🟠 Moderate Evidence
Children and young people in Delhi and Dhaka experience significantly higher rates of respiratory symptoms, anxiety, and school absences on days when air pollution peaks, according to a cross-sectional study published in PLOS Global Public Health by researchers including Constance Bwire and Ana Bonell at the London School of Hygiene and Tropical Medicine. The real-time survey captured health and activity data from 814 young people during periods of high and low air quality in both cities, revealing immediate and measurable impacts on daily functioning.
Key takeaways
- During high-pollution days (PM2.5 > 55.5 µg/m³), children and young people reported significantly higher rates of itchy eyes, respiratory difficulties, and headaches compared to days with good air quality (PM2.5 ≤ 35.4 µg/m³)
- School or work absences, missed meetings, and social event cancellations increased substantially during periods of high air pollution, with young people requiring greater family assistance
- Mental health symptoms including anxiety, stress, and low mood were significantly elevated on high-pollution days, alongside difficulty concentrating
Study at a Glance
| Source | PLOS Global Public Health |
| Study type | Cross-sectional real-time digital survey |
| Sample size | N = 814 (Delhi: 365; Dhaka: 449) |
| Population | Children and young people aged 13–29 years and parents of children under 18 |
| Country | India and Bangladesh |
Health symptoms reported during high-pollution versus good air quality days
Percentage of children and young people in Delhi and Dhaka reporting symptoms, January (high PM2.5) versus March (low PM2.5), 2025
Source: PLOS Global Public Health, 2025 | Georgian Medical Journal News
Pollution levels track closely with symptom severity
The timing of the survey was deliberate: January dates in both cities corresponded to peak pollution season, with fine particulate matter (PM2.5) concentrations exceeding 55.5 µg/m³, whilst March surveys coincided with improved air quality (PM2.5 ≤ 35.4 µg/m³). This design allowed researchers to isolate pollution’s acute health effects within the same population, controlling for seasonal and demographic factors.
According to the study by Bwire and colleagues at the London School of Hygiene and Tropical Medicine, associations between high-pollution days and symptoms remained statistically significant even after adjusting for age, gender, and other demographic variables. This persistence suggests direct physiological causation rather than confounding by other factors.
School absences and activity disruption increase during pollution peaks
Beyond acute health symptoms, the research documented substantial disruptions to daily functioning. Young people reported greater odds of being late to or missing school or work during high-pollution periods, alongside cancellations of social events, healthcare appointments, and meetings. The need for family assistance—such as help with household tasks or care—also increased significantly on high-pollution days.
These findings have particular significance for educational equity and public health planning in South Asia. According to the World Health Organization, children’s developing lungs are more susceptible to air pollution’s effects than those of adults, making school attendance and learning continuity vulnerable to pollution fluctuations.
Mental health and cognitive effects warrant closer attention
A noteworthy finding was the significant association between high-pollution days and mental health outcomes. Beyond itchy eyes and respiratory symptoms, young people reported elevated anxiety, stress, low mood, and difficulty concentrating during periods of high PM2.5 exposure. Sleep quality also declined during high-pollution days, a finding consistent with prior research on air pollution and sleep disruption.
These psychological and cognitive impacts extend the public health burden of air pollution beyond respiratory and cardiovascular disease—domains traditionally emphasized in outdoor air quality guidance. The study suggests that mental health and educational outcomes should be incorporated into air quality policy discussions and school closure decisions in heavily polluted cities.
High-pollution days were associated with significantly higher reports of itchy eyes, respiratory difficulties, headaches, skin irritation or rash, diarrhoea or vomiting, low mood, anxiety or stress, and difficulty concentrating, with these associations remaining significant after adjusting for demographics.
— Constance Bwire and colleagues, London School of Hygiene and Tropical Medicine (PLOS Global Public Health, 2025)
What this means
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Frequently asked questions
Why are children more vulnerable to air pollution than adults?
Children’s lungs are still developing, their breathing rate is higher (increasing pollutant inhalation per kilogramme of body weight), and their immune systems are less mature. According to the WHO, exposure during childhood can cause lifelong reductions in lung function and increased susceptibility to respiratory disease.
What is PM2.5 and why is it the focus of pollution monitoring?
PM2.5 refers to fine particulate matter smaller than 2.5 micrometres, which can penetrate deep into the lungs and bloodstream. The WHO recommends limiting annual PM2.5 exposure to 15 µg/m³, making the concentrations observed in Delhi and Dhaka (often exceeding 55 µg/m³ in winter) substantially above safe levels.
Can air pollution levels change rapidly enough to affect daily attendance?
Yes. The study’s survey design, comparing surveys just days apart, demonstrates that pollution fluctuates on timescales measured in days, making real-time air quality communication essential for parents and school administrators to respond effectively.
As cities across South Asia and beyond grapple with chronic air pollution, the evidence for its impact on youth health and educational continuity continues to mount. This research underscores the need for integrated environmental health policies that address not only respiratory disease prevention but also mental health support and educational resilience during high-pollution periods. Investment in clean air technologies and emissions reduction remains the most effective long-term intervention, but in the interim, real-time air quality monitoring and youth-centred health services can mitigate immediate harms.
Source: Real-time impacts of air pollution on the health, well-being, and daily life of children and young people in Delhi and Dhaka, PLOS Global Public Health, 2025
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