Air Pollution as a Determinant of Undernutrition Prevalence among Under-Five Children in India: An Exploratory Study.

Aim The association of air pollution with prevalence of undernutrition indices (namely, anaemia, stunting, wasting and underweight) among under-five children in India was investigated. Methods Estimates of population weighted annual average gridded PM_2.5 concentrations and proportion of households using solid cooking fuel (HSCF usage percent) during 2017 in India, reflecting the magnitude of ambient and household air pollution respectively, were extracted in a state-wise manner from India State Level Disease Burden Initiative (ISLDBI) reports. Their relationships with the corresponding prevalence of anaemia, underweight, wasting and stunting in under-five children were analysed. Results The state-level PM_2.5 concentrations (mean: 65.5 µg/m³; median: 49.2 µg/m³; range: 17.3–209.0 µg/m³) correlated significantly (P < 0.01) with anaemia (r = 0.65), stunting (r = 0.58) and underweight (r = 0.50) prevalence; while HSCF usage (mean: 49.3%; median: 46.0%; range: 1.9–81.5%) correlated significantly (P < 0.01) with stunting (r = 0.69) and underweight (r = 0.58) prevalence. When examined across median cut-offs and after adjusting for socio-demographic index, the association of anaemia prevalence with PM_2.5 concentrations persisted. This association was maintained even after controlling for the coverage of anaemia-specific interventions (namely, iron supplements and deworming medications). The mean difference in PM_2.5 concentrations between the high and low PM_2.5 states was 58.6 µg/m³, which accounted for 11.8% higher anaemia prevalence in the former as compared to the latter. Conclusion The burden of childhood undernutrition, particularly anaemia, in India may be linked to PM_2.5 levels. To mitigate this burden, it may be necessary to complement the ongoing nutritional interventions with air pollution control measures. [ABSTRACT FROM AUTHOR]