Abstract
BackgroundPeople 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. MethodsWe 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. ResultsWe 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. ConclusionAAP 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.
Highlights
Sub-Saharan African (SSA) is undergoing an epidemiological transition, characterized by a heavy burden of both infectious diseases and non-communicable diseases (NCDs)(Dagadu and Patterson, 2015; Mboera et al, 2014; Nyaaba et al, 2017; Nyirenda, 2016)
This figure is almost entirely based on data obtained from low- and middle-income countries (LMICs) outside Africa, and the magnitude of the risk attributable to ambient air pollution (AAP) has not been well documented for the African continent
As shown in a PRISMA flow diagram (Fig. 1), the initial searches provided 1402 non-duplicate records, of which 139 full texts were assessed for eligibility
Summary
Sub-Saharan African (SSA) is undergoing an epidemiological transition, characterized by a heavy burden of both infectious diseases and non-communicable diseases (NCDs)(Dagadu and Patterson, 2015; Mboera et al, 2014; Nyaaba et al, 2017; Nyirenda, 2016). The impact of exposure to AAP on human health has been well documented(Brunekreef and Holgate, 2002; Kampa and Castanas, 2008) This ranges from minor upper respiratory irritation to serious chronic respiratory and cardiac disorders, from aggravation of pre-existing heart and lung conditions to premature mortality, and reduced life expectancy. People from low- and middle-income countries are disproportionately affected by the global burden of adverse health effects caused by ambient air pollution (AAP). We used a systematic review approach to critically analyze and summarize levels of outdoor air pollutants, and data on health effects associated with AAP. Of the 23 studies reporting health effects, 14 originated from South Africa, and most countries within SSA contributed no data at all. Efforts are needed to monitor AAP in African cities, to identify its main sources, and to reduce adverse health effects by enforcing legislation
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