The Accra School Health and Environment Study (ASHES): A study of the urban environment and child health and development in Accra

Abstract Elementary school and early education are crucial for children’s cognitive and social development, as well as lifetime health and well-being. For children in cities, urban schools present numerous advantages in education quality and access to resources and opportunities that stimulate learning and improve health. In Sub-Saharan African (SSA) cities, the complexity of the urban environment requires careful consideration of school environments in enhancing child health and development. Yet, little is known about environmental conditions in schools and schoolchildren’s health in rapidly urbanizing SSA cities. This paper describes the various datasets captured within the Accra School Health and Environment Study (ASHES), a study platform designed to characterize air and noise pollution at elementary schools and for schoolchildren, and their influence on key markers of childhood health and development. We outline environmental exposures and health and developmental outcomes among children living in a major metropolitan area in SSA, along with preliminary results and planned analyses. ASHES was implemented in Accra, one of the fastest growing metropolises in SSA. Between July 2022 and May 2023, 1,037 children (∼60% female) aged 8-12 were recruited from 90 public (74%) and private primary schools. Weeklong fine particulate matter (PM2.5), black carbon (BC), and sound pressure levels were measured in the schoolyards. Homes of the children were geocoded and linked with spatial prediction models to estimate ambient pollutant concentrations at each child’s residence. Data were also captured on anthropometry, blood pressure, respiratory function, cognitive and behavioral functions, and sleep quality. Questionnaires gathered additional information on school, household, and sociodemographic factors. Preliminary results suggest that a third of children were hypertensive, 30% were overweight or obese, and 14% had behavioral problems. PM2.5 and noise levels across schools exceeded local and international standards. Several ongoing epidemiologic analyses will examine the key exposures in relation to the major outcomes. Competing Interest Statement The authors have declared no competing interest. Funding Statement The ASHES project was in parts supported by the National Geographic Society exploratory grant [NGS-64242R-19], Pathways to Equitable Healthy Cities grant (209376/Z/17/Z) and Climate Change Resilient Equitable Healthy Cities in Africa (CLARITY-Africa) grant (227779/Z/23/Z) from the Wellcome Trust, and UMass SPHHS Dean's Research Enhancement grant. For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Institutional Review Boards of the University of Massachusetts Amherst (Reference #: 3157) and University of Ghana, Legon (Reference #: ECH 149/18-19). Additional authorizations to conduct research within schools were obtained from different levels of the GES. We first secured approval from the National Headquarters. We then obtained additional approvals from all lower administrative levels within the GES structure, with each letter minuted to the next level, in the following order: (i) Greater Accra Regional Directorate; (ii) District and Municipal Directorate; and (iii) Heads of the participating school. The field team hand-delivered these letters and followed up with phone calls to obtain the approvals. Written informed consent was obtained from school administrators and parent/guardian(s) before taking part in this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Environmental measurement data is available through the open-source platform, Zenodo, De-identified health data can be made available to investigators with projects that fall within the overall aim of ASHES. Those interested in gaining access to the data should contact Raphael E Arku [rarku{at}umass.edu].