According to a new report by World Health Organization (WHO), India had the highest number of air pollution-induced deaths of children below five years in 2016. India has reported at least 50 deaths for every 100,000 children due to respiratory infections.

The report, named ‘Air Pollution and Child Health’ studied the horrific impact of toxic air on the health of children in 194 countries. It was released in Geneva last week.

Nigeria with 98,001 deaths was at the top of the list of worst child mortality rate list followed by Pakistan (38,252), Democratic Republic of Congo (32,647) and Ethiopia (20,330). India came at number five after that. Death rates, or the ratio of deaths to population during a particular period, were higher in these four countries than that of India.

Of the countries surveyed, India recorded the highest premature deaths among children under five years due to outdoor air pollution in 2016 and the second highest number of deaths due to exposure from indoor air pollution — only after Nigeria.

98% of the children in India under the age of five are exposed to PM2.5 levels which means particulate matters that have a diameter of less than 2.5 micrometers. It has exceeded WHO’s annual standard of 25 micrograms per cubic metres. The fine particles can enter the bloodstream and severely affect the lungs.

Half of all deaths due to acute lower respiratory infections, which include pneumonia and influenza, in children below five years is caused by exposure to high air pollution levels in low- and middle-income countries, estimates WHO.

“This study provided some of the first quantitative estimates of the effects of exposure to PM2.5 in India to birth weight. It contributed evidence of this association that is relevant for high-exposure settings in LMICs that experience the dual health burdens of ambient air pollution and household air pollution,” it said.

The report quoted a case control study in India which showed a correlation between exposure to HAP from solid fuel combustion and the risk of contracting TB in children less than 5 years of age.

“The evidence suggests a positive association between exposure to air pollution and TB infection in children, although further research is needed,” the report said.