Department of Economics, COMSATS University Islamabad, Lahore Campus, Off Raiwind Road, Lahore, Pakistan.
Department of Public Health, Health Services Academy, Islamabad, Pakistan.
BMC Public Health. 2024 Oct 29;24(1):2996. doi: 10.1186/s12889-024-20476-y.
Despite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths.
This cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998-2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants.
Outdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10-1.18; p < 0.001). Moderate and high household air pollution exposure also heightened this risk, with increases of 37% (OR: 1.37; 95% CI: 1.24-1.53; p < 0.001) and 40% (OR: 1.40; 95% CI: 1.26-1.56; p < 0.001), respectively, compared to no exposure. Multilevel models (Models 5a and 10a) produced similar estimates to standard logistic regression, indicating robust associations. Additionally, Population Attributable Fraction analysis revealed that approximately 11.9% of under-five mortality could be prevented by reducing ambient PM2.5 exposure and 12.0% by mitigating household air pollution. The interaction between indoor and outdoor pollution revealed complex dynamics, with moderate and high household exposure associated with a reduction in mortality risk when combined with PM2.5. Geographical disparities were observed, with stronger correlations between outdoor air pollution and child mortality in Africa compared to Asia, and more pronounced impacts in low-income countries. However, household air pollution had stronger association with child mortality in Africa and lower- and middle-income countries.
Our findings could serve as a guide for policy development aimed at reducing under-five mortality, ultimately contributing to the attainment of the Sustainable Development Goal (SDGs).
尽管取得了进展，但五岁以下儿童死亡率仍然很高，特别是在撒哈拉以南非洲和南亚地区，每天约有 13400 名儿童死亡。环境污染物，包括来自室外空气和家庭空气污染的 PM2.5，是这些可预防死亡的主要原因。
本跨国研究结合卫星数据和来自 IPUMS-DHS 数据集（1998-2019 年）的 113 项调查，研究了 41 个发展中国家的五岁以下儿童死亡率。利用社会经济数据和应用中心（SEDAC）的全球年度 2.5 微米或更小直径的颗粒物（PM2.5）网格和 DHS 计划的地理空间数据，综合分析了室内和室外空气污染，特别是 PM2.5 与儿童死亡率之间的关联，使用逻辑回归和多层次逻辑回归模型，并估计人口归因分数（PAF）来量化这些污染物造成的死亡负担。
室外空气污染，用 PM2.5 的一个标准差增加来衡量，显著增加了儿童死亡的风险（比值比[OR]：1.14；95%置信区间[CI]：1.10-1.18；p<0.001）。中度和高度家庭空气污染暴露也增加了这种风险，暴露增加 37%（OR：1.37；95% CI：1.24-1.53；p<0.001）和 40%（OR：1.40；95% CI：1.26-1.56；p<0.001），而没有暴露的情况下则没有。多层次模型（模型 5a 和 10a）得出的估计值与标准逻辑回归相似，表明存在稳健的关联。此外，人口归因分数分析表明，通过降低环境 PM2.5 暴露，大约 11.9%的五岁以下儿童死亡可以预防，通过减轻家庭空气污染，大约 12.0%的儿童死亡可以预防。室内和室外污染之间的相互作用揭示了复杂的动态，当与 PM2.5 结合使用时，中度和高度家庭暴露与死亡率风险降低有关。还观察到了地理差异，与亚洲相比，非洲室外空气污染与儿童死亡率之间的相关性更强，在低收入国家的影响更为显著。然而，家庭空气污染与非洲和低收入和中等收入国家的儿童死亡率的关联更强。
我们的研究结果可以为旨在降低五岁以下儿童死亡率的政策制定提供指导，最终有助于实现可持续发展目标（SDGs）。
