Article Text

Original research
Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya
  1. Hellen Meme1,
  2. Evans Amukoye1,
  3. Cressida Bowyer2,
  4. Jeremiah Chakaya1,
  5. Darpan Das3,
  6. Ruaraidh Dobson4,
  7. Ulrike Dragosits5,
  8. Jonathan Fuld6,
  9. Cindy Gray7,
  10. Matthew Hahn8,
  11. Richard Kiplimo1,
  12. Maia Lesosky9,
  13. Miranda M Loh3,
  14. Jean McKendree10,
  15. Kevin Mortimer11,12,
  16. Amos Ndombi1,
  17. Louis Netter2,
  18. Angela Obasi13,14,
  19. Fred Orina1,
  20. Clare Pearson5,
  21. Heather Price15,
  22. Jennifer K Quint16,
  23. Sean Semple4,
  24. Marsailidh Twigg5,
  25. Charlotte Waelde17,
  26. Anna Walnycki18,
  27. Melaneia Warwick19,
  28. Jana Wendler20,
  29. Sarah E West10,
  30. Michael Wilson19,
  31. Lindsay Zurba21,
  32. Graham Devereux22
  1. 1 Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
  2. 2 Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
  3. 3 Institute of Occupational Medicine, Edinburgh, UK
  4. 4 Institute for Social Marketing and Health, University of Stirling, Stirling, UK
  5. 5 UK Centre for Ecology & Hydrology, Penicuik, UK
  6. 6 Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  7. 7 School of Social and Political Sciences, University of Glasgow, Glasgow, Glasgow, UK
  8. 8 Theatre for Development Facilitator, Folkstone, UK
  9. 9 Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
  10. 10 Department of Environment and Geography, University of York, York, UK
  11. 11 Department of Medicine, University of Cambridge, Cambridge, UK
  12. 12 Department of Medicine, College of Health Sciences University of KwaZulu-Natal, Durban, South Africa
  13. 13 Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
  14. 14 Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Liverpool, UK
  15. 15 Biological and Environmental Sciences, University of Stirling, Stirling, UK
  16. 16 NHLI, Imperial College London, London, UK
  17. 17 Centre for Dance Research, Coventry University, Coventry, UK
  18. 18 International Institute for Environment and Development, London, UK
  19. 19 School of Design & Creative Arts, Loughborough University, Loughborough, UK
  20. 20 Playfuel Games Ltd, Manchester, UK
  21. 21 Education for Health Africa, Durban, South Africa
  22. 22 Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  1. Correspondence to Professor Graham Devereux, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; graham.devereux{at}


Background Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms.

Methods Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM2.5) was estimated.

Results 2373 children participated, 1277 in Mukuru (median age, IQR 11, 9–13 years, 53% girls), and 1096 in Buruburu (10, 8–12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM2.5. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, ‘current wheeze’ (9.5% vs 6.4%, p=0.007) and ‘trouble breathing’ (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to ‘vapours, dusts, gases, fumes’, mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads.

Conclusion Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.

  • asthma
  • asthma epidemiology
  • paediatric asthma

Data availability statement

Data are available on reasonable request.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data are available on reasonable request.

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  • Contributors All authors meet all four criteria for authorship in the ICMJE recommendations. HM, GD, KM and SEW conceived the original idea, all authors contributed to the study design. CB, CG, MH, HM, LN, FO, MW and JW designed and coordinated the sensitisation campaign. EA, JC, RK, HM, AN, AO, FO and LZ contributed to instrument design, data acquisition and quality control in Kenya. DD, RD, MML, FO, HP, CP, SS and MT contributed to the design, conduct, analysis of air quality monitoring component. JF, CG, HP and SEW contributed to the design, conduct, analysis of qualitative components. Data analysis was conducted by GD, RK and ML. Study statistician was ML. All authors contributed to the interpretation of results, drafting of manuscripts and their revisions and agreed for the final version to be published. GD is the guarantor of the study.

  • Funding Funded by UKRI MRC/Kenya National Research Fund (NRF) UK-Kenya Joint Partnership on Non-Communicable Disease programme under the Newton fund MR/S009027/1. Sensitisation activities additionally funded by Wellcome Public Engagement Fund 218935/Z/19/Z. For the purpose of open access, the author has applied a CC BY public copyright licence (where permitted by UKRI, ‘Open Government Licence’ or ‘CC BY-ND public copyright licence may be stated instead) to any Author Accepted Manuscript version arising’.

  • Competing interests RD has declared employment by the University of Stirling for the duration of the study. ML has declared employment by the Institute of Occupational Medicine and funding for the study from UKRI MRC/Kenya National Research Fund. JKQ has declared personal funding from GlaxoSmithKline, Boehringer Ingelheim, AstraZeneca, Chiesi, Teva, Insmed, Bayer and institutional funding from UKRI MRC, Health Data Research UK, GlaxoSmithKline, Bayer, Boehringer Ingelheim, Chiesi, AstraZeneca and Asthma and Lung UK. All other authors have declared they have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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