Tackling bad air and promoting prevention and care for chronic lung diseases in sub-Saharan Africa

Abstract   Chronic respiratory diseases (CRD) are de facto neglected diseases in Sub-Saharan Africa (SSA) although prevalences are significantly rising and more women and young people are affected. Disabilities from CRD lead to decreased productivity and steep increases in direct and indirect costs for individuals, families, and society. The wide implications are recognized but serious challenges to effective action remain. We conducted scoping reviews of literature and policy documents on CRD and interviewed key informants to identify specific determinants and current health system responses in SSA to formulate targeted and feasible strategies that could inspire future interventions to address the issue. In SSA, air quality is poor and worsening (100% exposed to PM2.5 levels exceeding WHO guideline value), affecting development of and damaging lungs. Poor air quality is driven by socio-demographic phenomena with accelerated rural-to-urban migration and mobility needs; industrial and agricultural pollution; fossil fuel driven transport; inadequate waste management; electric power generation. A large component is indoor air pollution from inefficient burning technologies of unclean fuels and tobacco smoke, combined with insufficient ventilation. Health systems responses to CRDs are poor/non-existent. Medications are rarely available, CRD knowledge is low among healthcare professionals and the population, prevention activities are lacking. Holistic approaches to tackle outdoor & indoor air pollution and labour regulations for decent work can be part of the solutions. “Basic CRD care packages” can be introduced and decision-support to healthcare professionals offered. Engagement of stakeholders (communities; civil society, e.g., women's organisations, professional associations) can be commenced. Sporadic/scattered projects/programs can be stimulated towards synergistic actions. An assessment tool determining contextual applicability of strategies can help tailor appropriate responses. Key messages Chronic respiratory diseases (CRD) are on the rise in sub-Saharan Africa, commonly caused by outdoor air pollution (bronchial asthma) & use of biomass fuels (chronic obstructive pulmonary disease). Contextualized multisectoral actions are needed to tackle bad air and its causes (rapid urbanization; industrial, agricultural pollution; unclean fuels, etc) and address CRDs and risk factors.