Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya

Hellen Meme, Evans Amukoye, Cressida Bowyer, Jeremiah Chakaya, Darpan Das, Ruaraidh Dobson, Ulrike Dragosits, Jonathan Fuld, Cindy Gray, Matthew Hahn, Richard Kiplimo, Maia Lesosky, Miranda M Loh, Jean McKendree, Kevin Mortimer, Amos Ndombi, Louis Netter, Angela Obasi, Fred Orina, Clare PearsonHeather Price, Jennifer K Quint, Sean Semple, Marsailidh Twigg, Charlotte Waelde, Anna Walnycki, Melaneia Warwick, Jana Wendler, Sarah E West, Michael Wilson, Lindsay Zurba, Graham Devereux

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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.
Original languageEnglish
Article numberthorax-2023-220057
Pages (from-to)1118-1125
Number of pages8
Issue number11
Early online date6 Jun 2023
Publication statusPublished - 1 Nov 2023

Bibliographical note

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:


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


  • asthma epidemiology
  • paediatric asthma
  • asthma


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