Prevalence and determinants of respiratory symptoms and functional disorders among children exposed to particulate matter through domestic and maternal occupational solid fuel use in Abidjan, Côte d’Ivoire – a cross-sectional study

Background

Children from low– and middle-income countries are particularly vulnerable to air pollution, a major environmental health risk, due to the immaturity of their lungs and their proximity to sources of household pollution. This study aimed to investigated the effect of exposure to biomass combustion through domestic and maternal occupational activities on respiratory health of children living in disadvantaged urban areas of Abidjan, Côte d’Ivoire.

Methods

Between February and December 2023, we conducted a cross-sectional observational study among children <16 years from households of women using biomass fuel for cooking (Group (G) 1), engaged in occupational fish smoking activities (G2), or primarily using gas for domestic cooking (G3). We assessed reported respiratory symptoms through standardized questionnaires and the presence of lung function impairments (LFI) though pulmonary function tests (spirometry and Rint). We assessed the association between study groups and key covariates with respiratory symptoms and LFI using mixed-effects regression models.

Results

Of 210 children enrolled – 119 (56.8%) female, median age 9 (6–12) years, 82 (39.0%) in G1, 47 (22.4%) in G2, and 81 (38.6%) in G3 – 15 (7.1%) reported wheezing in the last 12 months, 82 (39.0%) reported dry cough at night, 9 (4.9%) presented with dyspnea and 5 (2.7%) had chest pain on clinical examination, for an overall proportion of children with reported respiratory symptoms of 43.8% (92/210). Of 176 children who underwent pulmonary function testing, 59 (33.5%) had LFI detected, including 34 (45.9%) in G1, 8 (22.2%) in G2, and 17 (25.8%) in G3 ( p = 0.011). Study group was associated with respiratory symptoms (G1 vs G3; aOR 3.82, 95% CI 1.68-8.68; p < 0.001), as well as with LFI ( p = 0.042). Girls were at greater risk of LFI than boys (aOR 2.69, 95% CI 1.24-5.80; p = 0.012). Children whose mothers used charcoal or wood as cooking fuel had higher odds of respiratory symptoms (OR 2.61, 95% CI 1.22–5.58; p = 0.013) but no association was found with LFI ( p = 0.459) compared with unexposed children.

Conclusion

Respiratory symptoms and lung function impairments were highly prevalent among children living disadvantaged, especially when mothers cook with wood or charcoal. Targeted maternal awareness and broader interventions to reduce household air pollution in disadvantaged urban areas are urgently needed to protect long-term respiratory health.

ARTICLE SUMMARY

• What is already known on this topic – Low– and middle-income countries are particularly affected by ambient air pollution, and children are especially vulnerable. In these settings, biomass fuels are still widely used and are implicated as a risk factor for acute lower respiratory infections in children.

• What this study adds – This study suggests that the respiratory health of children living in disadvantaged settings is impaired with high prevalence of non-reversible OVDs, potentially indicating an early trajectory toward COPD at younger ages, and that exposure to charcoal and wood combustion suggest detrimental effects on both respiratory symptoms and pulmonary function, particularly in girls. Children living in households of fish smoking women however did not seem to be at higher risks of negative respiratory outcomes, probably due to limited exposure time in the smoking sites.

• How this study might affect research, practice or policy – Targeted awareness interventions for mothers, aiming to reduce household air pollution, as well as broader actions in disadvantaged urban areas, are needed to protect the long-term respiratory health of these children. The transition from charcoal to clean fuels such as gas or electricity for domestic use could help protect the health of children living in disadvantaged settings.