Epidemiological burden and trends of neonatal and under-five mortality from lower respiratory infections associated with PM2.5 pollutions in India: A systematic analysis of the Global Burden of Disease Study (1990-2021)

Background Lower respiratory infections (LRIs) caused by PM _2.5 pollution are a major factor in neonatal and under-five mortality across India. Therefore, this study explores the linkage between PM _2.5 pollution on neonatal and under-five mortality from LRIs. Materials and Methods This study utilized ambient PM _2.5 geographic mean estimates from Washington University and a household air pollution dataset from the fifth round of the National Family Health Survey (NFHS-5). Furthermore, child mortality data were extracted from the Global Burden of Disease 2021 to assess the impact of PM _2.5 on child mortality attributable from LRIs in India. The study employed 'Getis-Ord-Gi*' statistics in ArcMap 10.4 to identify PM _2.5 hotspots and cold spots. Temporal trends for neonatal and under-five mortality were analyzed using joinpoint regression analysis, and risk factors of LRIs were visualized through a heat map using MS Excel. Results From 1990 to 2021, the neonatal mortality rate (NMR) per 100,000 live births declined significantly by 66%, from 6,989.96 in 1990 to 2,377.36 in 2021. Similarly, the under-five mortality rate (U5MR) per 100,000 live births declined by 74%, from 358.52 to 94.15 per 100,000 live births. Additionally, from 2019 to 2021, a notable decline in mortality was observed for both sexes (NMR: -11.56%; U5MR: -16.21%). However, states such as Rajasthan, Haryana, Uttar Pradesh, and Bihar had notably experienced elevated PM _2.5 concentrations, which were likely contributing factors to the higher burden of neonatal and under-five mortality. Additionally, HAP was a major contributor to PM _2.5 concentrations in the Indo-Gangetic Plain region (IGP), largely due to the limited usage of clean fuels. Conclusion The study revealed that elevated PM _2.5 concentrations are likely linked to contributing factors for higher child mortality, particularly in the IGP region. To address this issue, the study suggests increasing public awareness and implementing targeted policies to reduce neonatal and under-five mortality across India.