Real-time impacts of air pollution on the health, well-being, and daily life of children and young people in Delhi and Dhaka.

Air pollution is a major global health threat, with children and young people (CYP) among the most vulnerable. Delhi (India) and Dhaka (Bangladesh) are two of the world's most polluted cities, with persistently high levels of fine particulate matter (PM2.5). This study aimed to generate CYP-centered evidence on the real-time impacts of air pollution in these cities by comparing health, well-being, and daily activities during periods of high air pollution and good air quality, while also capturing CYP's ideas for air quality management. A cross-sectional, real-time digital survey was conducted in Delhi on January 9-10 and 15 March 2025, and in Dhaka on January 21-22 and March 13-16, 2025. For both cities, the January dates correspond to a period with high air pollution (PM2.5 > 55.5 µg/m3) and the March dates to good air quality (PM2.5 ≤ 35.4 µg/m3). Participants included CYP aged 13-29 years and parents of children under 18. Recruitment was carried out online. Data on health symptoms, well-being (general feelings and sleep quality), and daily activity disruptions were analyzed using descriptive statistics, chi-square tests, and regression models adjusted for demographics. Responses to open-ended questions were thematically coded. A total of 814 eligible responses were collected (Delhi = 365; Dhaka = 449). High-pollution days were associated with significantly higher reports of itchy eyes, respiratory difficulties, headaches, skin irritation or rash, diarrhoea or vomiting, low mood, anxiety or stress, and difficulty concentrating. These associations remained significant after adjusting for demographics. Disruptions to daily activities also increased, including reduced physical activity and greater odds of being late or missing school or work, meetings, social events, and healthcare, as well as a greater need for family assistance (adjusted odds ratios approximately 3.8 to 4.8). In Delhi, changes were more pronounced across most outcomes, particularly a sharper drop in physical activity. In Dhaka, the same pattern was observed, along with additional increases in sore throat, cough, food insecurity, and difficulty accessing clean water. Participants' suggestions clustered around five themes: cleaner environments, stronger communities, improved healthcare and education, pollution and technology solutions, and other ideas. High air pollution was linked to widespread impacts on health, well-being, and daily routines among CYP. Their proposed solutions offer insights for participatory and equitable approaches to urban air quality management.