Abstract
BackgroundAmbient air pollution and malnutrition, particularly anemia, are risk factors for pneumonia, a leading cause of death in children under five. We simultaneously assessed these risk factors in Quito, Ecuador.MethodsIn 2005, we studied two socioeconomically similar neighborhoods in Quito: Lucha de los Pobres (LP) and Jaime Roldos (JR). LP had relatively high levels of air pollution (annual median PM2.5 = 20.4 μg/m3; NO2 = 29.5 μg/m3) compared to JR (annual median PM2.5 = 15.3 μg/m3; NO2 = 16.6 μg/m3). We enrolled 408 children from LP (more polluted) and 413 children from JR (less polluted). All subjects were aged 18-42 months. We obtained medical histories of prior physician visits and hospitalizations during the previous year, anthropometric nutrition data, hemoglobin levels, and hemoglobin oxygen saturation via oximetry.ResultsIn anemic children, higher pollution exposure was significantly associated with pneumonia hospitalization (OR = 6.82, 95%CI = 1.45-32.00; P = 0.015). In non-anemic children, no difference in hospitalizations by pollution exposure status was detected (OR = 1.04, NS). Children exposed to higher levels of air pollution had more pneumonia hospitalizations (OR = 3.68, 1.09-12.44; P = 0.036), total respiratory illness (OR = 2.93, 95% CI 1.92-4.47; P < 0.001), stunting (OR = 1.88, 1.36-2.60; P < 0.001) and anemia (OR = 1.45, 1.09-1.93; P = 0.013) compared to children exposed to lower levels of air pollution. Also, children exposed to higher levels of air pollution had significantly lower oxygen saturation (92.2% ± 2.6% vs. 95.8% ± 2.2%; P < 0.0001), consistent with air pollution related dyshemoglobinemia.ConclusionsAmbient air pollution is associated with rates of hospitalization for pneumonia and with physician's consultations for acute respiratory infections. Anemia may interact with air pollution to increase pneumonia hospitalizations. If confirmed in larger studies, improving nutrition-related anemia, as well as decreasing the levels of air pollution in Quito, may reduce pneumonia incidence.
Highlights
Ambient air pollution and malnutrition, anemia, are risk factors for pneumonia, a leading cause of death in children under five
Jaime Roldos (JR) and Lucha de los Pobres (LP), of closely comparable socioeconomic status (SES) (Figure 1, Table 1), but which differ in levels of ambient air pollution
We considered Lucha de los Pobres to be a community with relatively higher air pollution levels compared to Jamie Roldos, a community with relatively lower air pollution levels
Summary
Ambient air pollution and malnutrition, anemia, are risk factors for pneumonia, a leading cause of death in children under five. We simultaneously assessed these risk factors in Quito, Ecuador. Pneumonia is the leading cause of childhood death [1,2]. The pathogenesis of pneumonia includes environmental and host factors, such as air pollution and malnutrition [2]. Particulate air pollution (PM), especially particles < 10 μm (PM10) and < 2.5 μm (PM2.5) in aerodynamic diameter, and nitrogen oxides (NOx) are linked to childhood ARI [7,8,9]. Outdoor (ambient) air pollution, and indoor pollution from biofuel use, have been identified as major pneumonia risk factors [2,3]
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