Background Children in urban areas are affected by breathing traffic-related air pollutants (TRAP). In Malawi many children walk to school on roads in poor condition and the schools are even located along major highways, increasing both exposure to high-speed traffic and high levels of TRAP.

Objective Develop a set of ranking interventions designed to reduce both the risk of injury and exposure to poor air quality on their walks to school among 12–16-year-olds in Blantyre, Malawi

Methods Employing a mixed methodology approach, a prospective observational study was conducted in 2022. Data collection involved a cross-sectional survey studying knowledge, attitudes, and practices, mobility surveys, school zone speed and pedestrian observations, and star ratings for school assessments across six urban schools. The study incorporated qualitative methods such as Focus Group Discussions (FGDs), and Photovoice from two primary schools. Additionally, a stakeholder engagement based on Delphi methodology engaged a panel of national and international experts to rank the interventions.

Results Among the 2466 surveyed learners, 134 (5.4%) experienced crashes, while 732 (29.7%) encountered "near-miss" incidents in the preceding 6 months. Vehicle speeds around schools ranged from 18.0 to 47.7 km/h, and star-ratings varied from 2 to 5 stars. Community input highlighted road safety concerns, emphasizing behavioural issues, inadequate infrastructure, and personal safety worries. Proposed solutions included educational initiatives for learners, infrastructure improvements, and stricter penalties. The study also unveiled a lack of understanding regarding air pollution, primarily linked to unpleasant odors. Recommendations to address air pollution focused on educational interventions related to waste disposal and hygiene practices. Moreover, a panel of experts identified and ranked 40 interventions across road safety and air pollution in three rounds of assessments.

Conclusion This study underscores the multifaceted challenges faced by school-going adolescents regarding road safety and air quality. It is important to highlight the lack of understanding of air pollution compared with road safety. The findings provide a robust basis for tailored interventions, emphasizing the need for holistic approaches to enhance both road safety and air pollution during school commutes in urban areas like Blantyre, Malawi.