PUBLIC HEALTH Are we slowly killing our children? Nine out of 10 children are exposed to second-hand smoke in Bangladesh

The percentage of global smokers has dropped in the past 25 years, but in countries like Bangladesh, where as many as 40 percent of people smoke on a daily basis, the figure has remained constant from 1990 to 2015. Similarly, though worldwide 40 percent of children are exposed to second-hand smoking (SHS), in Bangladesh—a country with laws against smoking in public places—as many as 95 percent of children are affected, which is more than double the global ratio.

This shocking data came out in December last year, after the saliva samples of 479 students of class five (aged 11 to 13), recruited from 12 primary schools of Mirpur and Savar area of Dhaka, were tested. Of the participants, 453 were being exposed to high levels of nicotine (above the threshold level), 198 were living with a smoker and 419 were reported as having been recently exposed to SHS in public spaces. It was the first ever survey on biochemically validated second-hand smoke exposure among children in a low and middle-income country. The results were published in the journal Nicotine and Tobacco Research.

The survey titled “Second-hand Smoke Exposure in Primary School Children: A Survey in Dhaka, Bangladesh” was jointly conducted by the Department of Health Sciences, University of York, University of Edinburgh and Leeds City Council, UK, in collaboration with the Department of Economics, University of Dhaka.

Dr Rumana Haque, Bangladesh’s principle investigator of the survey and an Economics professor at the University of Dhaka, informs us that in 2013-2014, they had conducted a self reported SHS exposure survey among different communities. “We found that it was tough to get the actual scenario based on the answers they provided, as children are not always able to give the correct information. As such, experts recommended that we test the nicotine exposure of children through biomarkers such as, hair, urine or saliva. Between 2015 to 2016, we collected saliva samples in different phases through sterilised kits and sent those to the ABS Labs, UK for the cotinine test. This time, we are confident about the validity of the survey,” she says.

Alarming still is that the survey found symptoms of respiratory diseases among the children exposed to SHS. Rumana informs us that they are currently working on a report highlighting the trend.

According to the World Health Organisation (WHO), every year, more than 6,00,000 people die from SHS exposure; 1,65,000 of them are children. Most of these child deaths occur from respiratory infections during the first few years of their lives.

Since the ventilation rates of infants and children are higher than that of adults, they are more susceptible to the harmful effects of SHS exposure. Child Specialist Professor Dr Syed Khairul Amin, who is also the former Academic Director of Bangladesh Institute of Child Health, Dhaka Shishu Hospital, states that the number of paediatric respiratory patients has been increasing over the years.

“The newborns face breathing difficulties due to SHS exposure. When they grow up, SHS causes bronchiolitis and asthma attacks. On the other hand, if a pregnant mother smokes on a regular basis, her developing foetus can be greatly affected by this. It increases the risk of miscarriage, stillbirth, preterm birth, birth deformities and childhood cancer,” he says.

A 2010 report published by the WHO also shows that maternal smoking and prenatal exposure affects the pulmonary growth, birth weight and head circumference of a child.

Despite the statistics, there seems to be no effort on the part of the government to counter the adverse effects of smoking in public places—there is no implementation of the existing ban. The public, too, remains unaware, and for the most part, unconcerned about the dangerous long-term impact of SHS. As policy analyst and advocate Syed Mahbubul Alam Tahin, who is also the Technical Advisor of the International Union against Tuberculosis and Lung Disease, argues, “Our smokers are free to smoke at their sweet will, wherever they choose. The situation is even worse outside Dhaka, where, in most cases, people don’t hesitate to smoke in front of children, both inside and outside the home, and no one seems to care about the harmful effects or the law.”

Dr Rumana Haque states that they have developed a school-based intervention whereby the teachers sensitise students, and the students, in turn, sensitise their parents not to smoke at home. Children are also taught to move away if someone smokes in front of them. “But we should keep in mind that children are not only exposed to SHS at home, rather a large number of children (87 percent according to the survey) are exposed to SHS in public spaces. Regrettably, we could not do anything in this regard. We believe no change can be made without mass awareness. At the same time, the 2013 law that banned smoking in public places must be implemented strictly,” she urges.

The data that has come out from the survey indicates that we are pushing our future generations into danger through our irresponsible attitude towards smoking. It is high time the government, parents and communities take note of the urgent health hazard.