balakrishnan added. “Results from on-going randomised control trials In India are expected to strengthen the case for such interventions.”

Balakrishnan said addressing the impacts of air pollution on adverse pregnancy outcomes and newborn health is important for low- and middle-income countries. “...[it is] not only because of the high prevalence of low birth weight, preterm birth, and child growth deficits but because it allows the design of strategic interventions that can be directed at these vulnerable groups.”

Of all neonatal deaths attributable to air pollution globally, household air pollution accounted for about 64% of them. The rest were due to outdoor air pollution. The highest percentage of deaths attributable to household air pollution (80%) was estimated to be in the sub-Saharan region. The lowest was in high-income regions (less than 2%).

Global map of age-standardised rates of death attributable to PM2.5 in 2019. (Sourced)

Long-term exposure to outdoor and household air pollution contributed to over 1.67 million annual deaths from stroke, heart attack, diabetes, lung cancer, chronic lung diseases, and neonatal diseases in India last year, making air pollution the largest risk factor for deaths among all health risks.

Deaths attributable to particulate matter in 2019 among babies in their firth month of life in the GBD Super Regions. (Sourced)

Based on experience from the SARS-CoV-1 outbreak between 2002 and 2004, the report said air pollution could lead to both a higher number of Covid-19 infections and deaths.

Pallavi Pant, a scientist at Health Effects Institute, said the evidence on the link between air pollution and Covid-19 is rapidly growing. “It is clear that long-term exposure to air pollution can cause many of the health conditions associated with increased vulnerability to Covid-19 such as diabetes and chronic heart and lung diseases. Evidence increasingly suggests that people living in areas with high air pollution are likely to experience more severe outcomes from Covid 19,” said Pant. “Even before the Covid-19 pandemic hit, India carried a heavy burden of chronic respiratory and other diseases and India has also experienced high exposures for a long time. Exposures to air pollution have been shown to affect the human body’s immune defence making an individual more susceptible to respiratory infections such as pneumonia.”