The project AIRQALI 4 ASMAFRI (hence A4A) will examine the air pollution-asthma relationship in urban West Africa, where different types of air pollution sources (anthropogenic and natural) are combined. A4A will focus on asthma in children in sub-Saharan Africa because: i) This complex chronic inflammatory disease of the respiratory tract is an excellent model for studying the health impacts of air pollution; ii) Sub-Saharan Africa is the low- and middle-income region of the world where asthma prevalence among adolescents (13-14 years) is highest (15.3%); iii) Asthma is under-recognised, under-diagnosed, under-treated, and insufficiently prevented in this region. It is a major noncommunicable disease which remains little studied and not sufficiently considered in public policy priorities in Africa, including Benin. A4A will be based in Cotonou, the economic capital of Benin, which is particularly affected by air pollution. Traffic-related pollution is one of the main contributors to air pollution, especially near some schools in the inner city where NO2 levels are high. Annual average concentrations of PM2.5 are also well above the WHO guideline, as are VOCs (benzene), ultrafine particles associated with polycyclic aromatic hydrocarbons (PAHs). A4A aims to amplify evidence-based decision-making of policy actors on health and air quality issues. The project's research efforts will aim to demonstrate that a less polluted air both indoors and outdoors can help alleviate the burden of asthma in children by reducing asthma exacerbations and improving lung capacity. Because the project is solution oriented, A4A will show that health literacy in children and their families on asthma and the provision of real-time air pollution information promote more protective behaviours, more effective care, and better children’s quality of life. A4A will also provide policy support and technical guidance - locally adapted and meeting country-specific needs – to manage air pollution health risks and set up an air quality warning system. To achieve these goals, we set the following objectives: Implement: • A long-term follow-up (3 years) of a schoolchildren cohort (aged 13-14 years) with diagnosed asthma; and the collection for the first time in Africa of environmental, social, and medical data to better understand the links between air pollution and asthma in children. • A cohort-targeted air pollution warning system, with sensors in schools and living areas. Produce: • Time series at local scale of air pollution exposure to PMs. • Measurements of personal exposure to pollutants as a continuum, in indoors (household, classroom, etc.) and outdoors (during outdoor activities and school-home commuting, etc.). • Unbiased and repeated measurements of lung function, oxidative stress, and airway inflammation in children with asthma. Analyse: • Characterise air pollutants and children’s exposure (indoor and outdoor). Analyse the nature and toxicity of primary contaminants, and measure the external exposure dose, personal exposure (school/commute/home) and their biological effects (biomarkers). • Determine pollutant thresholds in relation to asthma risks. Model the relationship between pollution, weather factors and exacerbation episodes. • Identify the modifiable risk factors by controlling confounding variables. Study the role of environmental factors in asthma and of socio-spatial vulnerability factors on air pollution exposure related to child asthma. Provide: • A demonstrator to model future urban air pollution scenarios and their health impacts. • The development of a self-management care package, including personalized health education and counselling using the project’s datasets. • Training materials to support capacity building for college teachers and health staff to raise awareness about exposure to air pollution and adverse health effects among schoolchildren. • A project for a pre-operational air pollution warning system in Cotonou.