Exploring the link between particulate matter pollution and acute respiratory infection risk in children using generalized estimating equations analysis: a robust statistical approach.

BACKGROUND: India is facing a burdensome public health challenge due to air pollution, with a particularly high burden of acute respiratory infections (ARI) among children. To address this issue, our study aims to evaluate the association between exposure to fine particulate matter (PM2.5) and ARI incidence in young children in India. MATERIALS AND METHODS: Our study used PM2.5 data provided by the Atmospheric Composition Analysis Group at Washington University to assess the association between PM2.5 exposure and ARI incidence in 223,375 children sampled from the 2019-2021 Demographic Health Survey in India. We employed the generalized estimating equation and reported odds ratios and 95% confidence intervals for a 10 µg/m3 increase in PM2.5 and quartiles of PM2.5 exposure. RESULTS: Each 10 µg/m3 increase in PM2.5 levels was associated with an increased odds of ARI (OR: 1.23, 95% CI: 1.19-1.27). A change from the first quartile of PM2.5 (2.5-34.4 µg/m3) to the second quartile (34.5-51.5 µg/m3) of PM2.5 was associated with a two-fold change (OR: 2.06, 95% CI: 1.60-2.66) in the odds of developing ARI. Similarly, comparing the first quartile to the fourth quartile of PM2.5 exposure (78.3-128.9 µg/m3) resulted in an over four-fold increase in the odds of ARI (OR: 4.45, 95% CI: 3.37-5.87). CONCLUSION: Mitigation efforts must be continued implementing higher restrictions in India and to bring new interventions to ensure safe levels of air for reducing the burden of disease and mortality associated with air pollution in India.

First 72-hours after birth: Newborn feeding practices and neonatal mortality in India.

BACKGROUND: The reductions in mortality levels among children under five years are observed in most populations, including populations that were lagging the progress in the past. However, the reduction is not uniform across ages during childhood. The mortality declines within the first month have shown relatively slow progress. Early initiation of breastfeeding and discarding pre-lacteal feed protects the newborn from acquiring infection and, thereby, reduces mortality. This paper assesses the change in the prevalence of early initiation of breastfeeding and pre-lacteal feed along with their associated factors, and their association with neonatal mortality in India. METHODS: We used data from the three rounds of National Family Health Surveys conducted during 2005-06, 2015-16 and 2019-21 in India. We used bivariate and multivariate analyses to examine prevalence rates, risk factors, and relationships between breastfeeding practices, including early initiation of breastfeeding and pre-lacteal feed, and neonatal mortality. RESULTS: Early initiation of breastfeeding within one hour after birth increased rapidly from 25% in 2005-06 to 42% in 2019-21, and the pre-lacteal feeding practice declined from 57% in 2005-06 to 15% in 2019-21. Pre-lacteal feed is lower in states/districts where early breastfeeding initiation is predominant and vice versa. The role of health professionals during pregnancy and the first two days after delivery significantly improved breastfeeding practice. Further, the findings suggest that an early breastfeeding initiation is associated with lower neonatal mortality, whereas pre-lacteal feed is not harmful compared to late breastfeeding initiation. CONCLUSION: Prevalence of pre-lacteal feed reduced, and initiation of early breastfeeding increased considerably after the launch of the National Rural Health Mission in India. However, after 2015-16, early breastfeeding initiation has stagnated, and the decline in pre-lacteal feed has slowed down. The future program needs special attention to emphasize the availability and accessibility of breastfeeding advisers and observers in health facilities to help mitigate adverse neonatal outcomes.