Lung Health in Children in Sub-Saharan Africa: Addressing the Need for Cleaner Air

Abstract

Air pollution is increasingly recognized as a global health emergency with its impacts being wide ranging, more so for low- and middle-income countries where both indoor and outdoor pollution levels are high. In Africa, more than 80% of children live in households which use unclean sources of energy. The effects of both indoor and outdoor pollution on lung health on children who are the most vulnerable to their effects range from acute lower respiratory tract infections to long-term chronic health effects. We reviewed the literature on the effects of air pollution in children in Sub-Saharan Africa from prenatal exposure, infancy and school-going children. Data from Sub-Saharan Africa on quantification of exposures both indoor and outdoor mainly utilizes modelling or self-reporting. Exposures to biomass not only increases the risk of acute respiratory tract infections in young children but also increases the risk of carriage of pathogenic bacteria in the upper respiratory tract. Although there is limited evidence of association between asthma and pollution in African children, airway hyper-responsiveness and lower lung function has been demonstrated in children with higher risk of exposure. Interventions at a policy level to both quantify the exposure levels at a population level are urgently needed to address the possible interventions to limit exposure and improve lung health in children in Sub-Saharan Africa.

Ambient Air Pollution and Respiratory Health in Sub-Saharan African Children: A Cross-Sectional Analysis

“…A very limited number of African studies suggested that traffic- or industry-related air pollution [ 32 , 33 , 34 , 35 , 36 ], which most often occurs in urban areas, was associated with wheeze, cough, allergic rhinitis and phlegm in children. However, most of these studies had only assessed residential proximity to main road, industrial or mine areas rather than individual air pollutants [ 15 , 16 ]. More recently, a study in the Western Cape province found that modelled-NO 2 , but not modelled-PM 2.5 , was significantly associated with a new onset of asthma symptoms among school-aged children residing in informal settlements [ 37 ].…”

“…However, there is a dearth of data for such associations in the SSA region [ 14 ]. Among the limited number of studies in Africa, most have used crude proxies of ambient air pollution (e.g., residential proximity to industrial areas, heavy-traffic roads or mine dumps) instead of individual air pollutants [ 15 , 16 ]. This has largely explained the inconsistent findings across the studies and also inhibited comparisons with studies in which individual air pollutants were investigated.…”

Long-Term PM2.5 Exposure Is Associated with Symptoms of Acute Respiratory Infections among Children under Five Years of Age in Kenya, 2014

“…Indoor pollution exposures, primarily through tobacco smoking or the use of biomass cooking fuels, have been shown to impact health in low-income countries [ 3 , 4 ]. Biomass cooking fuels are associated with acute respiratory infections (ARIs) [ 5 ], tuberculosis [ 6 ], COPD [ 7 ], and asthma [ 8 , 9 ]. Less well-understood are the associations between ambient (outdoor) air exposures to pollutants, such as PM and respiratory health in SSA.…”

Ambient air pollution and non-communicable respiratory illness in sub-Saharan Africa: a systematic review of the literature

“…Indoor pollution exposures, primarily through tobacco or the use of biomass cooking fuels, have been shown to have impacts on public health in low-income countries [ 28 , 29 ]. In SSA countries, research has shown that indoor cooking using biomass fuels is associated with a number of non-communicable respiratory diseases (NCRDs), including acute respiratory infections [ 30 ], tuberculosis [ 31 ], chronic obstructive pulmonary disease (COPD) [ 32 ], and asthma [ 33 ]. Less well understood, however, are the associations between ambient (outdoor) air exposures and NCRDs in SSA.…”