Ambient air pollution and health in Sub-Saharan Africa: Current evidence, perspectives and a call to action

• Published in: Environmental research Vol. 173; pp. 174 - 188
• Main Authors: Katoto, Patrick D.M.C., Byamungu, Liliane, Brand, Amanda S., Mokaya, Jolynne, Strijdom, Hans, Goswami, Nandu, De Boever, Patrick, Nawrot, Tim S., Nemery, Benoit
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.06.2019
• Subjects: adverse effects; Aged; Air Pollutants; air pollution; Air Pollution - statistics & numerical data; Cardio-respiratory diseases; Child; children; Cities; cooperative research; Cross-Sectional Studies; elderly; Environmental Exposure - statistics & numerical data; Environmental justice; Global health; health effects assessments; Humans; laws and regulations; morbidity; mortality; Outdoor air pollution; South Africa; statistics; systematic review; Urban health; World Health Organization; South Africa; Cities; Global health; Urban health; Outdoor air pollution; Environmental justice; Cardio-respiratory diseases
• ISSN: 0013-9351; 1096-0953; 1096-0953
• DOI: 10.1016/j.envres.2019.03.029

People from low- and middle-income countries are disproportionately affected by the global burden of adverse health effects caused by ambient air pollution (AAP). However, data from Sub-Saharan Africa (SSA) are still scarce. We systematically reviewed the literature to describe the existing knowledge on AAP and health outcomes in SSA. We searched PubMed, Medline-OVID, EMBASE and Scopus databases to identify studies of AAP and health outcomes published up to November 15, 2017. We used a systematic review approach to critically analyze and summarize levels of outdoor air pollutants, and data on health effects associated with AAP. We excluded occupational and indoor exposure studies. We identified 60 articles, with 37 only describing levels of AAP and 23 assessing the association between air pollution and health outcomes. Most studies (75%) addressing the relation between AAP and disease were cross-sectional. In general, exposure data were only obtained for selected cities in the framework of temporary international collaborative research initiatives without structural long-term continuation. Measurements of AAP revealed 10–20 fold higher levels than WHO standards. Of the 23 studies reporting health effects, 14 originated from South Africa, and most countries within SSA contributed no data at all. No studies, except from South Africa, were based on reliable morbidity or mortality statistics at regional or country level. The majority of studies investigated self-reported respiratory symptoms. Children and the elderly were found to be more susceptible to AAP. AAP and its negative health effects have been understudied in SSA compared with other continents. The limited direct measurements of air pollutants indicate that AAP in SAA cities is high compared with international standards. Efforts are needed to monitor AAP in African cities, to identify its main sources, and to reduce adverse health effects by enforcing legislation. •Continuous air quality monitoring hardly occurs in Sub-Saharan Africa (SSA).•SSA cities exhibit higher ambient air pollution (AAP) than WHO standards.•Most health studies of AAP in SSA were cross-sectional and relied on questionnaires.•Children and the elderly were found to be more susceptible to AAP.•Africa-specific longitudinal studies of ambient air pollution are needed.