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In-utero exposure to multiple air pollutants and childhood undernutrition in India

Journal of Exposure Science & Environmental Epidemiology (2023)Cite this article

Abstract

Background

Several studies have been conducted to understand the impact of socioeconomic and maternal factors on child undernutrition. However, the past literature has not directly examined the joint impacts of fuel use and ambient pollution and have primarily focused on PM2.5.

Objective

This study explored the individual and community-level associations of both indoor (cooking fuel type) and ambient air pollution (PM2.5, NO2 and SO2) during maternal gestation on child undernutrition.

Methods

This study analysed stunting, being underweight, and anaemia of children aged 0–59 months (n = 259,627) using the National Family Health Survey. In-utero exposures to ambient PM2.5, NO2, and SO2 were measured using satellite data and self-reported fuel type was a marker of indoor pollution exposure. The study used univariate and bivariate Moran’s I, spatial lag model and multivariable logistic regression models after adjusting for other covariates to understand the effect of pollution on in-utero exposure and child health status at the individual and community-levels.

Results

Higher concentration of indoor and ambient air pollution was found in the Northern and parts of Central regions of India. Estimates of spatial modelling show that each 1 μg/m–3 increase in maternal exposure to ambient PM2.5 across the clusters of India was associated with a 0.11, 9 and 19 percentage points increase in the prevalence of stunting, underweight and anaemia, respectively. The results of multi-pollutant model show that a higher ambient PM2.5 exposure during pregnancy was linked to higher odds of stunting (AOR:1.38; 95% CI:1.32–1.44), underweight (AOR:1.59; 95% CI:1.51–1.67) and anaemia (AOR:1.61; 95% CI:1.52–1.69) in children. Weaker but similar associations were observed for NO2, but not with SO2. Indoor pollution exposure during in-utero periods was also significantly associated with childhood undernutrition and this association was modified by ambient PM2.5 levels, where exposure to both indoor and ambient air pollution had even greater odds of being undernourished.

Impact statement

  • Our research on multi-pollutant models has revealed the initial proof of the individual impacts of indoor and outdoor pollution (PM2.5, NO2, and SO2) exposure during fetal development on children’s nutrition.

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Fig. 1: Prevalence and clustering map of child undernutrition indicators across India.
Fig. 2: Spatial distribution of ambient air pollution across India.
Fig. 3: Spatial relationships between stunting, ambient and indoor air pollution.
Fig. 4: Spatial relationships between underweight, ambient and indoor air pollution.
Fig. 5: Spatial relationships between childhood anaemia and ambient and indoor air pollution.

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Data availability

The study uses secondary data which are available on reasonable request through https://dhsprogram.com/data/ and https://giovanni.gsfc.nasa.gov/giovanni/. The data and code used in this study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the Ministry of Health and Family Welfare (MoHFW), Government of India for funding and providing the National Family Health Survey (NFHS) (http://rchiips.org/nfhs/). We gratefully acknowledge the University Grants Commission (UGC) for the doctoral fellowship received by Arup Jana and Akancha Singh for the research work. The authors express their gratitude to NASA for making the data on air pollution available in the public domain.

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Authors and Affiliations

  1. Department of Population & Development, International Institute for Population Sciences, Deonar, Mumbai, 400088, India

    Arup Jana, Akancha Singh & Aparajita Chattopadhyay

  2. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 48109, USA

    Sara D. Adar & Jennifer D’Souza

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Contributions

Conceptualisation: AJ, AC. Data curation: AJ. Formal analysis: AJ. Methodology: AJ, AC. Software: AJ. Writing: AJ, AC, AS. Review & editing: AC, AS, AJ, SDA, JD.

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Correspondence to Aparajita Chattopadhyay.

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The authors declare no competing interests.

Ethics approval

The organization committee of the survey received ethical approval from the Ministry of Health and Family Welfare (MoHFW) to collect the human data. The Indian Demographic and Health Survey (DHS) is known as National Family Health Survey (NFHS) in India. We used published large-scale national data where every respondent was anonymized in the data set itself. As it is not based on a primary survey- cases, we were not required to do any anonymization in the study as the data is already made in that fashion following all ethical protocols. Thereby, it is certified that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of the survey. Also, verbal as well as written informed consent was obtained from all the participants. The informed consent was taken from their parent or legal guardian. The dataset is publicly available, thus, consent for publication is not applicable for the study.

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Jana, A., Singh, A., Adar, S.D. et al. In-utero exposure to multiple air pollutants and childhood undernutrition in India. J Expo Sci Environ Epidemiol (2023). https://doi.org/10.1038/s41370-023-00591-5

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