Re-examining the Nexus Between Maternal Smoking Behavior and Under-Five Children's ARI in India: A Comprehensive
Margubur Rahaman1, Avijit Roy2, Md Abdul Latif3
1Department of Migration & Urban Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India.
Insights
Maternal smoking significantly increases the risk of acute respiratory infections (ARIs) in Indian children under five. Breastfeeding offers protection, while combined household smoking and poor ventilation exacerbate risks.
Area of Science:
- Environmental Health
- Pediatric Health
- Epidemiology
Background:
- Acute respiratory infections (ARIs) pose a significant health burden on children under five in lower and middle-income countries (LMICs).
- Indoor smoking exposure is a known risk factor for ARIs in India.
- This study investigates the specific impact of maternal smoking on ARIs in young children in India.
Purpose of the Study:
- To re-examine the association between maternal smoking and ARIs in children under five in India.
- To analyze the influence of other indoor air pollutants and covariates on this relationship.
- To confirm existing findings and explore potential differentials using advanced analytical methods.
Main Methods:
- Utilized data from the National Family Health Survey (NFHS-5) for the period 2019-2021.
- Employed descriptive statistics, bivariate analysis, and multivariable logistic regression models.
- Incorporated interaction analysis to assess combined effects of risk factors.
Main Results:
- Children under five with smoking mothers had a 1.24 times higher adjusted likelihood of ARI (95% CI: 1.04-1.48).
- Combined exposure to maternal smoking, other household smokers, and unclean cooking fuel without adequate ventilation increased ARI risk significantly (AOR: 2.01; 95% CI: 1.98-2.67).
- Breastfeeding demonstrated a protective effect against indoor smoking exposure; never breastfed and infants with abnormal birth size were more vulnerable.
Conclusions:
- Maternal smoking is strongly associated with increased ARIs in Indian children under five.
- Public health interventions should focus on reducing maternal smoking and promoting breastfeeding.
- Improving household air quality, particularly in homes using unclean cooking fuel, is crucial for respiratory health.
Background:
The burden of acute respiratory infections (ARIs) among children under-five is a serious concern in lower and middle-income countries (LMICs), including India, where it is positively associated with indoor smoking exposures. This study re-examines the impact of maternal smoking on ARIs among children under 5 in India, considering other indoor air pollutant factors and covariates. The aim is to establish existing findings and capture any differentials in results using comprehensive analytical approaches.
Methods:
Data from the National Family Health Survey (NFHS-5), 2019 - 21, was used. Descriptive statistics, bivariate analysis, multivariable logistic regression models, and interaction analysis were applied to accomplish the study objective.
Results:
The adjusted likelihood of ARI was 1.24 (95% CI: 1.04-1.48) times higher in under-five children with smoking mothers than those with non-smoking mothers. The result was also observed to be almost similar across all seasons. Moreover, the combined effect of maternal smoking with other household members smoking and using unclean cooking fuel without a separate ventilated kitchen escalated the risk (AOR: 2.01; 95% CI: 1.98-2.67). Breastfeeding was found to be a preventive measure for reducing the risk of indoor smoking exposure. The children who were never breastfed and were born large or small were more susceptible to maternal smoking.
Conclusion:
The study highlights the association between maternal smoking and ARIs in Indian under-five children. Interventions include reducing maternal smoking, promoting breastfeeding, and improving respiratory health in fuel-exposed households.
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