Skip to main content
Have a personal or library account? Click to login
Human Health Risk Assessment of PM2.5, NO2, and SO2 and its Impact on Mortality in Nkangala and Gert Sibande, South Africa Cover

Human Health Risk Assessment of PM2.5, NO2, and SO2 and its Impact on Mortality in Nkangala and Gert Sibande, South Africa

Open Access
|Aug 2025

References

  1. Health Effects Institute. State of Global Air. Published 2024. Accessed April 12, 2025. https://www.stateofglobalair.org/sites/default/files/documents/2024-06/soga-2024-report_0.pdf.
  2. Glenn BE, Espira LM, Larson MC, Larson PS. Ambient air pollution and non‑communicable respiratory illness in sub‑Saharan Africa: A systematic review of the literature. Environ Health Global Access Sci. 2022;21(1):40. doi:10.1186/s12940-022-00852-0.
  3. Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E. Environmental and health impacts of air pollution: A review. Front Public Health. 2020;8:14. doi:10.3389/fpubh.2020.00014.
  4. Tran HM, Tsai FJ, Lee YL, et al. The impact of air pollution on respiratory diseases in an era of climate change: A review of the current evidence. Sci Total Environ. 2023;898:166340. doi:10.1016/j.scitotenv.2023.166340.
  5. Lee BJ, Kim B, Lee K. Air pollution exposure and cardiovascular disease. Toxicol Res. 2014;30(2):7175. doi:10.5487/TR.2014.30.2.071.
  6. Mahiyuddin WR, Ismail R, Mohammad Sham N, Ahmad NI, Nik Hassan NM. Cardiovascular and respiratory health effects of fine particulate matters (PM2.5): A review on time series studies. Atmosphere. 2023;14(5):856. doi:10.3390/atmos14050856.
  7. Shetty SS, Deepthi D, Harshitha S, et al. Environmental pollutants and their effects on human health. Heliyon. 2023;9(9):e19496. doi:10.1016/j.heliyon.2023.e19496.
  8. Chandra M, Rai CB, Kumari N, et al. Air pollution and cognitive impairment across the life course in humans: A systematic review with specific focus on income level of study area. Int J Environ Res Public Health. 2022;19(3):1405. doi:10.3390/ijerph19031405.
  9. Christiani DC. Ambient air pollution and lung cancer: Nature and nurture. Am J Respir Crit Care Med. 2021;204(7):752753. doi:10.1164/rccm.202107-1576ED.
  10. Huang X, Chen J, Zeng D, et al. The association between ambient air pollution and birth defects in five major ethnic groups in Liuzhou, China. BMC Pediatr. 2021;21(1):232. doi:10.1186/s12887-021-02687-z.
  11. Ward C, Shukla SD, Walters EH. Air pollution as a risk factor for lung cancer: Potential mechanisms. Am J Respir Crit Care Med. 2022;205(3):367. doi:10.1164/rccm.202108-2010LE.
  12. Parliamentary Monitoring Group. Green peace report on air pollution in Mpumalanga: DEA, Eskom & Sasol responses. 2018. Accessed April 30, 2024. https://Pmg.Org.Za/Committee-Meeting/27603/.
  13. Millar DA, Kapwata T, Kunene Z. et al. Respiratory health among adolescents living in the Highveld air pollution priority area in South Africa. BMC Public Health. 2022;22(1):2136. doi:10.1186/s12889-022-14497-8.
  14. Stats SA. Census 2022, Provinces at a Glance. Statistics South Africa, report No. 03‑01‑43. Accessed April 30, 2024. https://census.statssa.gov.za/assets/documents/2022/provinces_at_a_Glance.pdf.
  15. DEA. Department of Environmental Affairs, South Africa, National Ambient Air Quality Standard for Particulate Matter with Aerodynamic Diameter Less Than 2.5 Micron Metres (PM2.5). June, 2012. Accessed April 30, 2024. https://www.gov.za/sites/default/files/gcis_document/201409/35463gon486.pdf.
  16. Olufemi AC, Mji A, Mukhola MS. Health risks of exposure to air pollutants among students in schools in the vicinities of coal mines. Energ Explor Exploitation. 2018;37(6):16381656. doi:10.1177/0144598718765489.
  17. Maji KJ, Dikshit AK, Deshpande A. Human health risk assessment due to air pollution in 10 urban cities in Maharashtra, India. Cogent Environ Sci. 2016;2(1):1193110. doi:10.1080/23311843.2016.1193110.
  18. Bhat HT, Jiawen G, Farzaneh H. Air pollution health risk assessment (AP‑HRA), principles and applications. Int J Environ Res Public Health. 2021;18(4):1935. doi:10.3390/ijerph18041935.
  19. Alfeus A, Molnar P, Boman J, Shirinde J, Wichmann J. Inhalation health risk assessment of ambient PM2.5 and associated trace elements in Cape Town, South Africa. Hum Ecol Risk Assess. 2022;28(8):917929. doi:10.1080/10807039.2022.2110449.
  20. Edlund KK, Killman F, Molnár P, Boman J, Stockfelt L, Wichmann J. Health risk assessment of PM2.5 and PM2.5‑bound trace elements in Thohoyandou, South Africa. Int J Environ Res Public Health. 2021;18(3):1359. doi:10.3390/ijerph18031359.
  21. Howlett‑Downing C, Boman J, Molnár P, Shirinde J, Wichmann J. Health risk assessment of PM2.5 and PM2.5 ‑bound trace elements in Pretoria, South Africa. J Environ Sci Health A. 2023;58(4):342358. doi:10.1080/10934529.2023.2186653.
  22. Morakinyo OM, Mukhola MS, Mokgobu MI. Ambient gaseous pollutants in an Urban area in South Africa: Levels and potential human health risk. Atmosphere. 2020;11(7):751. doi:10.3390/atmos11070751.
  23. Okello NO, Okello TW, Zunckel M. Changes in health risk associated with air pollution and policy response effectiveness, Richards Bay, South Africa. Clean Air J. 2020;30(1):110. doi:10.17159/caj/2020/30/1.8012.
  24. Ncipha X. Highveld Priority Area Air Quality Monitoring Network Monthly Report – March 2020. Pretoria: South African Weather Service; 2020
  25. Walton NM, Piketh SJ, van Zyl P, et al. Source apportionment of ambient fine and coarse aerosols in Embalenhle and Kinross, South Africa. Clean Air J. 2021;31(2).
  26. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: A systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):12231249. doi:10.1016/S0140-6736(20)30752-2.
  27. Norman R, Cairncross E, Witi J, Bradshaw D, Group SACRAC. Estimating the burden of disease attributable to urban outdoor air pollution in South Africa in 2000. S Afr Med J. 2007;97(8 Pt 2):782790.
  28. Zapata‑Diomedi B, Barendregt JJ, Veerman JL. Population attributable fraction: Names, types and issues with incorrect interpretation of relative risks. Br J Sports Med. 2018;52(4):212213. doi:10.1136/bjsports-2015-095531.
  29. Republic of South Africa, DFFE, & SAWS. South African air quality information system. 2024. Accessed April 30, 2024. https://saaqis.environment.gov.za/.
  30. US‑EPA. National Ambient Air Quality Standards (NAAQS) for PM. 2024. Accessed April 12, 2025. https://www.epa.gov/pm-pollution/national-ambient-air-quality-standards-naaqs-pm.
  31. Republic of South Africa. Government Gazette: South African National Air Quality Guidelines. 2023. Accessed April 12, 2025. https://www.dffe.gov.za/sites/default/files/legislation/2023-09/nemaqa_pa.airqualitymanagementplan_g48211gon3152.pdf.
  32. WHO. WHO global air quality guidelines: Particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. 2021. Accessed April 29, 2024. https://www.ncbi.nlm.nih.gov/books/NBK574594/.
  33. Wigenstam E, Elfsmark L, Bucht A, Jonasson S. Inhaled sulfur dioxide causes pulmonary and systemic inflammation leading to fibrotic respiratory disease in a rat model of chemical‑induced lung injury. Toxicology. 2016;368‑369:2836.
  34. Frampton MW, Boscia J, Roberts NJ Jr, et al. Nitrogen dioxide exposure: Effects on airway and blood cells. Am J Physiol Lung Cell Mol Physiol. 2002;282(1):L155L165.
  35. Garland R, Wernecke B, Feig G, Langerman K. The new WHO global air quality guidelines: What do they mean for South Africa? Clean Air J. 2021;31(2):12. doi:10.17159/caj/2020/31/2.12915.
  36. USEPA. Chapter 7: Characterizing Risk and Hazard. In: Human Health Risk Assessment Protocol. U.S. Environmental Protection Agency; 2005.
  37. Yitshak‑Sade M, Bobb JF, Schwartz JD, Kloog I, Zanobetti A. The association between short and long‑term exposure to PM2.5 and temperature and hospital admissions in New England and the synergistic effect of the short‑term exposures. Sci Total Environ. 2018;639:868875. doi:10.1016/j.scitotenv.2018.05.181.
  38. Josipovic M, Annegarn HJ, Kneen MA, Pienaar JJ, Piketh SJ. Concentrations, distributions and critical level exceedance assessment of SO2, NO2 and O3 in South Africa. Environ Monit Assess. 2009;171(1–4):181196. doi:10.1007/s10661-009-1270-5.
  39. Jury MR. Statistics and meteorology of air pollution episodes over the South African Highveld based on satellite–model datasets. J Appl Meteorol Climatol. 2010;56(6):15831594. doi:10.1175/JAMC-D-16-0354.1.
  40. Language B, Piketh SJ, Wernecke B, Burger R. Household air pollution in South African low‑income settlements: A case study.viron. WIT Trans Ecol Environ. 2016;201(1):227236. doi:10.2495/AIR160211.
  41. Lourens AS, Beukes JP, Van Zyl PG, et al. Spatial and temporal assessment of gaseous pollutants in the Highveld of South Africa. S Afr J Sci. 2011;107(1/2):8. doi:10.4102/sajs.v107i1/2.269.
  42. Wright CY, Oosthuizen R, John J, et al. Air quality and human health among a low income community in the Highveld Priority Area. Clean Air J. 2011;20(1):1220. doi:10.17159/caj/2011/20/1.7180.
  43. Adebayo‑Ojo TC, Wichmann J, Arowosegbe OO, Probst‑Hensch N, Schindler C, Künzli N. Short‑term effects of PM10, NO2, SO2 and O3 on cardio‑respiratory mortality in Cape Town, South Africa, 2006–2015. Int J Environ Res Public Health. 2022;19(13):8078. doi:10.3390/ijerph19138078.
  44. Roomaney RA, Wright CY, Cairncross E, et al. Estimating the burden of disease attributable to household air pollution from cooking with solid fuels in South Africa for 2000, 2006 and 2012. S Afr Med J. 2022;112(8b):718728. doi:10.7196/SAMJ.2022.v112i8b.16474.
  45. Shirinde J, Wichmann J. Temperature modifies the association between air pollution and respiratory disease mortality in Cape Town, South Africa. Int J Environ Health Res. 2023;33(11):11221131. doi:10.1080/09603123.2022.2076813.
  46. Simelane SP, Langerman KE. The sensitivity of health impact assessments of PM2.5 from South African coal‑fired power stations. Air Qual Atmos Health. 2023;17(2):325340. doi:10.1007/s11869-023-01447-5.
  47. Thabethe NDL, Voyi K, Wichmann J. Association between ambient air pollution and cause‑specific mortality in Cape Town, Durban, and Johannesburg, South Africa: Any susceptible groups? Environ Sci Pollut Res Int. 2021;28(31):4286842876. doi:10.1007/s11356-021-13778-w.
  48. Wichmann J, Voyi K. Ambient air pollution exposure and respiratory, cardiovascular and cerebrovascular mortality in Cape Town, South Africa: 2001–2006. Int J Environ Res Public Health. 2012;9(11):39784016. doi:10.3390/ijerph9113978.
  49. Feig G, Garland RM, Naidoo S, Maluleke A, van der Merwe M. Assessment of changes in concentrations of selected criteria pollutants in the Vaal and Highveld Priority Areas. Clean Air J. 2019;29(2):113. doi:10.17159/caj/2019/29/2.7464.
  50. Kelly FJ. Oxidative stress: Its role in air pollution and adverse health effects. Occup Environ Med. 2003;60(8):612616. doi:10.1136/oem.60.8.612.
  51. Thomson EM. Air pollution, stress, and allostatic load: Linking systemic and central nervous system impacts. J Alzheimers Dis. 2019;69(3):597614. doi:10.3233/JAD-190015.
  52. Feng S, Gao D, Liao F, Zhou F, Wang X. The health effects of ambient PM2.5 and potential mechanisms. Ecotoxicol Environ Saf. 2016;128:6774. doi:10.1016/j.ecoenv.2016.01.030.
  53. Sharma S, Chandra M, Kota SH. Health effects associated with PM2.5: A systematic review. Curr Pollut Rep. 2020;6(4):345367. doi:10.1007/s40726-020-00155-3.
  54. Sun Y, Milando CW, Spangler KR, et al. Short term exposure to low level ambient fine particulate matter and natural cause, cardiovascular, and respiratory morbidity among US adults with health insurance: Case time series study. BMJ. 2024;384:e076322. doi:10.1136/bmj-2023-076322.
  55. Kloog I, Ridgway B, Koutrakis P, Coull BA, Schwartz JD. Long‑ and short‑term exposure to PM2.5 and mortality. Epidemiol. 2013;24(4):555561. doi:10.1097/EDE.0b013e318294beaa.
  56. Chen C, Zhu P, Lan L, et al. Short‑term exposures to PM2.5 and cause‑specific mortality of cardiovascular health in China. Environ Res. 2018;161:188194. Accessed April 25, 2024.
  57. Brunekreef B, Strak M, Chen J, et al. Mortality and morbidity effects of long‑term exposure to low‑level PM2.5, BC, NO2, and O3: An analysis of European cohorts in the ELAPSE project. Res Rep Health Eff Inst. 2021;2021(208):1127.
  58. Yu W, Guo Y, Shi L, Li S. The association between long‑term exposure to low‑level PM2.5 and mortality in the state of Queensland, Australia: A modelling study with the difference‑in‑differences approach. PLOS Med. 2020;17(6):e1003141. doi:10.1371/journal.pmed.1003141.
  59. Amnuaylojaroen T, Parasin N. Future health risk assessment of exposure to PM2.5 in different age groups of children in Northern Thailand. Toxics. 2023;11(3):291. 10.3390/toxics11030291.
  60. Altieri KE, Keen SL. Public health benefits of reducing exposure to ambient fine particulate matter in South Africa. Sci Total Environ. 2019;684:610620. doi:10.1016/j.scitotenv.2019.05.355.
  61. Lindeque LF, Burger RP, Piketh SJ. The health and economic benefits of reduced residential solid fuel burning on the South African Highveld. Atmosphere. 2021;12(11):1405. doi:10.3390/atmos12111405.
  62. Matandirotya NR, Burger RP. Spatiotemporal variability of tropospheric NO2 over four megacities in Southern Africa: Implications for transboundary regional air pollution. Environ Challenges. 2021;5:100271. doi:10.1016/j.envc.2021.100271.
  63. Orellano P, Reynoso J, Quaranta N. Short‑term exposure to sulphur dioxide (SO2) and all‑cause and respiratory mortality: A systematic review and meta‑analysis. Environ Int. 2019;150:106434. doi:10.1016/j.envint.2021.106434.
  64. Huang Y, Zhu M, Ji M, et al. Air pollution, genetic factors, and the risk of lung cancer: A prospective study in the UK biobank. Am J Respir Crit Care Med. 2021;204(7):817825. doi:10.1164/rccm.202011-4063OC.
  65. Wang M, Li H, Huang S, et al. Short‑term exposure to nitrogen dioxide and mortality: A systematic review and meta‑analysis. Environ Res. 2021;202:111766. doi:10.1016/j.envres.2021.111766.
  66. Kobayashi Y, Santos JM, Mill JG, et al. Mortality risks due to long‑term ambient sulphur dioxide exposure: Large variability of relative risk in the literature. Environ Sci Pollut Res. 2020;27(29):3590835917. doi:10.1007/s11356-020-07867-5.
DOI: https://doi.org/10.5334/aogh.4779 | Journal eISSN: 2214-9996
Language: English
Submitted on: Apr 22, 2025
Accepted on: Aug 7, 2025
Published on: Aug 29, 2025
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2025 Danielle A Millar, Marcus A Howard, Natasha Naidoo, Thandi Kapwata, Riëtha Oosthuizen, Caradee Wright, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.