Tackling pneumonia and low birth weight through better air quality management

Bangladesh has made remarkable progress in reducing childhood mortality over the last two decades. Yet, every year around 1,15,000 children die in Bangladesh from various causes, according to the most recent national demographic and health survey. Pneumonia and prematurity or low birth weight being two leading causes of death among children claim the lives of over 50,000 children before reaching the age of five in Bangladesh.

To understand the disease burden and health service needs in Bangladeshi public health facilities, we conducted a prediction exercise using the District Health Information Software 2 (DHIS2) data. This is a digital platform used in Bangladesh to collect, manage, and analyse health data. It helps health workers and policymakers make informed decisions by providing real-time data on various health indicators. This study was conducted in collaboration between icddr,b and the Johns Hopkins University supported by a grant from the Bill & Melinda Gates Foundation to the Countdown to 2030 for Women's, Children's, and Adolescents' Health through the US Fund for UNICEF. This study aimed to assess the magnitude of service requirements in public health facilities in each division in 2025. The prediction was based on the number of services and cases that occurred between 2021 and 2023.

Two particular observations from this data analysis are worth highlighting. First, we observed the highest increase in service requirements in Dhaka for childhood pneumonia, with an estimated 42 per cent increase compared to 2023. Our predictions indicate that around 17,600 services will be required each month for childhood pneumonia in Dhaka in 2025. This number is strikingly high compared to other divisions, where the predicted service requirements ranged between 3,000 to 8,000.

Second, we observed an interesting trend in the number of low birth weight babies and the number of Kangaroo Mother Care (KMC) services in a facility. KMC is a low-cost intervention aimed at nurturing premature or low birth weight babies. This method requires the infant to be held closely, typically by the mother, ensuring direct skin-to-skin contact. Essentially, the baby is nestled against the parent's chest, benefiting from the warmth and comfort of this proximity. Not only does this foster a deep physical bond between the infant and the caregiver, but it also plays a significant role in the baby's development and well-being. While we anticipate a significant increase in the number of low birth weight babies in almost all divisions based on the observed trend between 2021 and 2023, the utilisation of KMC is expected to decrease this year, making it harder to ensure the survival of low birth weight babies. Compared to all other divisions, Dhaka is predicted to have the highest number of low birth weight babies this year.

This raises an important question - why is Dhaka so heavily impacted by both low birth weight and pneumonia cases? Could it be that the city's congestion, pollution, and high population density are key contributors to these issues? Daily life in Dhaka often involves spending long hours in traffic, surrounded by large vehicles that create a claustrophobic environment. Many residents, including myself, have experienced the difficulty of breathing in such conditions. While we frequently discuss Dhaka's poor air quality, we may not fully realise how suffocating it can become, making it hard to breathe!

Poor air quality in Dhaka significantly contributes to the prevalence of pneumonia, especially among children. The city's air is heavily polluted with particulate matter, carbon monoxide, and other harmful pollutants from vehicle emissions, industrial activities, and construction sites. Dhaka residents face constant dust problems because of these ongoing construction projects. Many of the vehicles add to the problem by releasing harmful fumes, especially during traffic jams. These pollutants irritate the respiratory system, making individuals more susceptible to respiratory infections like pneumonia. The situation worsens during the colder months when the air quality deteriorates further, leading to a surge in pneumonia cases. Continuous exposure to such polluted air compromises the immune system, making it harder for the body to fight off infections and increasing the risk of developing pneumonia.

Furthermore, poor air quality in Dhaka can significantly impact pregnancy outcomes, leading to an increased risk of low birth weight and premature births. The city's high levels of air pollution expose pregnant women to harmful toxins. Studies have shown that continuous exposure to polluted air during pregnancy can restrict fetal growth, resulting in babies being born with low birth weight. Addressing air pollution is crucial to improving maternal and infant health in Dhaka.

Cognizant of these facts, the Ministry of Environment, Forest and Climate Change (MoEFCC) and the Department of Environment (DoE), with contributions from the member ministries and agencies of the National Committee on Air Pollution Control (NCAPC) of Bangladesh, designed and developed The Bangladesh National Air Quality Management Plan (NAQMP) with the purpose of mapping a clear pathway and the actions required for Bangladesh to meet air quality standards. The action plan highlights the main contributors to air pollution in the Greater Dhaka Area. Households using biomass cooking stoves are the largest source, followed by power plants, brick kilns, and the open burning of municipal solid waste. Additionally, road dust and exhaust emissions from road transport, particularly from diesel vehicles, also play a significant role in polluting the air.

This action plan calls for urgent action to improve the air quality of Dhaka by strengthening environmental policies. It also outlines certain measures for managing air quality in Bangladesh, particularly Dhaka. For instance, offering incentives for households to use cleaner fuels and for industries to adopt cleaner technologies could reduce pollutants' contribution to the environment. A continuous emissions monitoring programme should be implemented to measure air pollutant emissions. The government should introduce additional financial measures targeting major sources of pollution. This includes implementing carbon and vehicle emission taxes, offering tax breaks for electric vehicles and green technology, providing tax credits to small businesses for improving indoor air quality, and repurposing harmful subsidies and emission charges. Preserving green spaces, planting more trees, and promoting rooftop gardening will enhance air quality.

Moreover, access to clean cooking should be promoted. The Lancet Regional Health - Southeast Asia recently published an article in 2024 on the effect of an improved cooking stove on the birth weight of neonates in Bangladesh. This study conducted by a team of researcher of icddr,b, presented a low-cost kitchen with sufficient ventilation and an improved cooking stove with specific components. Biomass fuels like wood, dung, leaves, jute sticks, and other materials are placed on a grate, ensuring complete combustion. The grate maintains an optimal distance of 10 inches to direct the flames towards the bottom of the cookware, allowing air to circulate and fully burn the fuels. A chimney attached to the stove directs polluted smoke out of the kitchen, reducing exposure to harmful air pollutants. The total cost for the model kitchen with the improved stove is approximately USD 100. The study showed a 37 per ent reduction in the risk of low birth weight by using this improved cooking stove. This model could be employed in the urban slum or peri-urban area within the greater Dhaka area.

To recapitulate, tackling Dhaka's air pollution crisis demands a comprehensive approach involving the government, private sector, and civil society. Public awareness campaigns are essential to educate citizens about air pollution and encourage their participation in initiatives like tree planting and waste management. Together, we can envision and create a cleaner, greener Dhaka, where every breath we take is fresh and revitalising. By uniting our efforts, we can gradually transform our city into a place of healthy living for ourselves and future generations.

Aniqa Tasnim Hossain is an Assistant Scientist and Ema Akter is a Research Investigator working at icddr,b. (aniqa.hossain@icddrb.org)

Dr. Md Toufiq Hassan Shawon is a Medical Officer at the Management Information System (MIS) of the Directorate of Health Services (DGHS) in Bangladesh.