AUTHOR=Balasubramani Karuppusamy , Prasad Kumar Arun , Kodali Naveen Kumar , Abdul Rasheed Nishadh Kalladath , Chellappan Savitha , Sarma Devojit Kumar , Kumar Manoj , Dixit Rashi , James Meenu Mariya , Behera Sujit Kumar , Shekhar Sulochana , Balabaskaran Nina Praveen 

TITLE=Spatial epidemiology of acute respiratory infections in children under 5 years and associated risk factors in India: District-level analysis of health, household, and environmental datasets

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.906248

DOI=10.3389/fpubh.2022.906248

ISSN=2296-2565

ABSTRACT=Background:
In India, Acute Respiratory Infections (ARI) are a leading cause of mortality in children under five. Mapping the hotspots of ARI and its associated risk factors can help understand their association at the district level across India. 
Methods:
Data on ARI in children under five and household variables (unclean fuel, improved sanitation, mean maternal BMI, mean household size, mean number of children, median months of breastfeeding the children, percentage of poor households, diarrhoea in children, low birth weight %, tobacco use, and immunization status of children) were obtained from the National Family Health Survey-4. Surface and ground-monitored PM2.5 and PM10 datasets were collected from the Global Estimates and National Ambient Air Quality Monitoring Programme. Population density and illiteracy data were extracted from the Census of India. Geographic Information System was used for mapping, and ARI hotspots were identified using the Getis-OrdGi* spatial statistic. The quasi-Poisson regression model was used to estimate the association between ARI and household, children, maternal, environmental, and demographic factors.
Results:
ARI hotspots were predominantly seen in the North-Indian states/UTs of Uttar Pradesh, Bihar, Delhi, Haryana, Punjab, and Chandigarh, and also in the border districts of Uttarakhand, Himachal Pradesh, and Jammu and Kashmir. There is a substantial overlap between PM2.5, PM10, population density, tobacco smoking, and unclean fuel use with hotspots of ARI. The quasi-Poisson regression analysis shows PM2.5,  illiteracy levels, diarrhoea in children, and maternal body mass index to be associated with ARI. 
Conclusions:
To decrease ARI in children, urgent interventions are required to reduce the levels of PM2.5 and PM10 (the major environmental pollutants) in the hotspot districts. Furthermore, improving sanitation, literacy levels, using clean cooking fuel, and curbing indoor smoking may minimize the risk of ARI in children.