Pesticide use and serum acetylcholinesterase levels among flower farm workers in Ethiopia—a cross-sectional study

The flower industry in East Africa has grown in recent years, especially in the production and export of roses. The aim of this study was to assess pesticide use on selected flower farms in Ethiopia. Serum cholinesterase levels in workers were used as a marker of pesticide exposure. This study was a cross-sectional study involving 588 workers from 15 different flower farms. It had a response rate of 95.5%. The participants included 277 males (mean age 26 years; 148 pesticide sprayers and 129 non-sprayers) and 311 females (mean age 25 years; 156 working in greenhouses and 155 working outside the greenhouses). The researchers undertook structured interviews, blood sampling, and walkthrough surveys. Descriptive statistics and Poisson regression were used in the statistical analyses. A total of 154 different trade names of pesticides were found. Of them, 31 (27%) were classified as moderately hazardous by the WHO, and 9% were organophosphates. Serum levels of cholinesterase deviating from 50–140 Michel units were considered abnormal. Abnormal serum cholinesterase levels (above 140 Michel units) were found in 97 participants (16.5%, 95% confidence interval 13.7–19.7%). There were no differences between the four job groups regarding cholinesterase levels. The high prevalence of abnormal serum cholinesterase levels might indicate the presence of pesticide intoxication. Thus, there is a need for routine monitoring of all workers exposed to pesticides, not only sprayers.publishedVersio

Dust Exposure, Fractional Exhaled Nitric Oxide and Respiratory Symptoms among Volcanic Rock Miners in Kilimanjaro, Tanzania

Volcanic rock for use as building material is mined extensively in the North Eastern Region of Tanzania. Dust emitted from the rock may contain harmful elements such as crystalline silica, arsenic (As), cobalt (Co), boron (B) and mercury (Hg) which might contribute to severity and onset of health symptoms. Objective: This study assessed respiratory symptoms and fractional exhaled nitric oxide as a marker for respiratory inflammation in relation to dust exposure among workers in different job sections in volcanic block mining. Materials and Methods: A cross-sectional study assessed a total of 135 workers in which 70 were exposed and 65 none exposed. The mining activities are mainly manual, and include cutting of blocks underground, transporting blocks to the shaping area, shaping blocks, loading blocks and aggregates (Murom) to vehicles and clearing or expanding the site. Respiratory health questionnaires were administered through face–to-face interviews. A total of 28 samples of “total” dust were collected around the breathing zone of the workers using SKC Sidekick pump (model 224–50) with a flow rate of 2.0 l/min. FENO assessed respiratory system inflammation using a portable electrochemistry-based sensor (NIOX MINO). Findings: The overall arithmetic mean concentration of personal total dust exposure among the workers was 4.37 mg/m3 (range 0.15-20.84). The prevalence of acute cough and red eyes were significantly higher among exposed than among non exposed (35% vs 10% and 45% vs 14%, respectively). The ANOVA Boniferroni test showed a significant difference in mean FENO between stone cutters and none exposed (P = 0.005). Conclusions: This study suggests the strong association between working as a stone cutting and shaping with respiratory inflammation. There is a need for respiratory mask type P2 use to protect workers from the exposure. There is also need for the follow up study involving cohorts of all workers happened to be in the mine

Patterns of pesticide usage in agriculture in rural Tanzania call for integrating agricultural and public health practices in managing insecticide-resistance in malaria vectors.

BACKGROUND: Unrestricted use of pesticides in agriculture is likely to increase insecticide resistance in mosquito vectors. Unfortunately, strategies for managing insecticide resistance in agriculture and public health sectors lack integration. This study explored the types and usage of agricultural pesticides, and awareness and management practices among retailers and farmers in Ulanga and Kilombero districts in south-eastern Tanzania, where Anopheles mosquitoes are resistant to pyrethroids. METHODS: An exploratory sequential mixed-methods approach was employed. First, a survey to characterize pesticide stocks was conducted in agricultural and veterinary (agrovet) retail stores. Interviews to assess general knowledge and practices regarding agricultural pesticides were performed with 17 retailers and 30 farmers, followed by a survey involving 427 farmers. Concurrently, field observations were done to validate the results. RESULTS: Lambda-cyhalothrin, cypermethrin (both pyrethroids) and imidacloprids (neonicotinoids) were the most common agricultural insecticides sold to farmers. The herbicide glyphosate (amino-phosphonates) (59.0%), and the fungicides dithiocarbamate and acylalanine (54.5%), and organochlorine (27.3%) were also readily available in the agrovet shops and widely used by farmers. Although both retailers and farmers had at least primary-level education and recognized pesticides by their trade names, they lacked knowledge on pest control or proper usage of these pesticides. Most of the farmers (54.4%, n = 316) relied on instructions from pesticides dealers. Overall, 93.7% (400) farmers practised pesticides mixing in their farms, often in close proximity to water sources. One-third of the farmers disposed of their pesticide leftovers (30.0%, n = 128) and most farmers discarded empty pesticide containers into rivers or nearby bushes (55.7%, n = 238). CONCLUSION: Similarities of active ingredients used in agriculture and malaria vector control, poor pesticide management practices and low-levels of awareness among farmers and pesticides retailers might enhance the selection of insecticide resistance in malaria vectors. This study emphasizes the need for improving awareness among retailers and farmers on proper usage and management of pesticides. The study also highlights the need for an integrated approach, including coordinated education on pesticide use, to improve the overall management of insecticide resistance in both agricultural and public health sectors

A call from 40 public health scientists for an end to the continuing humanitarian and environmental catastrophe in Gaza

Abstract An under-recognised aspect of the current humanitarian catastrophe in Gaza is the impact of the war on the environment and the associated risks for human health. This commentary contextualises these impacts against the background of human suffering produced by the overwhelming violence associated with the use of military force against the general population of Gaza. In calling for an immediate cessation to the violence, the authors draw attention to the urgent need to rebuild the health care system and restore the physical and human infrastructure that makes a liveable environment possible and promotes human health and well-being, especially for the most vulnerable in the population. Environmental remediation should therefore form one of the most important parts of international efforts to assist reconstruction, through which we hope Palestinians and Israelis will achieve lasting peace, health, and sustainable development, all as part of accepted international human rights obligations

Health Impact of Exposure to Pesticides in Agriculture in Tanzania

AIM The aim of the study was to assess health hazards posed by pesticide handling, storage and use on agricultural estates and small farms in Tanzania where coffee, cotton, and other important crops are grown, with a view to developing strategies for the control of pesticide exposure and prevention of pesticide poisoning. METHODS The target population was made up of farmers and other agricultural workers applying pesticides in coffee and cotton farms, as well as of non-agricultural control subjects, health care providers and extension workers in the same areas. -Background data were collected -Focused observations of target farms carried out, -Erythrocyte-acetylcholinesterase and organochlorine residue levels in blood samples determined and -Extensive interviews of agricultural workers, control subjects, health care providers, and extension service workers conducted. RESULTS Background data A total of 104 pesticide chemical names and 179 trade names were compiled in Tanzania. Most of the pesticides were organophosphates, but carbamates, organochlorines, and pyrethroids were also represented. The pesticides included aldrin, endosulfan, DDT, dieldrin, camphechlor and lindane, which are either endocrine disruptors or persistent organic pollutants, and were banned or restricted in their countries of origin. Some were classified by World Health Organization as extremely or highly hazardous. For the period 1989/90, a total of 736 pesticide-poisoning cases were reported in the Tanzanian in-patient district hospital medical records with more women than men poisoned, however, the medical records were inadequate as they failed to show the cause or type of poisoning. Focused observations More pesticide formulations were used on coffee compared with cotton, and in individually owned compared with cooperative farms. Coffee farms more often displayed unlabeled pesticide containers and missing instructions, while cotton pesticides were stored in bedrooms, near food, and near open fires, and pesticide leftovers were often present. Hazardous practices were more pronounced at the individually owned than the cooperative farms, with significant differences for pesticide storage areas, unlabeled and non-original containers. Acute health effects Assessment of the extent and intensity of organophosphate exposure showed that erythrocyte acetylcholinesterase activities during spraying and non-spraying period were comparable. Similarly, the prevalence of cough, headache, abdominal pain, excessive sweating, nausea, diarrhoea, and vomiting did not differ significantly between spraying and non-spraying periods. There was no suggestion of decreased acetylcholinesterase activity in exposed subjects who complained of organophosphate­related symptoms compared to symptomless exposed subjects. Use of boots, head cover, face cover, and coverall was not significantly associated with acetylcholinesterase activity. Pesticide knowledge and practices in health care and agricultural extension services. Eighty per cent of 104 health care providers interviewed reported to have seen pesticide poisoning, nine having seen two to four cases in the preceding three months. Pesticide poisoning was considered a major problem in the community by 63% of the health care providers, and a third thought that a number of poisoning cases remained unrecognised. Only one percent of the respondents could identify the group of pesticides predominantly used in the study areas. Only every fourth of the agricultural extension workers perceived pesticides as a major health problem in the community they served. Although high proportion claimed knowledge of first aid procedures in case of pesticide poisoning, many procedures described were not appropriate for the treatment of pesticide poisoning. CONCLUSION Pesticide handling-practices on farms increased the risks of exposure of farm workers and their families to pesticides, thus undermining pesticide safety in many small farms in Tanzania. There was no strong indication for adverse effects of organophosphorus pesticides during the study period, either based on erythrocyte acetylcholinesterase or on symptoms. However, a great concern over potential long-term effects arising from the use of pesticides in these areas is eminent because pesticides suspected of long-term adverse effects are being used in hazardous work and living conditions. The extensionists were not aware of the health effects of pesticides and did not know what measures should be taken in case of poisoning. The failure of health care providers to distinguish the pesticide class, e.g. organophosphates and organochlorines, reflects a lack of understanding of the fundamental principles of diagnosis and treatment of pesticide poisoning, and may have a great impact on the prognosis. It also undermines the medical recording system especially for pesticide poisoning incidences. Therefore, pesticide exposures need to be reduced. Health care provides and extensionists need empowerment for prevention and treatment of adverse health effects.AIM The aim of the study was to assess health hazards posed by pesticide handling, storage and use on agricultural estates and small farms in Tanzania where coffee, cotton, and other important crops are grown, with a view to developing strategies for the control of pesticide exposure and prevention of pesticide poisoning. METHODS The target population was made up of farmers and other agricultural workers applying pesticides in coffee and cotton farms, as well as of non-agricultural control subjects, health care providers and extension workers in the same areas. -Background data were collected -Focused observations of target farms carried out, -Erythrocyte-acetylcholinesterase and organochlorine residue levels in blood samples determined and -Extensive interviews of agricultural workers, control subjects, health care providers, and extension service workers conducted. RESULTS Background data A total of 104 pesticide chemical names and 179 trade names were compiled in Tanzania. Most of the pesticides were organophosphates, but carbamates, organochlorines, and pyrethroids were also represented. The pesticides included aldrin, endosulfan, DDT, dieldrin, camphechlor and lindane, which are either endocrine disruptors or persistent organic pollutants, and were banned or restricted in their countries of origin. Some were classified by World Health Organization as extremely or highly hazardous. For the period 1989/90, a total of 736 pesticide-poisoning cases were reported in the Tanzanian in-patient district hospital medical records with more women than men poisoned, however, the medical records were inadequate as they failed to show the cause or type of poisoning. Focused observations More pesticide formulations were used on coffee compared with cotton, and in individually owned compared with cooperative farms. Coffee farms more often displayed unlabeled pesticide containers and missing instructions, while cotton pesticides were stored in bedrooms, near food, and near open fires, and pesticide leftovers were often present. Hazardous practices were more pronounced at the individually owned than the cooperative farms, with significant differences for pesticide storage areas, unlabeled and non-original containers. Acute health effects Assessment of the extent and intensity of organophosphate exposure showed that erythrocyte acetylcholinesterase activities during spraying and non-spraying period were comparable. Similarly, the prevalence of cough, headache, abdominal pain, excessive sweating, nausea, diarrhoea, and vomiting did not differ significantly between spraying and non-spraying periods. There was no suggestion of decreased acetylcholinesterase activity in exposed subjects who complained of organophosphate­related symptoms compared to symptomless exposed subjects. Use of boots, head cover, face cover, and coverall was not significantly associated with acetylcholinesterase activity. Pesticide knowledge and practices in health care and agricultural extension services. Eighty per cent of 104 health care providers interviewed reported to have seen pesticide poisoning, nine having seen two to four cases in the preceding three months. Pesticide poisoning was considered a major problem in the community by 63% of the health care providers, and a third thought that a number of poisoning cases remained unrecognised. Only one percent of the respondents could identify the group of pesticides predominantly used in the study areas. Only every fourth of the agricultural extension workers perceived pesticides as a major health problem in the community they served. Although high proportion claimed knowledge of first aid procedures in case of pesticide poisoning, many procedures described were not appropriate for the treatment of pesticide poisoning. CONCLUSION Pesticide handling-practices on farms increased the risks of exposure of farm workers and their families to pesticides, thus undermining pesticide safety in many small farms in Tanzania. There was no strong indication for adverse effects of organophosphorus pesticides during the study period, either based on erythrocyte acetylcholinesterase or on symptoms. However, a great concern over potential long-term effects arising from the use of pesticides in these areas is eminent because pesticides suspected of long-term adverse effects are being used in hazardous work and living conditions. The extensionists were not aware of the health effects of pesticides and did not know what measures should be taken in case of poisoning. The failure of health care providers to distinguish the pesticide class, e.g. organophosphates and organochlorines, reflects a lack of understanding of the fundamental principles of diagnosis and treatment of pesticide poisoning, and may have a great impact on the prognosis. It also undermines the medical recording system especially for pesticide poisoning incidences. Therefore, pesticide exposures need to be reduced. Health care provides and extensionists need empowerment for prevention and treatment of adverse health effects

Health Impact of Exposure to Pesticides in Agriculture in Tanzania

AIM The aim of the study was to assess health hazards posed by pesticide handling, storage and use on agricultural estates and small farms in Tanzania where coffee, cotton, and other important crops are grown, with a view to developing strategies for the control of pesticide exposure and prevention of pesticide poisoning. METHODS The target population was made up of farmers and other agricultural workers applying pesticides in coffee and cotton farms, as well as of non-agricultural control subjects, health care providers and extension workers in the same areas. -Background data were collected -Focused observations of target farms carried out, -Erythrocyte-acetylcholinesterase and organochlorine residue levels in blood samples determined and -Extensive interviews of agricultural workers, control subjects, health care providers, and extension service workers conducted. RESULTS Background data A total of 104 pesticide chemical names and 179 trade names were compiled in Tanzania. Most of the pesticides were organophosphates, but carbamates, organochlorines, and pyrethroids were also represented. The pesticides included aldrin, endosulfan, DDT, dieldrin, camphechlor and lindane, which are either endocrine disruptors or persistent organic pollutants, and were banned or restricted in their countries of origin. Some were classified by World Health Organization as extremely or highly hazardous. For the period 1989/90, a total of 736 pesticide-poisoning cases were reported in the Tanzanian in-patient district hospital medical records with more women than men poisoned, however, the medical records were inadequate as they failed to show the cause or type of poisoning. Focused observations More pesticide formulations were used on coffee compared with cotton, and in individually owned compared with cooperative farms. Coffee farms more often displayed unlabeled pesticide containers and missing instructions, while cotton pesticides were stored in bedrooms, near food, and near open fires, and pesticide leftovers were often present. Hazardous practices were more pronounced at the individually owned than the cooperative farms, with significant differences for pesticide storage areas, unlabeled and non-original containers. Acute health effects Assessment of the extent and intensity of organophosphate exposure showed that erythrocyte acetylcholinesterase activities during spraying and non-spraying period were comparable. Similarly, the prevalence of cough, headache, abdominal pain, excessive sweating, nausea, diarrhoea, and vomiting did not differ significantly between spraying and non-spraying periods. There was no suggestion of decreased acetylcholinesterase activity in exposed subjects who complained of organophosphate­related symptoms compared to symptomless exposed subjects. Use of boots, head cover, face cover, and coverall was not significantly associated with acetylcholinesterase activity. Pesticide knowledge and practices in health care and agricultural extension services. Eighty per cent of 104 health care providers interviewed reported to have seen pesticide poisoning, nine having seen two to four cases in the preceding three months. Pesticide poisoning was considered a major problem in the community by 63% of the health care providers, and a third thought that a number of poisoning cases remained unrecognised. Only one percent of the respondents could identify the group of pesticides predominantly used in the study areas. Only every fourth of the agricultural extension workers perceived pesticides as a major health problem in the community they served. Although high proportion claimed knowledge of first aid procedures in case of pesticide poisoning, many procedures described were not appropriate for the treatment of pesticide poisoning. CONCLUSION Pesticide handling-practices on farms increased the risks of exposure of farm workers and their families to pesticides, thus undermining pesticide safety in many small farms in Tanzania. There was no strong indication for adverse effects of organophosphorus pesticides during the study period, either based on erythrocyte acetylcholinesterase or on symptoms. However, a great concern over potential long-term effects arising from the use of pesticides in these areas is eminent because pesticides suspected of long-term adverse effects are being used in hazardous work and living conditions. The extensionists were not aware of the health effects of pesticides and did not know what measures should be taken in case of poisoning. The failure of health care providers to distinguish the pesticide class, e.g. organophosphates and organochlorines, reflects a lack of understanding of the fundamental principles of diagnosis and treatment of pesticide poisoning, and may have a great impact on the prognosis. It also undermines the medical recording system especially for pesticide poisoning incidences. Therefore, pesticide exposures need to be reduced. Health care provides and extensionists need empowerment for prevention and treatment of adverse health effects.AIM The aim of the study was to assess health hazards posed by pesticide handling, storage and use on agricultural estates and small farms in Tanzania where coffee, cotton, and other important crops are grown, with a view to developing strategies for the control of pesticide exposure and prevention of pesticide poisoning. METHODS The target population was made up of farmers and other agricultural workers applying pesticides in coffee and cotton farms, as well as of non-agricultural control subjects, health care providers and extension workers in the same areas. -Background data were collected -Focused observations of target farms carried out, -Erythrocyte-acetylcholinesterase and organochlorine residue levels in blood samples determined and -Extensive interviews of agricultural workers, control subjects, health care providers, and extension service workers conducted. RESULTS Background data A total of 104 pesticide chemical names and 179 trade names were compiled in Tanzania. Most of the pesticides were organophosphates, but carbamates, organochlorines, and pyrethroids were also represented. The pesticides included aldrin, endosulfan, DDT, dieldrin, camphechlor and lindane, which are either endocrine disruptors or persistent organic pollutants, and were banned or restricted in their countries of origin. Some were classified by World Health Organization as extremely or highly hazardous. For the period 1989/90, a total of 736 pesticide-poisoning cases were reported in the Tanzanian in-patient district hospital medical records with more women than men poisoned, however, the medical records were inadequate as they failed to show the cause or type of poisoning. Focused observations More pesticide formulations were used on coffee compared with cotton, and in individually owned compared with cooperative farms. Coffee farms more often displayed unlabeled pesticide containers and missing instructions, while cotton pesticides were stored in bedrooms, near food, and near open fires, and pesticide leftovers were often present. Hazardous practices were more pronounced at the individually owned than the cooperative farms, with significant differences for pesticide storage areas, unlabeled and non-original containers. Acute health effects Assessment of the extent and intensity of organophosphate exposure showed that erythrocyte acetylcholinesterase activities during spraying and non-spraying period were comparable. Similarly, the prevalence of cough, headache, abdominal pain, excessive sweating, nausea, diarrhoea, and vomiting did not differ significantly between spraying and non-spraying periods. There was no suggestion of decreased acetylcholinesterase activity in exposed subjects who complained of organophosphate­related symptoms compared to symptomless exposed subjects. Use of boots, head cover, face cover, and coverall was not significantly associated with acetylcholinesterase activity. Pesticide knowledge and practices in health care and agricultural extension services. Eighty per cent of 104 health care providers interviewed reported to have seen pesticide poisoning, nine having seen two to four cases in the preceding three months. Pesticide poisoning was considered a major problem in the community by 63% of the health care providers, and a third thought that a number of poisoning cases remained unrecognised. Only one percent of the respondents could identify the group of pesticides predominantly used in the study areas. Only every fourth of the agricultural extension workers perceived pesticides as a major health problem in the community they served. Although high proportion claimed knowledge of first aid procedures in case of pesticide poisoning, many procedures described were not appropriate for the treatment of pesticide poisoning. CONCLUSION Pesticide handling-practices on farms increased the risks of exposure of farm workers and their families to pesticides, thus undermining pesticide safety in many small farms in Tanzania. There was no strong indication for adverse effects of organophosphorus pesticides during the study period, either based on erythrocyte acetylcholinesterase or on symptoms. However, a great concern over potential long-term effects arising from the use of pesticides in these areas is eminent because pesticides suspected of long-term adverse effects are being used in hazardous work and living conditions. The extensionists were not aware of the health effects of pesticides and did not know what measures should be taken in case of poisoning. The failure of health care providers to distinguish the pesticide class, e.g. organophosphates and organochlorines, reflects a lack of understanding of the fundamental principles of diagnosis and treatment of pesticide poisoning, and may have a great impact on the prognosis. It also undermines the medical recording system especially for pesticide poisoning incidences. Therefore, pesticide exposures need to be reduced. Health care provides and extensionists need empowerment for prevention and treatment of adverse health effects

Pesticide safety practice and its determinants among small scale vegetables farmers in Eyasi area, Arusha region Tanzania

Background: Strategies to achieve the millennium agricultural development goals include increased use of pesticides to increase agricultural production in poor countries. However, the increased availability and use of such chemicals need to be paralleled with national and personal level practices to maximize safety for communities and environment.Aim and methods: The aim of this study was to determine the pesticide safety practices among rural farmers in Karatu District in Northern Tanzania. Farmers practicing horticulture farming in Mang’ola Division were interviewed about their practices during and after pesticides application.Results: The study included 148 farmers of whom 79.7% were male. A significantly high proportion (77.7%) of the farmers did not use protective gear while applying pesticides. A notable percentage ate while applying pesticides (17.6%), one out of five took fluids and about a quarter smoked cigarettes. Factors found to be significantly associated with those practices were education, marital status, reporting frequent household spraying, long duration since starting to apply pesticides and farm size (p<0.05).Conclusions: Given the lack of protective behavior, it is then very important that farmers and farm workers are reminded of the hazardous nature of pesticides and the need to have their health monitored regularly. Special educational and information strategies have to focus on those with low education, who are unmarried, working on large farms and have a high frequency of applying pesticides. To enhance sustained education and supervisions, community level surveillance and supervisors could be introduced

Pesticide Exposure and Health Problems Among Female Horticulture Workers in Tanzania

Commercialization of horticulture farming, expansion of farms, and the practice of monoculture favor the proliferation of pests, which in turn increases the need for pesticides. Increased exposure to pesticides is associated with inadequate knowledge on the hazardous nature of pesticides, poor hygiene practices, lack of availability of washing facilities, and insufficient adherence to precautionary instructions on pesticide labels. Mitigating the risks posed by pesticides is considered a less compelling interest than alleviating poverty. Women working in horticulture in Tanzania usually have low levels of education and income and lack decision-making power even on matters relating to their own health. This contributes to pesticide exposure and other health challenges. Because of multiple factors, some of which act as study confounders, few studies on exposure to pesticides and health effects have been conducted among women. This review identified factors that contribute to the increased health effects among women working in the horticultural industry and how these effects relate to pesticide exposure

Additional file 1 of Patterns of pesticide usage in agriculture in rural Tanzania call for integrating agricultural and public health practices in managing insecticide-resistance in malaria vectors

Various pesticide classes and formulations found in the agrovet market and used by the farmers in the surveyed area

Potential health risks due to in-car aerosol exposure across ten global cities

Car microenvironments significantly contribute to the daily pollution exposure of commuters, yet health and socioeconomic studies focused on in-car exposure are rare. This study aims to assess the relationship between air pollution levels and socioeconomic indicators (fuel prices, city-specific GDP, road density, the value of statistical life (VSL), health burden and economic losses resulting from exposure to fine particulate matter ≤2.5 µm; PM2.5) during car journeys in ten cities: Dhaka (Bangladesh); Chennai (India); Guangzhou (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Blantyre (Malawi); and Dar-es-Salaam (Tanzania). Data collected by portable laser particle counters were used to develop a proxy of car-user exposure profiles. Hotspots on all city routes displayed higher PM2.5 concentrations and disproportionately high inhaled doses. For instance, the time spent at the hotspots in Guangzhou and Addis Ababa was 26% and 28% of total trip time, but corresponded to 54% and 56%, respectively, of the total PM2.5 inhaled dose. With the exception of Guangzhou, all the cities showed a decrease in per cent length of hotspots with an increase in GDP and VSL. Exposure levels were independent of fuel prices in most cities. The largest health burden related to in-car PM2.5 exposure was estimated for Dar-es-Salam (81.6 ± 39.3 μg m−3), Blantyre (82.9 ± 44.0) and Dhaka (62.3 ± 32.0) with deaths per 100,000 of the car commuting population per year of 2.46 (2.28–2.63), 1.11 (0.97–1.26) and 1.10 (1.05–1.15), respectively. However, the modest health burden of 0.07 (0.06–0.08), 0.10 (0.09–0.12) and 0.02 (0.02–0.03) deaths per 100,000 of the car commuting population per year were estimated for Medellin (23 ± 13.7 μg m−3), São Paulo (25.6 ± 11.7) and Sulaymaniyah (22.4 ± 15.0), respectively. Lower GDP was found to be associated with higher economic losses due to health burdens caused by air pollution in most cities, indicating a socioeconomic discrepancy. This assessment of health and socioeconomic parameters associated with in-car PM2.5 exposure highlights the importance of implementing plausible solutions to make a positive impact on peoples’ lives in these cities