{
  "abstract": "Background: Exposure to ambient air pollution increases the risk of respiratory tract infections (RTIs). This systematic review and meta-analysis quantified the association between ambient air pollution and RTIs in low- and middle-income countries (LMICs).\n\nMethods: We searched Ovid Medline, Embase, and related databases for studies published between January 2000 and December 2024 reporting on ambient air pollution and RTIs in LMICs. Two reviewers independently screened studies, assessed risk of bias using the RoBANS tool, and conducted a random-effects meta-analysis. Studies reporting odds ratios (ORs) were included in a random-effects meta-analysis, and separately for each pollutant–outcome combination for studies reporting multiple pollutants.\n\nResults: Of 2,201 records identified, 111 full texts were assessed, 17 studies were included in the systematic review and 7 in the meta-analysis. Exposure to ambient air pollution was associated with increased odds of respiratory tract infections (pooled OR: 1.25, 95% CI: 1.04–1.49), with substantial heterogeneity (I² = 65.2%). Subgroup analyses suggested stronger associations in studies conducted in Africa (OR: 1.94, 95% CI: 1.46–2.58) compared to Asia (OR: 1.16, 95% CI: 0.92–1.45), and for pneumonia (OR: 1.74, 95% CI: 1.38–2.18) compared to other respiratory tract infections; though based on few studies. Among pollutants, PM2.5 showed the most consistent association with respiratory tract infections (OR: 1.05, 95% CI: 1.03–1.08), while associations for NO₂ and NOx were not statistically significant. Evidence of publication bias was suggested by funnel plot asymmetry. Meta-regression indicated a declining trend in effect estimates over time from 2018 to 2024.\n\nConclusion: Ambient air pollution, particularly PM2.5, is significantly associated with increased RTI risk, with stronger effects in African settings and for pneumonia. The association appears to weaken in more recent studies, potentially reflecting changing exposure patterns or research methodological advancements.\n\nTrial registration: PROSPERO Registration: CRD42024586784.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28257-5.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda",
    "Infectious Disease Institute, College of Health Sciences, Makerere University, Kampala, Uganda",
    "Centre for Global Health Law, School of Law, University of Warwick, Coventry, UK",
    "Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda",
    "The Eastern Africa GEOHealth Hub, Kampala, Uganda",
    "Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda",
    "Interdisciplinary Consortium for Epidemic Research (ICER), Kampala, Uganda",
    "Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, UK",
    "Department of Community Health and Behavioural Services, College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda",
    "Centre for Global Health Research, Warwick Medical School, University of Warwick, Coventry, UK"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Mudarshiru Bbuye"
    },
    {
      "affs": [
        3,
        4
      ],
      "name": "Simon Kasasa"
    },
    {
      "affs": [
        5
      ],
      "name": "Adrian Mwota Nampogo"
    },
    {
      "affs": [
        5,
        6
      ],
      "name": "Winters Muttamba"
    },
    {
      "affs": [
        1
      ],
      "name": "Stella Zawedde Muyanja"
    },
    {
      "affs": [
        2
      ],
      "name": "Sharifah Sekalala"
    },
    {
      "affs": [
        5,
        6
      ],
      "name": "Bruce J Kirenga"
    },
    {
      "affs": [
        1
      ],
      "name": "Stephen Okoboi"
    },
    {
      "affs": [
        5,
        7,
        6
      ],
      "name": "Wilber Sabiiti"
    },
    {
      "affs": [
        4,
        8
      ],
      "name": "Lynn M. Atuyambe"
    },
    {
      "affs": [
        0
      ],
      "name": "Esther Buregyeya"
    },
    {
      "affs": [
        9
      ],
      "name": "Olalekan A. Uthman"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1f8gzskn3tnvs.bib",
  "cited_by": 0,
  "doi": "10.1186/s12889-026-28257-5",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13737718/",
  "id": "1f8gzskn3tnvs",
  "issns": [
    "1471-2458"
  ],
  "landing_url": "https://doi.org/10.1186/s12889-026-28257-5",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Systematic Review"
    ],
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      "openalex",
      "2307|Air Quality and Health Impacts"
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  "openalex": "W7167097215",
  "pdf_url": null,
  "pmcid": "PMC13737718",
  "pmid": "42393621",
  "published": "2026-07-02",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/1f8gzskn3tnvs.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:22:50Z",
      "native_id": "PMC13737718",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12889-026-28257-5"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2307|Air Quality and Health Impacts",
      "subfield": "pharmacology-toxicology"
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  ],
  "title": "Ambient air pollution and risk of respiratory tract infections in low- and middle-income countries: a systematic review and meta-analysis",
  "title_text": "Ambient air pollution and risk of respiratory tract infections in low- and middle-income countries: a systematic review and meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:22:50Z",
  "url": "https://research.draconitic.com/paper/1f8gzskn3tnvs",
  "venue": "BMC Public Health",
  "versions": []
}