BY ABIGAIL ANNOH

Little Myles has been battling chronic asthma since he was two. Four years on, the boy lives with his single mother Bernice, here along the Pokuase-Nsawam highway. Long delayed road construction has shrouded the nearby communities for four years. That added to the  area’s vehicle emissions and fumes from cooking and waste burning, to make each breath Myles takes a risk.

Experts say Ghana’s worsening air quality is fuelling a growing public health crisis, but for people living with asthma – where inflamed airways make it hard to breathe – the burden is heavier, more personal, and often life-threatening.

“Every day is a prayer,” says Bernice. (The Ghanaian Times is concealing last names to protect the boy from stigma.) “I don’t know where he will go. I try to protect him, but it’s not always possible. I just pray God sees him through each day.”

Despite following a strict daily routine — keeping a toiletry bag stocked with face masks, inhalers, tissues, soap, and sanitiser, and visiting a clinic after school for nebulizer treatments — his condition remains precarious.

“Almost every two weeks, we are at the hospital,” she says. “Sometimes we miss an entire school term. It is exhausting — financially, emotionally, psychologically. And society doesn’t make it easier,” says Bernice. She has had to quit her corporate job to care for her son.

Myles’ story is far from unique. It represents the experiences of many asthmatic children living in Ghana whose conditions, experts say, are worsening each day due to environmental factors such as air pollution.

Asthma is a chronic respiratory disease marked by inflammation and narrowed airways in the lungs, causing wheezing, breathlessness, and chest tightness. If the airways narrow completely, the sufferer can die.

Globally, more than 260 million people live with asthma, according to the World Health Organization, with an estimated 1,000 people dying from the condition each day. Almost all of those deaths occur in low- and middle-income countries like Ghana, where cases are underdiagnosed and access to healthcare is limited. The Ghana Health Service estimates that about three out of every 100 people live with asthma, roughly a million people, with more than 80,000 new cases recorded annually.

Children like Myles are the most vulnerable. Reports estimate that one in 10 children worldwide live with asthma, while one in every 10 hospital admissions for children is asthma related.

While asthma can be triggered by allergens, infections and weather conditions, experts say environmental pollution is increasingly becoming a dominant driver. Air pollution levels in Accra have been increasing in recent years. Accra is one of Africa’s fastest growing cities and with poor waste management systems, little regulation of car emissions and low take up of clean cooking fuels, more people is going to mean more pollution.

 Concentrations of the most dangerous air pollution rose by 17 percent in the 10 years to 2023 according to the 2025 State of Global Air report. Outdoor air pollution ranked as the third leading cause for death.

“Respiratory conditions are becoming more severe,” says Dr Woedem Tettey, a public health physician specialist at the Greater Accra Regional Hospital. “We are seeing more respiratory infections and a rise in non-allergic asthma due to exposure to environmental irritants like smoke and fumes.”

She says emerging evidence suggests that prolonged exposure to polluted air is driving asthma even among individuals with no family history of the condition and may sometimes begin as early as pregnancy.

“Research indicates that four to five people die from asthma daily in Ghana,” Dr Tettey says, adding that “Air pollution is undermining gains in treatment and management.”

Daniel Ntiri, a final-year student at the Kwame Nkrumah University of Science and Technology, remembers growing up in a household where all four siblings, including himself, battled asthma. Born to an asthmatic mother, Ntiri recalls how regular hospital admissions, missed school classes and social isolation defined their childhood.

“My siblings and I used to alternate between hospitals. My mother was always at the hospital attending to one of us because of an attack. Those were very difficult moments,” he says.

Although Ntiri says he is now familiar with his triggers and better able to control attacks by avoiding unsafe environments and always keeping an inhaler or face mask nearby, he says other children may not be as fortunate to survive childhood asthma attacks as he was.

Asthma is just one of the many health impacts of air pollution affecting Ghanaians, says Dr Louisa Matey, Director of Health for the Accra Metropolitan Area.

She says air pollution is now recognised as a major risk factor for so-called “lifestyle” or non-communicable diseases that are rapidly increasing in Ghana, including asthma, hypertension, cardiovascular conditions, stroke, cancer, diabetes and infertility. These are diseases that are largely preventable if people know how to adjust their diet, lifestyle and environment.

For asthmatics, Dr Matey notes that the impact can be immediate and severe: reduced lung function, frequent attacks, increased medication use, and higher hospital admissions, especially among children whose lungs are still developing.

She joins calls from experts for stricter enforcement of Ghana’s environmental laws, cleaner transport systems and better urban planning to significantly reduce asthma-related illnesses and deaths.

“There is no reason for people to die prematurely from asthma triggers if we can reduce our particulate matter levels,” Dr Matey says. “Why should asthmatics living here die before they are 40, unlike in other countries where people with asthma are able to live their full lifespan? It’s because our environment is a major trigger, and the situation is dire. That is why we must take air pollution seriously and ensure that laws passed are enforced.”

Ghana’s efforts to tackle air pollution, experts caution, are currently fragmented, spanning environmental regulation, fuel standards and urban planning initiatives, with the Environmental Protection Agency (EPA) leading national efforts.

While a recent amendment to the Environmental Protection Act empowers the EPA to enforce laws on open waste burning and air quality management planning for urban centres, among others, experts say enforcement remains a major challenge. Some have called for a national clean air policy to consolidate efforts.

Beyond policy, however, are the real issues of cost and access to treatment for people living with and managing asthma across the country.

“Accra’s poor air quality keeps worsening asthma symptoms, leading to more frequent attacks, especially in children, and a higher use of inhalers, which are overly expensive and not subsidised. Treatment costs are rising and families are struggling,” says Anthea Awo Duker, Chief Executive Officer of the Asthma and Allergies Foundation Ghana, a non-governmental organisation.

She says limitations in access to asthma care under the National Health Insurance Scheme forces patients and caregivers to pay huge sums out of pocket to access treatment.

“Inhalers, both for relief and prevention, are often expensive, while lifesaving nebulisers are only available in a few facilities. Even where machines exist in regional and district hospitals, patients frequently have to purchase their own accessories,” says Duker.

“Ghana’s poor air quality is a major public health challenge for asthmatics, it also creates opportunities for stronger advocacy, policy changes and improved personal management of the disease.”

For caregivers like Bernice, addressing policy and healthcare gaps is urgent, but government should also be leveraging low-hanging interventions such as increased public education on asthma.

That, Bernice says that could go a long way in making life more comfortable for asthmatics and prolonging lives.

“If we understand that we are not alone in the environment, we will take steps to behave differently,” she says. “Little actions like smoke from waste burning in your home or cooking with fossil fuel could be choking someone else to death. If people know about asthma triggers, the effects of their actions, and how to offer basic help to persons suffering an attack, they will be more responsible and help save the lives of more asthmatic patients.”

For now, Bernice and a growing number of Ghanaian parents begin each morning wondering if their children will survive the day. This story was a collaboration with New Narratives. Funding for this story was provided by the Clean Air Fund. The Fund had no influence over the story’s conten