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The World Health Organization reports CRDs led to 4.1 million deaths in 2023, affecting 454.6 million people (5.54% globally). While tobacco smoking is the leading risk factor, others include air pollution, occupational hazards, childhood respiratory infections, and genetic predisposition. This study examines hydrology's role in CRD prevalence and spatial distribution, alongside household\u2010level factors. Using remote sensing, the Topographical Wetness Index (TWI) was calculated at 30\u00a0m resolution and linked to CRD prevalence data from 1,533 households across 15 income\u2010stratified neighborhoods in Dar es Salaam, Tanzania. Generalized linear mixed models, geovalidation, and ground truthing were employed for analysis. Results showed that CRD prevalence was significantly associated with higher TWI scores (OR\u00a0=\u00a01.18 [1.04, 1.33] per TWI unit increase,\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.009), with flood\u2010prone areas (TWI\u00a0\u2265\u00a015) exhibiting a ninefold greater risk (OR\u00a0=\u00a08.63 [2.13, 35]). Other independent risk factors included household size (OR\u00a0=\u00a01.15 [1.05, 1.25] per person,\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.003) and communal skip bin use (OR\u00a0=\u00a04.04 [1.04, 15.80],\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.045). Conversely, air conditioning reduced CRD risk (OR\u00a0=\u00a00.22 [0.06, 0.77],\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.017). Notably, neighborhood income was not directly associated with CRD prevalence after adjusting for other factors, indicating poverty acts as an indirect, rather than proximal, determinant. These findings link moist, mold\u2010prone environments to CRD risk, especially in urbanizing cities. Poor households often settle in flood\u2010prone areas due to affordability, underscoring hydrology's role in CRD disparities.\n                  <\/jats:p>","DOI":"10.1029\/2025gh001764","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T13:00:32Z","timestamp":1780405232000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Spatial Distribution of Chronic Respiratory Diseases in Dar es Salaam, Tanzania: Hydrological and Household Influences"],"prefix":"10.1029","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7878-5122","authenticated-orcid":false,"given":"Ibrahim","family":"Msuya","sequence":"first","affiliation":[{"name":"School of Biological, Earth and Environmental Sciences University College Cork  Cork Ireland"},{"name":"Department of Health Systems, Impact Evaluation and Policy Ifakara Health Institute  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Levira","sequence":"additional","affiliation":[{"name":"Department of Health Systems, Impact Evaluation and Policy Ifakara Health Institute  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Moshi","sequence":"additional","affiliation":[{"name":"Department of Health Systems, Impact Evaluation and Policy Ifakara Health Institute  Dar es Salaam Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"O'Dwyer","sequence":"additional","affiliation":[{"name":"School of Biological, Earth and Environmental Sciences University College Cork  Cork Ireland"},{"name":"Environmental Research Institute University College Cork  Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8583-8739","authenticated-orcid":false,"given":"Gerry F.","family":"Killeen","sequence":"additional","affiliation":[{"name":"School of Biological, Earth and Environmental Sciences University College Cork  Cork Ireland"},{"name":"Environmental Research Institute University College Cork  Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"13","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.applthermaleng.2014.03.055"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11869\u2010022\u201001277\u2010x"},{"issue":"2","key":"e_1_2_13_4_1","article-title":"Calculating topographic index using ArcGIS","volume":"4","author":"Ali H. 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