In many households in Mabopane and Soshanguve – townships on the northern outskirts of South Africa’s City of Tshwane that are marked by high poverty, unemployment and informal economic activity – evenings follow a familiar pattern.
When electricity cuts occur or power becomes unaffordable, families turn to gas stoves, paraffin heaters, or wood and coal fires to cook meals and keep warm. These energy sources contribute to air pollution, but the most harmful exposure often happens indoors, where children spend much of their time. These choices, though often unavoidable, put young children’s health at risk.
Children are particularly vulnerable to air pollution. Their lungs are still developing, their airways are narrower, and they breathe faster than adults.
In 2021, exposure to air pollution was linked to more than 700,000 deaths of children under five years old globally.
They are exposed by inhaling polluted air, swallowing contaminated dust or food, and through skin contact. Household fuel combustion releases tiny particles and harmful gases that irritate the lungs and airways. These pollutants can also damage the skin, triggering immune responses that worsen allergic conditions such as eczema and asthma.
As public health specialists, we examined the association between household air pollution and eczema and severe asthma symptoms among children aged seven years and younger in Mabopane and Soshanguve. We found that the use of polluting household fuels and gas was associated with an increased likelihood of eczema, followed by severe asthma symptoms.
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Eczema and its impact
Eczema, or atopic dermatitis, is a chronic skin condition that causes itching, redness and inflammation.
It can significantly affect a child’s life by disrupting sleep and increasing the risk of skin infections. It also raises the likelihood of developing asthma, hay fever, or food allergies later. Visible rashes can equally affect confidence, social interactions and participation in school or play. Exposure to cigarette smoke inside the home further increases the risk of developing or worsening eczema, especially when mothers or female caregivers smoke.
Severe asthma and its impact
Asthma is a long-term condition affecting the lungs and airways, making breathing difficult. Symptoms include wheezing, coughing, chest tightness and shortness of breath. Global asthma prevalence ranges from 9.1% to 9.5% for children.
Severe asthma refers to frequent, hard-to-control, and sometimes life-threatening symptoms. Children with severe asthma may struggle to speak during attacks and are far more likely to need emergency care or hospitalisation. Young children are particularly vulnerable because their lungs, skin barrier and immune systems are still developing. Exposure to indoor air pollution during these early years increases the risk of long-term health problems.
Our study
To understand how household environments affect children’s health, we studied preschool-aged children in Mabopane and Soshanguve, in South Africa’s largely urban Gauteng province, between January 2022 and March 2023.
We randomly selected 42 preschools and collected health and household information from caregivers of 1,840 children, including details on eczema, asthma symptoms, household fuel use, and exposure to cigarette smoke inside the home.
What we found
About one in eight children had experienced eczema at some point, and a similar proportion were currently experiencing symptoms. We also found that children from households using electricity for cooking and with no tobacco smoke exposure were less likely to have eczema than those who were exposed.
Children living in homes using open fires – such as paraffin, wood, or coal – for cooking or heating were more likely to have eczema. Exposure to cigarette smoke inside the home further increased this risk, particularly when mothers or female caregivers smoked.
Severe asthma symptoms were also common, affecting about one in six children. The use of gas for cooking or heating was strongly linked to severe asthma symptoms, even though gas is often viewed as a cleaner alternative during power cuts. Poor ventilation can increase indoor pollution, making these energy sources harmful to children.
The use of combined building materials in homes increased the likelihood of having eczema and corrugated iron significantly increased the likelihood of developing its symptoms. The frequency of trucks passing near the preschool children’s residences on weekdays was found to be associated with eczema and current symptoms. There was a significant association observed when trucks passed the children’s residences almost all day on weekdays. Children who walked to preschool had an increased risk of severe asthma symptoms compared with those using other modes of transport.
Why this matters
Although nearly 89% of residents in the study area have access to electricity, many households cannot rely on it consistently. Rising electricity costs and scheduled power cuts force families to use alternative fuels. These coping strategies, while understandable, increase children’s exposure to indoor air pollution during the most vulnerable stage of their development.
Eczema and severe asthma are not just medical issues but also social and environmental ones.
Our study confirmed that children in poorer communities face higher health risks due to their living environments, not just genetics. Susceptible groups, such as children, should be prioritised to reduce the adverse health effects of both outdoor and indoor air pollution.
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What needs to change
Protecting children’s health requires more than asking parents to make better choices, as many families do not have safe, affordable alternatives.
Public health education on the dangers of cigarette smoke is crucial. Education campaigns, smoking cessation support and community-level interventions can help reduce children’s exposure to environmental tobacco smoke.
Stronger action on indoor and household air pollution is urgently needed. Evidence from this study can support the South African government in fast-tracking regulations and enforcing ambient air quality laws. It can also help in promoting safer household energy options.
Cleaner air inside homes is not a luxury. For South Africa’s children, it is a public health necessity.
Dr Mandla Bhuda receives funding from University of Pretoria and Ninety-one projects pty (Ltd).
Janine Wichmann receives funding from University of Pretoria and South African National Research Foundation
Joyce Shirinde receives funding from University of Pretoria and Ninety-One projects pty (Ltd).
This article was originally published on The Conversation. Read the original article.
