Dissertation Proposal: Preventing and Managing Childhood Respiratory Diseases

Effective Intervention in Preventing and Managing Childhood Respiratory Diseases Due to Air Pollution and its Effects on Children Aged 0-15 years in Nigeria, India, and the USA.

Introduction

Research Background

Globalisation and deforestation are becoming the chief sources of air pollution in underdeveloped, developing and developed countries. Air pollution is the leading problem for low-income, middle-income, and high-income high-income countries simultaneously. Using biomass and solid fuels indoors for cooking and cleaning purposes contributes to air pollution.

It is linked to the increase in respiratory diseases that are also considered the leading cause of death in the world (Boogaard et al., 2019). Respiratory illness and diseases in children are becoming common due to increasing indoor and outdoor exposure to air pollutants and particles. By the name of respiratory diseases in children, pneumonia and asthma come to mind.

Still, there can be many other complexities and endpoints to the impacts of air pollution in children in low income, middle income and high-income countries. The indoor air pollution in which biomass, soli fuels, tobacco smoking are prominent can develop acute otitis media in the children of the house (Mustapha et al., 2011).

Prolonged exposure to indoor moulds can result in acute pulmonary haemorrhage. Outdoor air pollution and long term exposure to ozone can develop bronchospasm and asthma in many children. Increased exposure to air particles and pollutants and indirect smoking is why many sudden infant deaths syndrome (SIDS).

It is estimated by world health organisations (WHO) that 11 million children die annually before the age of 5. Out of these 11 million deaths, many are preventable. Environmental health problems contribute to the burden of diseases for all types of countries. DALY means “inability changed life years” and is a typical estimation unit for grimness and mortality.

DALYs mirror the aggregate sum of healthy life lost to all causes, regardless of whether from untimely mortality or from some level of incapacity during a timeframe (Balakrishnan et al., 2014). The engaging quality of this estimation lies in how it joins data about dreariness and mortality in a solitary number.

DALYs permit the misfortunes of inability and the misfortunes of sudden passing to be communicated in a similar unit. As per the World Health Report (2002), the greatest supporter of chronic weakness in the world’s children is underweight. The second most significant benefactor is hazardous to water, disinfection, and cleanliness. The third most significant donor is indoor smoke from strong powers (Childhood respiratory diseases linked to the environment, n.d.).

As may be obvious, in 2002, encompassing (open-air) air pollution contributed undeniably less to chronic frailty in little youngsters. It is not necessarily the case that it isn’t significant. Yet, its impact on little youngsters’ health is nearly not exactly that of indoor air pollution since small kids invest the greater part of their energy inside, where levels of air pollution can be a lot higher than those outside.

Children living in emerging nations experience a twofold or even triple weight of illness. This alludes to the openings, grimness and mortality from sicknesses related to low degrees of advancement like ARI and the runs, just as more current dangers related with industrialisation like asthma and sensitivities.

At the point when children have two children of openings and are poor and malnourished, it addresses a triple weight. These ideas are significant for understanding the setting of respiratory ailments related to pollution. Note that respiratory illnesses lead the rundown in both arising and constant issues.

Children might be more helpless against the impacts of air pollution than adults. Children’s lung advancement isn’t finished upon entering the world. Lung advancement continues through the multiplication of pneumonic alveoli and vessels until the age of 2 years (Childhood respiratory diseases linked to the environment, n.d.).

From that point, the lungs develop through alveolar extension until 5-8 years old. Lungs don’t finish their development until the full grown-up height is accomplished in pre-adulthood. The infants’ metabolic rate and oxygen consumption are much higher than the adults because infants have a higher surface area as per unit body weights and because the development rate in infants is higher than that of adults.

Due to the described reason, the oxygen consumption of the children is much higher than the adults, which impose a greater risk of respiratory diseases because of inhalation of pollutants (Smith, 2000). Children also have less immunity than adults, making them more prone to respiratory infections and diseases.

Another reason for the increased possibility of infection due to air pollution in children as compared to adults is the size of the air passageway. The adults have greater space in their airways as compared to children. Therefore, invasion of pollutants in adults will only cause slight irritation, but the same amount of pollutants can cause serious infection and blockage of airways in children.

Air pollution is regarded as the topmost concern of the regarded authorities in low-income and high-income countries (Nkwocha and Egejuru, 2008); it contributes heavily to the burden of diseases and affects the children of the countries. In developed countries like the USA, air pollution is caused by severe globalisation and urban development.

The intense industrialisation has increased the energy consumption of developing and developed countries. The development also calls for deforestation and conduction, contributing to air pollution. Air pollution not only influences the respiratory organs, but it has a severe impact on many other organ systems in the body.

For example, air pollution can lead to cardio cerebral vascular diseases ischemia heart disease. It can impact the nervous system, urinary system, digestive system, etc. long term exposure to air pollutants is observed to be the exhibiting factor for many dangerous diseases.

It is a severe problem for every world country; it is estimated that among the ratio of child deaths, 20% (approximately 1.9 million deaths) is attributed to respiratory diseases like pneumonia in the most developed countries of the world (Bennett et al. 2019). World health organisation (WHO) is working effortlessly to implement the interventions to reduce air pollution and respiratory diseases among children.

Research Problem Statement

Air pollution and pulmonary diseases are linked together and are studied by various researchers. Air pollution causes respiratory diseases, which contributes to a noticeable portion of child deaths annually. Chronic respiratory diseases and cardiovascular diseases contribute to the burden of diseases, and the countries of all worlds are fighting to reduce such diseases.

A country like Nigeria requires proper awareness programs and support from the world health organisation to eliminate diseases and air pollution. A similar situation is observed in the middle- and high-income countries like India and the USA. Globalisation and industrialisation are increasing air pollution.

Such measures need to be adopted that does not hinder the rapid urbanisation and also eliminate air pollutants. The research study aims to analyse the previous literature to study the current conditions and effective intervention of preventing children respiratory diseases in Nigeria, India and the USA. This study is a comparative analysis that analyses the literature relevant to the three selected countries and compares the efforts and outcomes.

Aim of the Research

The systematic narrative review aims “to study the effective intervention in preventing the childhood respiratory diseases due to air pollution in Nigeria, India, and the USA”.

Objectives of the Research

The objective of the current research study is

• to study the current situation of air population and its impact on the health of children in Nigeria, India and the USA
• To critically analyse the impact of respiratory diseases on children in three selected countries.
• To highlight the difference of situation, applied interventions and outcomes in Nigeria, India and USA.

Research Question

What is the current situation of air pollution and its impact on childhood respiratory disease? And what is the difference or similarity in the interventions and effort of the three different income based selected countries?

Rationale or Significance of the Research

The current research study is very effective and significant for the literature sphere. The analysis in the study can highlight the most effective and non-effective interventions. It will also highlight the strategies of effort that need to be adopted by different countries to eliminate air pollution.

The current study is a comparative systematic narrative review that analyses the current situation of three countries: Nigeria, India, and the USA. The study can help identify inaccuracies of each country they are making in dealing with air pollution. It will also highlight the wrong activities that increase air pollution and indicate what should be done alternatively to reduce air pollution.

The study will be very effective for the practical world. It can help countries study the sources and effects of air pollution and its impact on childhood respiratory diseases. As for the researchers,’ the research study can become the foundation for future research.

By acknowledging the aim of the research study, the research can aid in the gathering of global health implications that need to be practised and implemented. The published literature recommends more contribution to the local and national policy and awareness efforts from the private and public sectors.

Ethical and GDPR Considerations

The current research study is a systematic narrative review that is always based on secondary data; therefore, the research implies the ethical consideration relevant to the secondary data. The researchers carefully understand the ethical consideration of the study to maintain the integrity and validity of the research.

Moreover, the “European Union general data protection and regulation” (EU GDPR) and “United Kingdom (UK) data protection act (2018)” includes the “processing, storage protection and destruction of personal data” within the premises of the United Kingdom.

United Kingdom has passed their own data protection regulation followed by EU GDPR in January 2021. As for the current research study, the systematic narrative review does not imply any GDPR consideration because the systematic narrative review uses the data and information that have already been published and verified in the past.

Methodology

The methodology of the current research study is very different from the standard methodologies. The methodology of the systematic narrative review follows tentative 7 steps; these 7 steps comprehensively highlight the selected methods of the research and the theoretical too used for shaping the methodology.

Step 1: Research Question

The utilisation of the PICO framework frames the research question of the systematic narrative review. The critical analysis of the literature sources will be done using the PICO framework’s four interventions: a patient problem, intervention, comparison, and outcomes. The study’s research question proposes to comprehend the effective intervention of preventing childhood respiratory diseases in Nigeria, India, and the USA.

Nigeria is selected as a low-income country, India is selected as the middle income or developing country. In contrast, the USA is selected as a high-income country, but it is highlighted throughout the research that all income-based countries are battling with air pollution and its effects. In the current globalising times, the study is very much needed.

Step 2: Identify Eligibility Criteria

Inclusion Criteria

Electronic searching was done after completing the research question to select literature sources. The literature sources are searched in accordance with the research question and research objectives. The journals, articles, dissertations and published collections were searched in different databases, including Google scholar, Wiley online library, Eleveiser, Science direct, Researchgate and PubPsych.

All the sources related to air pollution and its impact on children, respiratory diseases in children and effective intervention to prevent the respiratory diseases in children were short listed. The journal articles were selected that analysed and investigated the situation of air pollution and respiratory diseases in countries like Nigeria, India and the USA.

Exclusion Criteria

The search was limited to India, Nigeria, and the United States. All other articles that were associated with any other countries were excluded. Additionally, all the articles that do not relate to respiratory diseases or extend to other types of diseases were also excluded from the search list.

Most importantly, the researchers have selected the articles that were published after 2000. The research sample dated more than 20 years was disregarded because of the time difference and technological advancement. The older times are known to be having less air pollution than today because of increased development and industrialisation.

Step 3: Develop your search strategy/ Identify studies

Boolean operators were used to developing the proposed narrative systematic review research question. Different searching terms were used for achieving better results and shortlisting the most relatable or appropriate articles. The following search terms were used in search of literature sources.

• “respiratory diseases intervention”
• “air pollution impacts”
• “sources of air pollution”
• “Childhood respiratory diseases”
• “Effective health implications”
• “Nigeria OR India OR United States”

Step 4: Data Extraction

Data extraction tools and the data collection forms will be sued the future researchers to collect and shortlist the preferred articles or sources. A “systematic review data repository” tool will also be used to collect and summarise the characteristic of the articles.

Step 5: Quality Assessment

Different layers have been prepared for the quality assessment of the selected articles. Initially, the researchers will shortlist the republished articles that are valid. All required and important information about the author of the research articles and the source of the article will be gathered to assess the validity of the literature source.

Secondly, the literature will be critically appraised by using the CASP tool (“Critical appraisal skills program”). The CASP tool verifies the validity of the research study. It analysed the validity in three questions: who has written the articles, what the results are, and how they will help in the current research study.

The CASP tool is effective and usable in all types of methods, including qualitative, mixed methods, and systematic literature sources. The tool is used to judge the effectiveness of the results of the research articles and their methodology; it also highlights the bias in the result of the study and indicates the importance of the study.

Some studies also follow the cross-sectional research designs in the shortlisted articles. Such articles will be assessed by using the STROBE (“Strengthening the reporting of observational studies in Epidemiology”) checklist.

Step 6: Data Analysis

The selected literature is analysed through the analysis of different themes. The literature review of the articles is pre-divided into four themes, making it easy for the researchers to identify the outcomes and list down the findings of the studies. The division of analysis in different themes enables the researchers to compare the three counties with each other. The researchers have studied the social constructivism theory to study and interpret the research findings.

Step 7: Interpretation of Findings

The preliminary literature sources suggest the health implications and interventions for eliminating and reducing air pollution and childhood repository diseases. The literature sources distinctively highlight the current situation and prevalence of air pollution, its impact, and its sources in the three different countries are Nigeria, India and the United States.

The literature sources’ findings also enhance the interventions and efforts of private and public healthcare organisations. It also indicates the sources of air pollution in indoor and outdoor settings. The knowledge was gathered from the preliminary sources.

Review of Literature Selected

Identifying social determinants of air pollution, the prevalence of childhood respiratory diseases, the effects of these diseases, and the effective interventions were pre-defined themes for the literature analysis. These defined themes effectively gather the information according to the research question. The literature review includes the systematic analysis of the methodology of the selected articles.

Possible Theme 1: Social Determinants of Air Pollution

For analysis of the social determinants of air pollution and its impact on childhood respiratory diseases in Nigeria, several articles are shortlisted that gather efficient information about air pollution and its impact in Nigeria (Mustapha et al. 2011; Komolafe et al. 2014; Yusuf et al. 2013; Guttikunda et al. 2014; Siddique et al. 2011; Parker et al. 2019).

Mustapha et al. (2011) have conducted cross sectional research with 1397 school going children. The study utilised the principal component analysis and highlighted air pollution’s impact on school-going children in Nigeria. The study highlighted the effects of indoor and outdoor pollution. Similarly, the same type of studies was also gathered for India and the United States.

REPO (2018) studied the air pollution prevalence in India and its impact on the burden of diseases. Balakrishnan et al. (2019) studied the air pollutant concentrations and highlighted the effects of exposure to air pollution, including the ambient particulate matter in India.

The study results highlighted that “mean exposure to ambient particulate matter PM_2·5 in India was 89·9 μg/m^3”. A similar type of research was also conducted in the United States to study and investigate the ambient particulate matter (PM) in the air and its impacts on children’s health (Bennett et al., 2019).

Possible Theme 2: Prevalence of Childhood Respiratory Disease

The studies about the prevalence of childhood pulmonary ailments highlighted that air pollution in all types of countries has very drastic impacts. Respiratory diseases in children are affecting the countries in non-reversible ways (Salvi, 2007).

The research articles shortlisted for this theme indicated that in Nigeria, India, and the USA, air pollution had caused severe losses, and respiratory diseases are counted as a burden that has increased the child morbidity and mortality rates in these countries. Ana et al. 2009 conducted a cross-sectional survey research among 8 secondary schools to study the prevalence of respiratory diseases in children.

Similarly, Ibrahim et al. (2021) evaluated the prevalence of respiratory diseases in low-income and middle-income countries. His study was a systematic literature review which was accumulated after the review of 41 research studies. Gouveia et al. (2018) studied children respiratory mortality in the United States.

His research study indicated that the united states had lost over 43 million people due to respiratory issues, and the air pollution levels were investigated to be very high from the world health organisation (WHO) stated guidelines (Pawankar et al. 2008).

Possible Theme 3: Effects of Respiratory Diseases on Children

The high prevalence of respiratory diseases in Nigeria, India and the United States has led to economic and social problems. The allocation of budget for the health care sector shifts drastically due to changes in the burden of diseases and their treatments.

Many literature sources have been shortlisted to gather information about the impacts of prevailing respiratory diseases among children in selected countries. Baiardini et al. (2006) studied the impact of prevailing respiratory diseases on the quality of life of people. Adetiloye and Erhabor (2013) analysed the impact of diseases on the quality of life of people in Nigeria through a systematic literature review.

Similarly, the further study investigated the impact in India and the United States, whose analysis will be provided comprehensively in the research study (Moudgil et al. 2000; Schoenwetter et al. 2004; Henley, K., 2008; Yorgancioglu et al. 2014).

Possible Theme 4: Effective Interventions in Preventing the Childhood Respiratory Diseases

The effective interventions and health implications for preventing childhood respiratory diseases are effectively analysed by the “World Health Organisation” (WHO) (“World Health Organization”, 2003). Many studies are shortlisted that provide interventions that can eliminate or reduce air pollution in underdeveloped or developed countries (Karim et al. 2017; Aït-Khaled et al. 2001; Bousquet et al. 2010; Ahmed et al. 2016; Bousquet et al. 2003).

Reflexivity: Personal Reflection

To indicate the personal reflection in academic work, it is very important to highlight the Personal and professional background because it has a huge impact on the review. (ADD STUDENT INFORMATION 2 LINES).

In my personal opinion, all industrialists and healthcare professionals should understand their duties. They need to understand that their contribution means a lot to the entire country. The completion of this proposal has broadened my perspective and knowledge about air pollution and respiratory diseases in children.

I have come to learn that air pollution has a drastic impact on the children of the society, and children are the future of the countries. The current research proposal proposes to compare the three different income-based countries; the underdeveloped countries need to focus on air pollution and its sources to eliminate the risk of increasing the burden of diseases.

The risk to the lives of children in underdeveloped countries imposes a risk to their sustainability and progress. As for the highly developed countries like the United States, the leading industrialist must optimise and evaluate their ways, which contribute to the country’s air pollution as the increased burden of diseases can have a negative impact on the economy and health progress of the country.

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