Climate Change Adaptation to Smoke Haze for Improved Child Health in Southeast Asia: Analysis Situation in Palembang,...

Background: Haze from forest and peatland fires is a major recurring hazard in Indonesia. During the 2015 fire crisis, more than 43 million people were affected, with PM₁₀ concentrations reaching 2,108.5 μg/m³ in Palangkaraya, while children were among the most vulnerable populations due to their increased susceptibility to air pollution. Objective: This study assessed the impact of forest and peatland fire haze on child respiratory health in Palembang, Indonesia, by examining associations between ambient concentrations of PM₁₀, PM_2.5, and SO₂ and the incidence of acute respiratory infection (ARI) and pneumonia to inform child-focused air quality management and public health preparedness. Methods: An ecological time-series study was conducted using data from 2011 to 2020 in Palembang, a city consistently affected by annual peatland fires. The dataset included 366,632 ARI cases and 27,574 pneumonia cases among children. Ambient air quality data were obtained from the Indonesian Meteorology, Climatology and Geophysics Agency (BMKG). Pearson correlation analyses with a one-month lag were performed, followed by linear regression modeling. Results: Particulate matter showed strong associations with increased childhood respiratory morbidity. Pneumonia demonstrated more consistent relationships with PM_2.5, reflecting the deeper penetration of fine particles into the respiratory tract. Regression models indicated that rises in PM_2.5 predicted higher pneumonia incidence, while PM₁₀ was more consistently associated with ARI. Associations involving SO₂ were less consistent, though it may act synergistically with particulate matter to worsen respiratory outcomes. Conclusion: Haze exposure significantly elevates the risk of respiratory illness in children. PM_2.5 is strongly linked to pneumonia, whereas PM₁₀ is more closely related to ARI. The persistent nature of haze and children's heightened vulnerability highlight the need to integrate child-centered risk mitigation into national air quality management and disaster preparedness strategies.