Performance of Road-Traffic-Based Exposure Proxies Against Personal PM2.5 Measurements in Three Sub-Saharan African Countries

IntroductionParticulate Matter (PM2.5) exposure contributes to the global disease burden, yet its monitoring remains sparse and uneven and is limited in many limited ground monitoring network settings. Road-traffic proxy indicators can provide indirect estimates of PM2.5 where measurements are limited but require context-specific validation. We evaluated three PM2.5 road-traffic related proxies:(I) population-Weighted Road Network Density (WRND), (ii) Euclidean (straight line) distance from highways (EH), and (iii) Euclidean distance from main roads (EM). MethodsWe validated proxies using high-resolution outdoor filtered PM2.5 personal exposure measurements collected over 1 year from 343 postpartum participants in The Gambia, Kenya, and Mozambique. Village-level spatial patterns for the PM2.5-proxy relationship were mapped using 5 km hexagonal aggregated tessellations. Proxy-PM2.5 associations were assessed using Spearman correlation, and predictive utility was tested using country-specific and global Random Forest (RF) models (3-fold cross-validation), reporting R2, RMSE, and feature importance ResultsSpatial mapping showed heterogeneous proxy-PM2.5 relationships across and within sites, with elevated PM2.5 occurring in both low- and high-proxy contests. WRND-PM2.5 correlations were weak overall and statistically significant only in Mozambique (r = 0.351; p = 0.005), with non-significant associations in Kenya (r = -0.041; p = 0.673) and The Gambia (r = -0.020; p = 0.909). EH-PM2.5 correlations were positive in The Gambia (r = 0.335; p = 0.053) and Mozambique (r = 0.292; p = 0.020) but negative and significant in Kenya (r = -0.224; p = 0.018).Single-variable RF models performed poorly across all countries (R2 < 0.45) and the Global model (R2=0.42). Combining proxies improved performance in Kenya (R2=0.52; RMSE=31.7{micro}g/m3) and Mozambique (R2=0.60; RMSE=8.9 {micro}g/m3), Global R2=0.46; RMSE=29.1 {micro}g/m3), although in The Gambia, the combined model (R2=0.53; RMSE=37.6 {micro}g/m3) did not exceed the best single-proxy model. ConclusionRoad-network proxies provide context-dependent signals of personal PM2.5 exposure, and predictive performance is strengthened when proxies are combined in a hybrid model.