Air pollution can severely impact child lung health, but is often not considered a public health priority by policy-makers and population in low-and-middle income countries.

We did an interdisciplinary mixed method study to assess exposure to air pollution and respiratory health in children aged 5-10 living in poorly condition in Abidjan and parent and child perceptions and knowledge of air pollution. We assessed pollution exposure with indoor and outdoor PM2.5 and PM10 concentrations and questionnaires, children's respiratory health with ISAAC questionnaire, clinical evaluation, spirometry and RINT, their perception of air pollution with a “Draw and express yourself” activity and that of parents with semi-structured interviews and questionnaires.

We enrolled 124 children from 65 households, that used mixed cooking with gas and charcoal in settings with important environmental air pollution. Median 48-hour PM10 and PM2.5 concentrations were 126.7 (IQR: 82.7) and 60.8 (IQR: 50.7) μg/m³, indoor respectively, and 112.8 (IQR: 57.8) and 58.2 (IQR: 37.6) μg/m³, outdoor in courtyards. 21 (16.9 %) children reported wheezing in the previous year, 65 (52.4 %) dry cough at night, and 63 (72.4 %) had lung function impairment on spirometry with 24 (27.6 %) asthma, 19 (21.8 %) non reversible obstruction and 20 (23.0 %) restrictive pattern. Adults and children were able to identify visible sources of air pollution but largely ignored effects on health.

Recommendations and awareness-raising for parents and children, starting at primary school level, are needed to limit the exposure to and respiratory consequences of air pollution.