ASSOCIATION OF ACUTE RESPIRATORY INFECTIONS AND INDOOR AIR
POLLUTION AMONG CHILDREN AGED 0-24 MONTHS, IN A SEMI-URBAN
AREA, ANKARA, TURKEY
Alev Yucel, MD1, Banu Cakir, MD2, Prof. Sabahat Tezcan, MD2
Altindag Health Center, Department of Public Health, Hacettepe University Medical
Acute respiratory infections (ARI) are the most common cause of childhood admissions to
health units in Turkey, and a leading cause of mortality among young children. Previous
research in Turkey indicates indoor air pollution and cigarette smoking as significant
predictors of ARI in young children.
Objective: The study aimed to examine the association between ARI and indoor air pollution,
cigarette smoking at home in particular, and some selected characteristics of the children,
parents, and housing.
Material and Method: A matched case-control study was conducted in Altindag Central
Health Center, Ankara, Turkey among children aged 0-24 months admitted to the health
center between December 2001 and January 2002. Altindag is a semi-urban area, where
families of basically low socio-economic status live. Fourty-two children with acute
respiratory tract infection (i.e., tonsillopharengitis, nasopharengitis, influenzal rhinitis,
rhinosinusitis, otitis media, bronchitis, pneumonia) and 42 sex- and age (0-12 months, 13-24
months)-matched controls were included in the study. Controls were selected from children
without cough, nasal discharge or any other symptoms suggestive of ARI.
Results: Presence of a family member with nasal discharge was significantly associated with
occurrence of ARI among children aged 0-24 months: the odds ratio was 2.82 (95% CI= 1.03-
7.84). The odds of ARI among children directly exposed to cigarette smoking at home was
3.28 times higher (95%CI= 1.22-8.95) than that for children who were not directly exposed to
cigarette smoking at home. Children who sleep in the living room had 4.11 times higher odds
of ARI (95% CI= 1.21-16.01) compared to that for children who had a private bedroom.
In the study group, ARI was not found to be statistically significantly (alpha= 0.05) associated
with some other characteristics of the child and family (birth weight, breastfeeding,
vaccination, sociodemographic characteristics of the parents, etc.), or of the house (type,
number of rooms, presence of a separate kitchen/windows, status of cigarette smoking at the
house/of the parents, type of heating and type of fuel used, etc.).
Conclusion: Cigarette smoking is very prevalent in Turkey, particularly among adult males,
and in more than 60% of the homes there is at least one individual who smokes cigarettes.
Being more prevalent in slum areas, coal and firewood are common means of heating. The
study implied that the direct exposure of the child to smoking, rather than the presence of
smoking at home, is a significant predictor of ARI among young children. Even when the
quality of indoor air could not be improved, parents should be educated of the importance of
avoiding children’s direct exposure to cigarette smoking and/or other indoor pollutants. The
cooperative efforts of the health personnel and media against indoor air pollution, cigarette
smoking in particular, will increase the awareness, and assist in the education of the public in