Nitrogen dioxide and acute respiratory tract infections in children in Indonesia

Abstract

We evaluated associations between air pollution (nitrogen dioxide [NO₂] and sulfur dioxide [SO₂]) and health in children aged 0–3 years in Indonesia. We included 4931 Indonesian children born between 2009 and 2011. We assigned participants provincial-levels of NO₂ and SO₂ and examined associations with low birth weight, infant death, neonatal death, and acute respiratory infection (ARI). We estimated odds ratios (OR) and 95% confidence intervals (CI) using a generalized estimating equations logistic regression model. NO₂ exposure increased the risk for ARI. An interquartile range increase in mean NO₂ exposure increased the risk for ARI by 18% (OR 1.18, 95% CI: 1.08–1.28), and was supported by quartile exposure category. SO₂ was not associated with the examined child health outcomes. NO₂ exposure increased the risk for respiratory infections in early childhood in Indonesia.

Abbreviations
ARI	=	acute respiratory infection
CI	=	confidence interval
GDRB	=	Gross Domestic Regional Bruto
GEE	=	generalized estimating equations
IDHS	=	Indonesian Demographic Health Survey
IQR	=	interquartile range
LBW	=	low birth weight
NO2	=	nitrogen dioxide
OR	=	odds ratio
SO2	=	sulfur dioxide

Keywords:

• Acute respiratory infection
• infant death
• low birth weight (LBW)
• neonatal death
• nitrogen dioxide
• sulfur dioxide

Conflict of interests

None declared.

Acknowledgements

We appreciate the valuable support from Saori Irie. We also thank Audrey Holmes, MA, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

Additional information

Funding

We would like to acknowledge The Indonesia Endowment Fund for Education-The Ministry of Research, Technology and Higher Education for their valuable support. This study was partly supported by a Grant-in-Aid for Scientific Research (C), No 17K0908509, from the Japanese Ministry of Education, Culture, Sports, Science and Technology. The sponsor was not involved in the study design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit the paper for publication.