31 July 2018

Public health expert: Air pollution is highly increasing risk of respiratory infections in Mongolian children

Public health expert Misbath Daouda working on her research in Ulaanbaatar.
©UNICEFMongolia/2018/Sabina Netrvalova

Air pollution is a serious problem in the Mongolian capital, says researcher Misbath Daouda, who came to Ulaanbaatar to find out how air pollution is affecting children’s health. In the interview, she also talks about the impacts of polluted air on infants’ brains, and gives recommendations on how parents should protect their children.  

What brought you to Mongolia?
I am completing the practicum part of my Master's in Public Health programme at Harvard University and for this I am doing an internship with UNICEF Mongolia. I am focusing on the impact of air pollution on children’s health and my goal is to collect the data, analyze it and interpret it so as to have the first comprehensive study of how air pollution has been potentially increasing the risk of respiratory illnesses in children. 

Why did you choose Mongolia?
I chose Mongolia because Ulaanbaatar is the second most polluted city in the world, and UNICEF had already started engaging and combating the effects of air pollution through various avenues. I felt that this study could provide evidence-based recommendations that could fit well into what UNICEF was already doing. Plus, the recent findings that we have about air pollution and health outcomes made the need for solutions even more urgent, I wanted to contribute to this effort.

Could you specify these findings? How is air pollution affecting children’s health?
Air pollution has been consistently associated with adverse respiratory and cardiovascular outcomes. More recently, other health impacts have been identified. For instance, there is a component of air pollution called particulate matter, or PM, that is small enough to not only enter the bloodstream but also to cross the blood-brain barrier. When it does so, it can affect neurodevelopmental outcomes. Some of the recent studies show that children, who have lived in environment where air pollution levels are really high, have for example reduced IQ or reduced language abilities.

"Some children, who have lived in environment where air pollution levels are really high, have reduced IQ or reduced language abilities."

During winter, Ulaanbaatar is one the most polluted cities in the world.
©UNICEFMongolia/2018/TamirBayarsaikhan

Can you tell us more about your research? When did you come to Mongolia for the first time?
I first came here in January for two weeks and the goal of that visit was to reach out to different academic and governmental institutions that have been monitoring the data I needed. I mostly worked with the Ulaanbaatar Health Department (UBDH) to collect both respiratory and birth outcomes over the past couple years. I was also able to connect with the Ulaanbaatar Air Pollution Reduction Department (APRD) which has different monitoring stations in Ulaanbaatar and has been recording the levels of the most common air pollutants on a daily, and sometimes also hourly basis. Then I visited a couple of the district hospitals to collect some additional data.
  
Could you share some of your discoveries?
The analysis is still in its preliminary stages. However, when looking at PM 2.5 trends in 2015-2017 for instance, we can see that the city levels exceeds the World Health Organization (WHO) annual guideline more than 90 percent of the year. This has alarming implications for children’s health. We estimated the risk ratio for acute lower respiratory infections (ALRI) among infants to be approximately 2.4 in wintertime in Ulaanbaatar compared to a counterfactual scenario where the PM 2.5 levels would be close to the annual WHO guideline. This is very high because it means that infants in Ulaanbaatar have more than twice the risk of getting an ALRI compared to infants in that scenario.

When you came to Ulaanbaatar in January, did the level of air pollution surprise you?
I had a pretty good idea of how bad it is and the data I gathered reflects it. I knew that the levels were usually much higher than what WHO recommends. However, it is one thing to read about it in articles and another to experience how difficult it is to simply breathe in these conditions.

Misbath and her colleague Jargalsaikhan sharing their findings with community health workers in Bayanzurkh district, Ulaanbaatar. ©UNICEFMongolia/2018/Sabina Netrvalova 

What would you like to achieve with your study?
The most important goal for me is the translation of the data into something that is tangible not only for health workers but also to laypersons, so they know what the air pollution level here is compared to other places, and how much it increases the risk of contracting any respiratory diseases. With the study, I’m also hoping to build up momentum to convince the key stakeholders that something has to be done immediately. Now that we have the data, we can quantify how bad air pollution is in Mongolia and how it is affecting Mongolian children. It will take a long time to implement measures such as coal stoves replacement so we have to minimize the pollution exposure in the meantime. I think that the study can contribute to that.
So far, I was only able to share my recommendations with the community health workers in Bayanzurkh district, and I would like to see them disseminated to all districts. I would like a module of air pollution prevention to be integrated into the training of community health workers and medical doctors. Air pollution seems to be a relatively new issue in Ulaanbaatar so it would be good to have it integrated in the future curriculum for medical doctors. I feel like once the health implications are taken up by doctors, then we will probably have larger scale change in the perception of air pollution because doctors are such respected and trusted members of the society.  

Can you mention some of your recommendations?
The recommendations focus on what parents can do to minimize their child’s exposure to air pollution. They are mostly based on the BreatheLife campaign (a global campaign led by WHO, UN Environment and the Climate & Clean Air Coalition mobilizing cities and people to bring air pollution to safe levels by 2030), and attempt to create lasting behavioral change among families. For instance, they include checking the city’s air quality website (ub-air.info) frequently and changing plans accordingly to avoid spending too much time outside or exercising when levels are unhealthy. 
Another recommendation is to avoid exposure to diesel exhaust from cars by staying away from high traffic roads. Especially when pushing a baby in a stroller, it is recommended to walk on the building side of a pavement versus the roadside. Also, as Mongolians spend a lot of time indoors during wintertime, it is crucial that families get the cleanest burning stoves available to preserve indoor air quality.


"My recommendation is to check city’s air quality website frequently and change plans accordingly to avoid spending too much time outside when levels are unhealthy." 

What challenges did you encounter while doing your research?
One of the challenges was definitely understanding the data itself because of the lack of consistency and rigor in the way it was monitored. Sometimes the data were not computerized so it was difficult for me to access them, other times I realized that the data was missing completely or that there were errors in the records. Also, some of the monitoring stations were not working for extended periods so that restricted the analysis to the stations that did not have as much missing values.

What about some positive surprises?
In the data itself, I wouldn’t say there were any positive surprises. However, what was very enriching and motivating for me was giving the training to the community health workers on air pollution. I think this is where the data can have the most impact; if it is shown to the health workers who can realize how detrimental of an issue air pollution is and share it with parents. When I was leading the training, all the community health workers were interested, engaging with the topic and brainstorming potential solutions. This definitely was very motivating for me.

Misbath Daouda working with Jargalsaikhan Galsuren from Mongolian National University of Medical Science.
©UNICEFMongolia/2018/Sabina Netrvalova

You have been working with local researchers and organizations. How was this experience?
I think one of the most amazing aspects of my project is how much support I got from everyone at UNICEF Mongolia. They were not only helping me to acquire the data but also providing guidance, recommendations and suggestions. I never felt like any idea I brought to the table was pushed to the side and that has been amazing. I was also able to work with Jargalsaikhan Galsuren from Mongolian National University of Medical Science, who was initially only supposed to do the translation when I was meeting with different stakeholders, but eventually really contributed to the study. The questions I had while interpreting the data were mostly answered by him, he gave a lot of insight and helped shape the analysis. I was able to learn a lot thanks to working with UNICEF and Jargalsaikhan. 


Misbath Daouda is a Master of Public Health candidate at Harvard University, and is focusing on environmental health studies. She will be graduating in December and her goal is to continue with the PhD in children’s environmental health in the context of climate change. She is interested in developing countries or low-resource communities and wants to understand how environmental factors prevent children from these communities to reach their full potential.


Written by 
Sabina Netrvalov√°
UNV in Communications
UNICEF Mongolia

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