Housing conditions and respiratory health in children in mining communities: an analysis of data from 27 countries in sub-Saharan Africa

Background Poor housing conditions, such as poor building materials and weak structures as well as high levels of indoor air pollution, are important risk factors for a broad range of diseases, including acute respiratory infections (ARI). In mining areas, research on the determinants of respiratory health predominantly focuses on exposures to outdoor air pollutants deriving from mining operations. However, mining projects also influence the socioeconomic status of households, which, in turn, affect housing quality and individual behaviors and, thus, housing quality and levels of indoor air pollution. In this study, we aimed to determine how proximity to an industrial mining project impacts housing quality, sources of indoor air pollution, and prevalence of ARI. Methods We merged data from 131 Demographic and Health Surveys (DHS) with georeferenced data on mining projects in sub-Saharan Africa (SSA) to determine associations between housing quality, indoor air pollution sources, and child respiratory health. Spatial differences in selected indicators were explored using descriptive cross-sectional analyses. Furthermore, we applied a quasi-experimental difference-in-differences (DiD) approach using generalized linear mixed-effects models to compare temporal changes in household and child health indicators at different operational phases of mining projects and as a function of distance to mines. Results For cross-sectional analyses, data of 183,466 households and 141,384 children from 27 countries in SSA were used, while 41,648 households and 34,406 children from 23 SSA countries were included in the DiD analyses. The increase in the share of houses being built from finished building materials after mine opening was more than 4-fold higher (odds ratio (OR): 4.32, 95% confidence interval (CI): 2.98-6.24) in close proximity to mining sites (i.e., ≤ 10 km) compared to areas further away (i.e., 10-50 km). However, these benefits were not equally distributed across socioeconomic strata, with considerably weaker effects observed among poorer households. Increases in indoor tobacco smoking rates in close proximity to operating mines were twice as high as in comparison areas (OR: 2.06, 95% CI: 1.15-3.68). The cross-sectional analyses revealed that traditional cooking fuels (e.g., charcoal, dung, and wood) were less frequently used (OR: 0.27, 95% CI: 0.23-0.31) in areas located in close proximity to mines than in comparison areas. Overall, no statistically significant association between mining operations and the prevalence of symptoms related to ARI in children under the age of 5 years was observed (OR: 0.78, 95% CI: 0.29-2.07). Conclusions Mines impact known risk factors for ARI through diverse pathways. The absence of significant changes in ARI symptoms among children is likely the result of counteracting effects between improvements in housing infrastructure and increased exposures to air pollutants from outdoor sources and tobacco smoking. For mining projects to unfold their full potential for community development, we recommend that impact assessments move beyond the mere appraisal of mining-related pollution emissions and try to include a more comprehensive set of pathways through which mines can affect ARI in exposed communities.