Poor air quality is a development challenge. Urbanization and industrial development along with increased populations have brought clear socio-economic benefits to Low-and Middle-Income Countries (LMICs) but can also bring disadvantages such as decreasing air quality. A lack of reliable air quality data in East African cities makes it difficult to understand air pollution exposure and to predict future air quality trends. This work documents urban air quality and air pollution exposure in the capital cities of Kampala (Uganda), Addis Ababa (Ethiopia) and Nairobi (Kenya). We build a situational awareness of air pollution through repeated static and dynamic mobile monitoring in a range of urban locations, including urban background, roadside (pavement and building), rural background, and bus station sites, alongside vehicle-based measurements including buses and motorcycle taxis. Data suggest that the measured particulate matter mass concentrations (PM_2.5, PM₁₀) in all studied cities was at high concentrations, and often hazardous to human health, as defined by WHO air quality guidelines. Overall, the poorest air quality was observed in Kampala, where mean daily PM_2.5 and PM₁₀ concentrations were significantly above the WHO limits at urban background locations by 122% and 69% and at roadside locations by 193% and 215%, respectively. Traffic is clearly a major contributor to East African urban air pollution; monitoring in Kampala and Addis Ababa, on motorcycle taxis, in buses and at bus stations indicated that drivers and commuters were exposed to poor air quality throughout their commute. Road-related air pollution can also impact indoor locations near roads. Using one exemplar building located within Nairobi’s Central Business District, it is shown that measured outdoor PM concentrations significantly correlate with the indoor air quality (r = 0.84). This link between roadside emissions and indoor air pollution within buildings located close to the road should be explored more fully. This study, through a series of case studies, provides clear evidence that roads and traffic need to be a focus for mitigation strategies to reduce air pollution exposure in East African cities.

Background: Household air pollution associated with biomass (wood, dung, charcoal, and crop residue) burning for cooking is estimated to contribute to approximately 4 million deaths each year worldwide, with the greatest burden seen in low and middle-income countries. We investigated the relationship between solid fuel type and respiratory symptoms in Uganda, where 96% of households use biomass as the primary domestic fuel. Materials and Methods: Cross-sectional study of 15,405 pre-school aged children living in charcoal or wood-burning households in Uganda, using data from the 2016 Demographic and Health Survey. Multivariable logistic regression analysis was used to identify the associations between occurrence of a cough, shortness of breath, fever, acute respiratory infection (ARI) and severe ARI with cooking fuel type (wood, charcoal); with additional sub-analyses by contextual status (urban, rural). Results: After adjustment for household and individual level confounding factors, wood fuel use was associated with increased risk of shortness of breath (AOR: 1.33 [1.10–1.60]), fever (AOR: 1.26 [1.08–1.48]), cough (AOR: 1.15 [1.00–1.33]), ARI (AOR: 1.36 [1.11–1.66] and severe ARI (AOR: 1.41 [1.09–1.85]), compared to charcoal fuel. In urban areas, Shortness of breath (AOR: 1.84 [1.20–2.83]), ARI (AOR: 1.77 [1.10–2.79]) and in rural areas ARI (AOR: 1.23 [1.03–1.47]) and risk of fever (AOR: 1.23 [1.03–1.47]) were associated with wood fuel usage. Conclusions: Risk of respiratory symptoms was higher among children living in wood compared to charcoal fuel-burning households, with policy implications for mitigation of associated harmful health impacts.

Background: A variety of public health interventions have been undertaken in low- and middle-income countries (LMICs) to prevent morbidity and mortality associated with household air pollution (HAP) due to cooking, heating and lighting with solid biomass fuels. Pregnant women and children under five are particularly vulnerable to the effects of HAP, due to biological susceptibility and typically higher exposure levels. However, the relative health benefits of interventions to reduce HAP exposure among these groups remain unclear. This systematic review aims to assess, among pregnant women, infants and children (under 5 years) in LMIC settings, the effectiveness of interventions which aim to reduce household air pollutant emissions due to household solid biomass fuel combustion, compared to usual cooking practices, in terms of health outcomes associated with HAP exposure. Methods: This protocol follows standard systematic review processes and abides by the PRISMA-P reporting guidelines. Searches will be undertaken in MEDLINE, EMBASE, CENTRAL, WHO International Clinical Trials Registry Platform (ICTRP), The Global Index Medicus (GIM), ClinicalTrials.gov and Greenfile, combining terms for pregnant women and children with interventions or policy approaches to reduce HAP from biomass fuels or HAP terms and LMIC countries. Included studies will be those reporting (i) pregnant women and children under 5 years; (ii) fuel transition, structural, educational or policy interventions; and (iii) health events associated with HAP exposure which occur among pregnant women or among children within the perinatal period, infancy and up to 5 years of age. A narrative synthesis will be undertaken for each population-intervention-outcome triad stratified by study design. Clinical and methodological homogeneity within each triad will be used to determine the feasibility for undertaking meta-analyses to give a summary estimate of the effect for each outcome. Discussion: This systematic review will identify the effectiveness of existing HAP intervention measures in LMIC contexts, with discussion on the context of implementation and adoption, and summarise current literature of relevance to maternal and child health. This assessment reflects the need for HAP interventions which achieve measurable health benefits, which would need to be supported by policies that are socially and economically acceptable in LMIC settings worldwide. Systematic review registration: PROSPERO CRD42020164998

Background: In low- and middle-income countries (LMICs), household air pollution as a result of using solid biomass for cooking, lighting and heating (HAP) is associated with respiratory infections, accounting for approximately 4 million early deaths each year worldwide. The majority of deaths are among children under five years. This population-based cross-sectional study investigates the association between solid biomass usage and risk of acute respiratory infections (ARI) and acute lower respiratory infections (ALRI) in 37 LMICs within Africa, Americas, Southeast Asia, European, Eastern Mediterranean and Western Pacific regions. Materials and methods: Using population-based data obtained from Demographic and Health surveys (2010–2018), domestic cooking energy sources were classified solid biomass (wood, charcoal/dung, agricultural crop) and cleaner energy sources (e.g., Liquid Petroleum Gas (LPG), electricity, biogas and natural gas). Composite measures of ARI (shortness of breath, cough) and ALRI (shortness of breath, cough and fever) were composed using maternally reported respiratory symptoms over the two-week period prior to the interview. Multivariable logistic regression was used to identify the association between biomass fuel usage with ARI and ALRI, accounting for relevant individual, household and situational confounders, including stratification by context (urban/rural). Results: After adjustment, in the pooled analysis, children residing in solid biomass cooking households had an observed increased adjusted odds ratio of ARI (AOR: 1.17; 95% CI: 1.09–1.25) and ALRI (AOR: 1.16; 95% CI 1.07–1.25) compared to cleaner energy sources. In stratified analyses, a comparable association was observed in urban areas (ARI: 1.16 [1.06–1.28]; ALRI: 1.14 [1.02–1.27]), but only significant for ARI among those living in rural areas (ARI: 1.14 [1.03–1.26]). Conclusion: Switching domestic cooking energy sources from solid biomass to cleaner alternatives would achieve a respiratory health benefit in children under five years worldwide. High quality mixed-methods research is required to improve acceptability and sustained uptake of clean cooking energy source interventions in LMIC settings.

In a drive to achieve net zero emissions, U.K. transport decarbonisation policies are predominantly focussed on measures to promote the uptake and use of electric vehicles (EVs). This is reflected in the COP26 Transport Declaration signed by 38 national governments, alongside city region governments, vehicle manufacturers and investors. However, emerging evidence suggests that EVs present multiple challenges for air quality, mobility and health, including risks from non-exhaust emissions (NEEs) and increasing reliance on vehicles for short trips. Understanding the interconnected links between electric mobility, human health and the environment, including synergies and trade-offs, requires a whole systems approach to transport policymaking. In the present paper, we describe the use of Participatory Systems Mapping (PSM) in which a diverse group of stakeholders collaboratively constructed a causal model of the U.K. surface transport system through a series of interactive online workshops. We present the map and its analysis, with our findings illustrating how unintended consequences of EV-focussed transport policies may have an impact on air quality, human health and important social functions of the transport system. We conclude by considering how online participatory causal modelling techniques could be effectively integrated with empirical metrics to facilitate effective policy design and appraisal in the transport sector.