Children under 5 worst sufferers of respiratory diseases in capital, healthcare personnel admit

Even as the capital of India has recorded severely bad air quality since November 2, 2023, a tour of Delhi hospitals by Down To Earth (DTE) showed how the maximum impact of the smog was often felt by the youngest: children under five years of age.

“There is an exponential increase in paediatric cases (in Delhi and the National Capital Region), as seen among newborns and also children from other age groups up to 12 years since pre-October. The worst-affected are those in the age range of two to five years,” Sanjeev Bagai, paediatrician and paediatric nephrologist told DTE.

On the morning of November 3, Delhi’s air quality plummeted to “severe plus”, surpassing the 450-mark. The data was outlined in a policy document from the Commission for Air Quality Management.

On the same day, as recorded by the Central Pollution Control Board (CPCB), the Air Quality Index (AQI) reading at Mundka station was the worst at 498. November 4 saw slight improvement in Delhi’s AQI conditions — 413 at 6 a.m. on November 4, from 468 at 4 pm on November 3.

The impact was to be seen in the hospitals that DTE visited.

Staff at Kalawati Saran Children’s Hospital—a government-run hospital in Connaught Place (Rajiv Chowk) dedicated to children—made some alarming revelations.

“Since the last 2-3 months, at least 70-80 per cent of an entire hospital ward known as ‘Unit 3’ have been child patients diagnosed with diseases like bronchitis, bronchiolitis, tuberculosis, asthma, pneumonia or lung diseases,” the staff told DTE on the condition of anonymity.

The number of child patients have doubled with the onset of winters, according to the hospital staff.

“The hospital does see cases of child deaths as it lacks availability of oxygen ports, flow meters and even beds. Due to the lack of facilities, the concerned doctors are often compelled to admit children with severe respiratory diseases or are compelled to make 3-4 children share one hospital bed. Such children do suffer fatal consequences,” said another hospital staff concerned with the ward, who does not want to be named.

The parents of a 10-month-old admitted in Ward 3 Cubicle 1 at Kalawati shared their distress. Her father, Naresh Kumar works as a painter near his house in Sangam Vihar. He said:

Payal, our daughter, fell sick for the first time ever since her birth. She developed breathing problems 10 days ago and was admitted here four days ago. She is able to breathe with the help of oxygen support. The hospital staff are yet to tell us what disease it is. There is hardly any update on her health improvement, only hollow assurances.

Bharti, Payal’s mother, was inconsolable.

“There is almost a 100 per cent increase in respiratory illnesses among children since the said timescale this year. These include throat infection, ear infection, wheezing, bronchitis, laryngitis and pneumonia,” Bagai told DTE.

This is because during the morning hours, when the temperature and the smog situation is the worst, children are more predisposed to respiratory involvement due to their paediatric airways smaller and shorter in diameter and length against adults. Also, children’s reserved capacity of lung function is much lesser than adults,” Bagai added.

Prior data from CPCB had called Delhi “India’s most polluted city” in 2022, with its Particulate Matter (PM) 2.5 levels surpassing safe limits. The city also had the third-highest average PM10 concentration then.

“This air pollution not only involves PM2.5, it is also PM 5, PM 10, dust, allergens, toxic gases including NOx and other particulate matter. It is difficult for children to wear a mask, especially during school hours. Hence, their exposure to air pollution is very high,” explained Bagai.    

A young doctor at Kalawati named Saumya seconded that most of the child patients admitted with respiratory issues were aged between 2 and 5 years.

During a visit to AIIMS, New Delhi, this reporter witnessed a greater patient influx in the OPD dedicated to paediatric cases than in the one under the pulmonology department.

“The proportion of children with respiratory problems has increased, especially over the past 3-4 weeks. Those who already have respiratory problems (asthma, bronchiectasis, cystic fibrosis, etc) have developed worsening of symptoms despite taking their regular treatment,” SK Kabra, head of department of the AIIMS Paediatric Department told DTE a day later on November 4.

DTE also met Raj Kumar, director of Vallabhai Patel Chest Hospital, who said: “The condition of individuals suffering from respiratory problems aggravates during the period every year.” The hospital is located in Delhi University’s North Campus.

CPCB’s AQI has several categories. An AQI of 1-50 is ‘good’, 51-100 is ‘satisfactory’, 101-200 is ‘moderate’, 201-300 is ‘poor’, 301-400 is ‘very poor’ and 401-500 is ‘severe’ category. An air quality of more than 501 is in an ‘emergency’ zone.

Each of these categories are decided based on ambient concentration values of air pollutants and their likely health impacts (known as health breakpoints), according to System of Air Quality and Weather Forecasting and Research (SAFAR). The latter is a national initiative introduced by the Union Ministry of Earth Sciences to measure the air quality of a metropolitan city.

“There is need to have long-term and short-term plans covering the whole year, since air pollution is not a seasonal issue in Delhi. One-time measures cannot tackle the situation. At individual level, measures like use of gas for cooking food, avoiding the use of kerosene, biofuel, avoidance of the use of disease generators, etc is necessary,” Kabra said.

“Also, try to reduce the use of vehicles and encourage carpooling. At the level of the government, a comprehensive plan to reduce air pollution due to vehicles, industry, construction work, etc in accordance with existing laws should be considered,” he added.