Air pollution exposure, respiratory consequences, and perceptions among urban African children living in poor conditions - A case study in Abidjan, Côte d'Ivoire.

Air pollution can severely impact child lung health but is often not considered a public health priority by policy-makers and population in low-and-middle income countries. We conducted an interdisciplinary mixed method study to assess exposure to air pollution and respiratory health on children aged 5-10 living in poorly condition in Yopougon, a district of Abidjan, Côte d'Ivoire, and to evaluate parent and child perceptions and knowledge of air pollution. We measured pollution exposure with indoor and outdoor PM10 and PM2.5 concentrations and questionnaires, assessed children's respiratory health with ISAAC questionnaire, clinical evaluation, spirometry or RINT, depending on their ability to perform a forced expiration, their perception of air pollution with a "Draw and express yourself" activity and that of parents with semi-structured interviews and questionnaires. We enrolled 124 children from 65 households, that used mixed cooking with gas and charcoal in settings with important environmental air pollution. Median 48-hour PM10 and PM2.5 concentrations were 126.7 (IQR: 82.7) and 60.8 (IQR: 50.7) μg/m3, indoor respectively, and 113.4 (IQR: 64.2) and 58.2 (IQR: 36.9) μg/m3, outdoor in courtyards. 21 (16.9%) children reported wheezing in the previous year, 65 (52.4%) reported dry cough at night, and 63 (72.4%) had lung function impairment on spirometry with 24 (27.6%) asthma, 19 (21.8%) non reversible obstruction and 20 (23.0%) restrictive pattern. Adults and children were able to identify visible sources of air pollution but largely ignored effects on health. Despite high exposure to air pollution with particulate matter concentrations significantly exceeding WHO recommendations, and a high prevalence of respiratory symptoms, lung function impairment and asthma, among children, children and adults, perception of air pollution as a health issue was very limited. Recommendations and awareness-raising for parents and children, starting at primary school, are needed to limit the exposure to air pollution and its respiratory consequences.