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CHERG - Child Epidemiology Reference Group
Child Mortality and Morbidity
Underlying causes of child death
Effect of co-morbidity on child mortality
Country-level causes of child mortality
Failures in the “pathways to survival”
Incidence and sequelae of child morbidity
Maternal Mortality and Morbidity
Causes of maternal mortality
Incidence and sequelae of maternal morbidity
Risk Factors
Indoor and outdoor air pollution
IUGR and preterm birth as risk factors for morbidity/mortality
Micronutrient deficiencies and nutritional status
Birth spacing as a risk factor of maternal and child mortality
Program-related Evidence
Intervention effectiveness to reduce maternal/child mortality
Measurement of intervention coverage
Enhance the LiST methodology


Indoor and outdoor air pollution

Indoor air pollution (IAP) from biomass and coal fuels affects one half of the world population, and about 80% in low-income countries of Africa and South Asia.  More than 900 million of the world’s estimated 1.1 billion smokers live in low and middle income countries.  Outdoor air pollution levels are highest in cities in developing countries, especially in Asia.  Environmental tobacco smoke (ETS; also known as secondhand smoke), indoor air pollution (IAP) from solid fuel use, and ambient air pollution, contain a large number of hazardous pollutants, with potential or documented effects on pregnancy/ birth outcomes and child morbidity and mortality, especially from respiratory infections.  Because of persistently-high or even increasing exposures, these risk factors may be responsible for a relatively large share of neonatal and child disease burden in developing countries.  This project will aim to provide definitive evidence on the effects of these risks on birth and child disease burden in the developing world through forming a small expert working group.

Methods and expected results

The steps for estimating the population level effects of these risk factors will include:

  • Quantify the distributions of risk factor by region
  • Quantify cause-specific mortality and incidence of outcomes by region
  • Quantify the relative risks (RRs) for effects of risk factors on disease-specific mortality
  • Calculate population-attributable fraction (PAF) and attributable deaths/disease burden using the above inputs

To complete the above steps, a major activity will be systematic review and meta-analysis of the epidemiologic studies, with emphasis on increasing the comparability of how exposures and outcomes are defined. After revisions based on peer review of the materials, estimates of the burden of disease for neonatal and child mortality and morbidity associated with these risk factors will be made and published for world sub-regions. These estimates will use the above inputs and the comparative risk assessment (CRA) analytical framework.

Related Publications

Association of Secondhand Smoke Exposure with Pediatric Invasive Bacterial Disease and Bacterial Carrieage: A Systematic Review and Meta-analysis. Lee, Chien-Chang, Nicole A. Middaugh, Stephen R.C. Howie, Majid Ezzati (2010). PLOS Medicine: 7(12) e1000374.

Exposure to particulate matter and adverse birth outcomes:  a comprehensive review and meta-analysis. Sapkota, Amir, Adam P. Chelikowsky, Keeve E. Nachman, Aaron J. Cohen, and Beate Ritz (2010). Air Qual Atmos Health. DOI: 10.1007/s11869-010-0106-3


Untitled Document

Examination of Child in Benin

PowerPoint Presentation
Global Child Mortality: Estimates of Levels and Causes for 2000-2010

New Publications 
Born Too Small: National and regional estimates of babies born small for gestational age. Healthy Newborn Network Blog on new article in Lancet Global Health

PLOS Med Collection: Measuring Coverage in Maternal, Newborn, and Child Health

LiST Tool
Download the the Lives Saved Tool

Lives Saved Tool in 2013: BMC Public Health Special Issue