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 PM2.5 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 PM2.5 concentrations (mean: 65.5 mu g/m(3); median: 49.2 mu g/m(3); range: 17.3-209.0 mg/m(3)) 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 PM2.5 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 PM2.5 concentrations between the high and low PM2.5 states was 58.6 mu g/m(3), 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 PM2.5 levels. To mitigate this burden, it may be necessary to complement the ongoing nutritional interventions with air pollution control measures.