Abstract:
BACKGROUND : Air pollution is a global, public health emergency. The effect of living in areas with very poor air quality
on adolescents’ physical health is largely unknown. The aim of this study was to investigate the prevalence of adverse
respiratory health outcomes among adolescents living in a known air pollution hotspot in South Africa.
METHODS : Ambient air quality data from 2005 to 2019 for the two areas, Secunda and eMbalenhle, in the Highveld
Air Pollution Priority Area in Mpumalanga province, South Africa were gathered and compared against national ambient
air pollution standards and the World Health Organization Air Quality Guidelines. In 2019, adolescents attending
schools in the areas completed a self-administered questionnaire investigating individual demographics, socioeconomic
status, health, medical history, and fuel type used in homes. Respiratory health illnesses assessed were
doctor-diagnosed hay fever, allergies, frequent cough, wheezing, bronchitis, pneumonia and asthma. The relationship
between presence (at least one) or absence (none) of self-reported respiratory illness and risk factors, e.g., fuel use at
home, was explored. Logistic regression was used to estimate the odds ratio and 95% confidence interval (CI) of risk
factors associated with respiratory illness adjusted for body mass index (measured by field assistants), gender, education
level of both parents / guardians and socio-economic status.
RESULTS : Particulate matter and ozone were the two pollutants most frequently exceeding national annual air quality
standards in the study area. All 233 adolescent participants were between 13 and 17 years of age. Prevalence of selfreported
respiratory symptoms among the participants ranged from 2% for ‘ever’ doctor-diagnosed bronchitis and
pneumonia to 42% ever experiencing allergies; wheezing chest was the second most reported symptom (39%). Half
(52%) of the adolescents who had respiratory illness were exposed to environmental tobacco smoke in the dwelling.
There was a statistically significant difference between the presence or absence of self-reported respiratory illness
based on the number of years lived in Secunda or eMbalenhle (p = 0.02). For a one-unit change in the number of
years lived in an area, the odds of reporting a respiratory illness increased by a factor of 1.08 (p = 0.025, 95% CI = 1.01–
1.16). This association was still statistically significant when the model was adjusted for confounders (p = 0.037).
CONCLUSIONS : Adolescents living in air polluted areas experience adverse health impacts Future research should
interrogate long-term exposure and health outcomes among adolescents living in the air polluted environment.
