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A high burden of chronic respiratory symptoms, spirometric abnormalities and air pollution exposures has been found in Malawian adults; whether the same would be true in children is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This cross-sectional study of children aged 6\u20138 years, in rural Malawi, included households from communities participating in the Cooking and Pneumonia Study (CAPS), a trial of cleaner-burning biomass-fuelled cookstoves. We assessed; chronic respiratory symptoms, anthropometry, spirometric abnormalities (using Global Lung Initiative equations) and personal carbon monoxide (CO) exposure. Prevalence estimates were calculated, and multivariable analyses were done.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We recruited 804 children (mean age 7.1 years, 51.9% female), including 476 (260 intervention; 216 control) from CAPS households. Chronic respiratory symptoms (mainly cough (8.0%) and wheeze (7.1%)) were reported by 16.6% of children. Average height-for-age and weight-for-age z-scores were \u22121.04 and \u22121.10, respectively. Spirometric abnormalities (7.1% low forced vital capacity (FVC); 6.3% obstruction) were seen in 13.0% of children. Maximum CO exposure and carboxyhaemoglobin levels (COHb) exceeded WHO guidelines in 50.1% and 68.5% of children, respectively. Children from CAPS intervention households had lower COHb (median 3.50% vs 4.85%, p=0.006) and higher FVC z-scores (\u22120.22 vs \u22120.44, p=0.05) than controls.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The substantial burden of chronic respiratory symptoms, abnormal spirometry and air pollution exposures in children in rural Malawi is concerning; effective prevention and control strategies are needed. Our finding of potential benefit in CAPS intervention households calls for further research into clean-air interventions to maximise healthy lung development in children.<\/jats:p><\/jats:sec>","DOI":"10.1136\/thoraxjnl-2018-212945","type":"journal-article","created":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T21:19:21Z","timestamp":1567113561000},"page":"1070-1077","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":39,"title":["Lung health and exposure to air pollution in Malawian children (CAPS): a cross-sectional study"],"prefix":"10.1136","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6459-9073","authenticated-orcid":false,"given":"Sarah","family":"Rylance","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Nightingale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Naunje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Mbalume","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Jewell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R","family":"Balmes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3109-6028","authenticated-orcid":false,"given":"Jonathan","family":"Grigg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8118-8871","authenticated-orcid":false,"given":"Kevin","family":"Mortimer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,29]]},"reference":[{"key":"2024092103201588000_74.11.1070.1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.14.0170"},{"key":"2024092103201588000_74.11.1070.2","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.14.0446"},{"key":"2024092103201588000_74.11.1070.3","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/S2213-2600(17)30293-X","article-title":"Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the global burden of Disease Study 2015","volume":"5","year":"2017","journal-title":"Lancet Respir Med"},{"key":"2024092103201588000_74.11.1070.4","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2008.106609"},{"key":"2024092103201588000_74.11.1070.5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2007.01325.x"},{"key":"2024092103201588000_74.11.1070.6","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1513\/AnnalsATS.201608-598OC","article-title":"Reduced forced vital capacity in an African population. 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