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Basic elementary school is compulsory for students in most countries of the world. Therefore, children spend a considerable amount of their time in school studying. Subsequently, exposure to substances in their school indoor environment can affect their studies and health. In addition , children are more susceptible to indoor pollutants because their organ systems are immature. In general, there has been more research on the impact of offices and industrial environments on adult occupants than research on school environments involving pupils. The aim of this thesis is to assess elementary schools’ indoor environmental quality, and its associations with pupils’ health and learning outcomes. Data were collected from three countries (samples including all elementary schools in Finland, seventy elementary schools in United States of America and five elementary schools in Nigeria). This included measuring classroom indoor and outdoor temperature, carbon dioxide, carbon monoxide and relative humidity. Ventilation rates were also assessed as well as cleaning effectiveness. A walkthrough was done to evaluate school building characteristics while students and school principals were asked questions about health and school environmental conditions respectively. Data were also recovered from registries. The results from Finland showed that noise and poor air quality in classrooms were the most prevalent indoor environmental (IEQ) factors causing discomfort, while headache, fatigue and stuffy nose were the most prevalent health problems reported by students. Where students reported poor air quality in classrooms, it was associated with high measured mean temperature and low ventilation rates in those classrooms. Respiratory symptoms increased with thermal discomfort, inadequate ventilation and moisture damage. Missed school days as a result of respiratory symptoms was more common in schools with inadequate ventilation. Inadequate ventilation was associated with learning outcomes. Ventilation rate was dependent on the type of the ventilation system. Upgraded systems were found to provide more adequate ventilation and thermal comfort in schools. A negative significant correlation was also found between the number of students in the classroom and ventilation rate per student. In the US study, academic performance such as passing mathematical and reading tests was related to ventilation rates and indoor temperature in classrooms. Inadequate ventilation was associated with increased visits to school nurses due to respiratory symptoms while biological contamination of high contact surfaces was related to increased visits due to gastro-intestinal symptoms. In the Nigerian study, thermal discomfort was observed in classrooms especially in the afternoon even though most classrooms were adequately ventilated judging by indoor carbon dioxide (CO2) concentration. There was lack of functioning bathrooms in most schools studied and biological contamination of student desk was moderately high based on adenosine triphosphate (ATP) testing. It was considered important that activities that emit or produce hazardous materials are not present or near school buildings, as this will ultimately affect the IEQ of classrooms. There is a need to constantly and continuously evaluate school buildings, so that the best possible indoo r environment can be provided for students at all times.