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EDITORIAL

Air pollution and child health: What can health care professionals do?

Air pollution is a major 
environmental health threat. 
Recent data released by the 
World Health Organization 
(WHO) revealed that air 
pollution has a vast and terrible 
impact on child health and 
survival. Globally, 93% of all 
children live in environments 
with air pollution levels above 
the WHO guidelines. More than 
one in every four deaths of 
children under 5 years is directly 

or indirectly related to environmental risks. Both ambient air 
pollution (AAP) and household air pollution (HAP) contribute 
to respiratory tract infections that resulted in 543 000 deaths in 
children under 5 years in 2016. Ambient air pollution (AAP) alone 
imposes enormous costs on the global economy, amounting to 
more than US$5 trillion in total welfare losses in 2013.1

In addition, the WHO reports that although air pollution 
is a global problem, the burden of disease attributable to 
particulate matter in air is heaviest in low- and middle-income 
countries (LMICs), particularly in the WHO African, South-East 
Asia, Eastern Mediterranean and Western Pacific regions. LMICs 
in these regions – especially the African region – have the 
highest levels of exposure to HAP due to the widespread use of 
polluting fuels and technologies for basic daily needs, such as 
cooking, heating and lighting.2 Poverty is correlated with high 
exposure to environmental health risks and can also compound 
the damaging health effects of air pollution, by limiting access 
to information, treatment and other health care resources. The 
sources of pollution differ in urban and rural contexts,3 the 
main sources in urban settings being fossil fuel combustion for 
energy production, transport, residential cooking and heating 
(household fuel use) and waste incineration.4

So what are the effects of pollution on children’s health? There is 
a wealth of evidence that links air pollution to a number of health 
problems in children. The list is not exhaustive but identifies the 
following conditions in children5:
a. Adverse birth outcomes: Growing evidence that maternal 

exposure especially to fine particulate matter (PM) increases 
the risk of preterm birth and low birth weight.

b. Childhood obesity: Positive associations between exposure 
to air pollution in utero and postnatal weight gain or attained 
body mass index (BMI) for age, and an association between 
traffic-related air pollution and insulin resistance in children.

c. Acute lower respiratory infection: Exposure to air pollutants 
such as PM2.5, nitrogen dioxide (NO

2
) and ozone (O

3)
 is 

associated with pneumonia and other respiratory infections 
in young children.

d. Asthma: Substantial evidence exists that exposure to AAP 
increases the risk of children for developing asthma and that 
breathing pollutants exacerbates childhood asthma as well.

e. Otitis media: Clear, consistent evidence of an association 
between AAP exposure and occurrence of otitis media in 
children.

f. Childhood cancers: Substantial evidence that exposure to 
traffic-related air pollution is associated with increased risk of 
childhood leukaemia.

WHO therefore recommends the following actions by health 
care professionals in the management of childhood exposure 
to air pollution: be informed; recognise exposure and related 
health conditions; research, publish and disseminate knowledge; 
prescribe solutions and educate families and communities; 
educate colleagues and students; advocate solutions to other 
sectors and policy- and decision-makers.5 These may be difficult 
for health care professionals to accomplish without political and 
industry support in reducing air pollution. However, if nothing is 
done, the children will continue to be exposed to air pollution and 
suffer from the various health conditions, which will have a direct 
effect on the burden of disease in the paediatric population. 
This is a call to action to stem the impact of air pollution on 
our children’s health. It will, in part, involve informing parents 
and guardians on alternative options to the widespread use of 
polluting fuels and technologies for basic daily needs, such as 
cooking, heating and lighting. Advanced biomass cook stoves 
(ACS) and clean renewable cooking alternatives such as biogas, 
solar and liquid biofuels are now available in Africa and should 
be up-scaled to replace conventional coal as the main source for 
cooking, heating and lighting.

Prof. Gboyega A Ogunbanjo 
Editor-in-chief: SAFPJ

References:
1. WHO. Air pollution and child health: prescribing clean air. WHO reference number: 

WHO/CED/PHE/18.01. [Accessed 21 Nov 2018]. Available from: http://www.who.
int/ceh/publications/air-pollution-child-health/en/ 

2. Barone-Adesi F, Dent JE, Dajnak D, Beevers S, Anderson HR, Kelly FJ, et al. Long term 
exposure to primary traffic pollutants and lung function in children: cross-sectional 
study and meta-analysis. PLoS One. 2015;10(11):e0142565.

3. Landrigan PJ, Sly JL, Ruchirawat M, Silva ER, Huo X, Diaz-Barriga F, et al. Health con-
sequences of environmental exposures: changing global patterns of exposure and 
disease. Ann Global Health. 2016;82(1):10.

4. WHO. Burning opportunity: clean household energy for health, sustainable de-
velopment, and wellbeing of women and children. Geneva: World Health Orga-
nization; 2016 [accessed 21 Nov 2018]. Available from: http://www.who.int/iris/
handle/10665/204717 

5. WHO Report. Air Pollution and Child Health: Prescribing Clean Air. Executive sum-
mary – Children’s exposure to air pollution. WHO 2018 [accessed 21 Nov 2018]:9-
20. Available from: http://www.who.int/ceh/publications/Advance-copy-
Oct24_18150_Air-Pollution-and-Child-Health-merged-compressed.pdf?ua=1