The disgraceful neglect of childhood pneumonia

Prepared for the report, Air pollution and child health: prescribing clean air. Published in The Lancet Global Health, 12 November 2018. 


"Lower respiratory tract infections, by which we usually mean pneumonia, are the second leading cause of death in under-5s worldwide, and the leading cause in Africa. Air pollution is just one of many poverty-linked risk factors, others being undernutrition, poor hygiene, limited or no breastfeeding, and lack of access to vaccines. In turn, death rates in those who succumb to infection are much higher in impoverished regions than in higher-income ones owing to slow care seeking (stemming from poor health education or geographical or financial barriers to care), diagnostic failure, and inappropriate treatment.


The WHO report recognises that the issue of air pollution, particularly ambient air pollution, is largely a high-level issue for governments and regions, and its recommendations for health professionals centre around awareness-raising, research, advocacy, and prescribing of household-level solutions (such as switching to cleaner fuels, where possible). But what about the other, potentially more tractable, risk factors and system failures that contribute to pneumonia’s standing as a barely surpassed killer of children?"

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Nigeria: respiratory health in Africa's most populous nation

by Ray Cavanaugh

Published in The Lancet Respiratory Medicine, 28 June 2018


“With 190 million people, Nigeria has by far the highest population of any African nation and recently overtook South Africa as the continent's largest economy. The recent growth of industry and population, combined with low levels of regulation enforcement, have seen Nigerian cities become some of the world's most polluted. This issue affects an increasing proportion of Nigerians: since the nation obtained independence in 1960, the segment of its population living in urban areas has more than trebled, climbing from 15% to 49%.”


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Impact of improved cookstoves on women's and child health in low and middle income countries: a systematic review and meta-analysis

by Thakur M, Nuyts PAW, Boudewijns EA, Flores Kim J, Faber T, Babu GR, van Schayck OCP, Been JV.

Published in Thorax, BMJ, June 20, 2018.


Improved biomass cookstoves may help reduce the substantial global burden of morbidity and mortality due to household air pollution (HAP) that disproportionately affects women and children in low and middle income countries (LMICs).


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Acute effects of ambient air pollution on lower respiratory infections in Hanoi children: an eight-year time series study

by authors Nhung NTT, Schindler C, Dien TM, Probst-Hensch N, Perez L, Künzli N.


Lower respiratory diseases are the most frequent causes of hospital admission in children worldwide. This is especially true in developing countries. Daily exposure to air pollution is associated with lower respiratory diseases. This association has been observed in many time-series studies. However, investigations in low-and-middle-income countries such as Vietnam remain sparse.


Researchers aimed to investigate the short-term association of ambient air pollution with daily counts of hospital admissions due to pneumonia, bronchitis and asthma among children aged 0-17 in Hanoi, Vietnam. The impact of age, gender and season on these associations was also explored.

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Kitchen PM2.5 concentrations and child acute lower respiratory infection in Bhaktapur, Nepal: The importance of fuel type

Bates MN, Pokhrel AK, Chandyo RK, Valentiner-Branth P, Mathisen M, Basnet S, Strand TA, Burnett RT, Smith KR.


Solid fuels are used by approximately 3 billion people for cooking around the world. A smaller number of people use kerosene. These fuels types have been linked to the incidence of acute lower respiratory infection (ALRI) in children. Previous work in Bhaktapur, Nepal showed comparable relationships of biomass and kerosene cooking fuels with ALRI in young children compared to those using electricity for cooking. Researchers examined the relationship of kitchen PM2.5 concentrations to ALRI in these households.


ALRI cases and controls (age-matched) were enrolled from a cohort of children aged 2-35 months. 24-hour PM2.5 was measured once in the kitchen of each study participant. Primary analysis was done with conditional logistic regression, with PM2.5 measures specified both continuously and as quartiles.

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