Systematic review and meta-analysis on the impact of COVID-19 related restrictions on air quality in low- and middle-income countries

Background: Low-and middle-income countries (LMIC) are disproportionately affected by air pollution and its health burden, representing a global inequity. The COVID-19 pandemic provided a unique opportunity to investigate the impact of unprecedented lockdown measures on air pollutant concentrations globally. We aim to quantify air pollutant concentration changes across LMIC settings as a result of COVID-19 restrictions.Methods: Searches for this systematic review and meta-analysis were carried out across five databases on 30th March 2022; MEDLINE, Embase, Web of Science, Scopus and Transport Research Information Documentation. Modelling and observational studies were included, as long as the estimates reflected city or town level data and were taken exclusively in pre-lockdown and lockdown periods. Mean percentage changes per pollutant were calculated and meta-analyses were carried out to calculate mean difference in measured ground-level observed concentrations for each pollutant (PROSPERO CRD42022326924).Findings: Of the 2982 manuscripts from initial searches, 256 manuscripts were included providing 3818 per-centage changes of all pollutants. No studies included any countries from Sub-Saharan Africa and 34 % and 39.4 % of studies were from China and India, respectively. There was a mean percentage change of-37.4 %,-21.7 %,-54.6 %,-39.1 %,-48.9 %, 16.9 %,-34.9 %,-30.6 % and -14.7 % for black carbon (BC), carbon monoxide (CO), nitric oxide (NO), nitrogen dioxide (NO2), oxides of nitrogen (NOx), ozone (O3), particulate matter 10 (PM10) and 2.5 (PM2.5) and sulphur dioxide (SO2), respectively. Meta-analysis included 100 manuscripts, providing 908 mean concentration differences, which showed significant reduction in mean concentration in all study settings for BC (-0.46 mu g/m3, PI-0.85;-0.08), CO (-0.25 mg/m3, PI-0.44;-0.03), NO2 (-19.41 mu g/m3, PI-31.14;-7.68) and NOx (-22.32 mu g/m3, PI-40.94;-3.70).Interpretation: The findings of this systematic review and meta-analysis quantify and confirm the trends reported across the globe in air pollutant concentration, including increases in O3. Despite the majority of global urban growth occurring in LMIC, there are distinct geographical gaps in air pollution data and, where it is available, differing approaches to analysis and reporting.