Association of air pollution on birth outcomes in New Delhi - a pilot study on the potential of HMIS data for environmental public health tracking.

Objectives: The study objective was to assess the gaps in current hospital health management information systems (ie. paper based records of prenatal, delivery, neonatal, discharge data) for environmental studies. This study also considers the feasibility of linking patient-level hospital data with ambient air pollution data recorded in real time by air quality monitoring stations.
Methods: This retrospective hospital based cohort study used a semi-ecologic design to explore the association of air pollution with a neonate's birth weight and gestational age. Maternal and neonatal data from 2007-2012 were encoded and linked with air pollution data based on distance to the nearest air quality monitoring station. Completeness and accuracy of neonatal anthropometric measures, maternal demographic information, nutritional status and maternal risk factors (gestational diabetes, anaemia, hypertension, etc.) were assessed.
Results: The records of 10,565 births in Sir Ganga Ram hospital in New Delhi were encoded and linked with real time air quality data. These were records of women who reported a New Delhi address during the time of delivery. The distance of each address to all the monitoring stations were recorded. Birth records were assigned pollution exposure levels averaged across records from monitoring stations within 10 kilometers of the address during the pregnancy period.
Conclusion: This pilot study will highlight the potential of hospital management information system in linking administrative hospital record data with information on environmental exposure. The linked health-exposure dataset can then be used for studying the impact of various environmental exposures on health outcomes. Mother's educational attainment, occupation, residential history, nutritional status, tobacco and alcohol use during pregnancy need to be documented for better health risk assessments or case management. Health institutions can provide data for public health researchers and environmental scientists and can serve as the backbone of an environmental public health tracking system.