Factors associated with asthma among under-fives in Mulago hospital, Kampala Uganda: a cross sectional study

Abstract

BackgroundAsthma is the most common chronic childhood illness, with rapidly increasing prevalence in low-income countries. Among young children, asthma is often under-diagnosed.We investigated the factors associated with asthma among under-fives presenting with acute respiratory symptoms at Mulago hospital, Uganda.MethodsA hospital-based cross sectional study of 614 children with cough and/or difficult breathing, and fast breathing, was conducted between August 2011 and June 2012. A questionnaire focusing on clinical history of the child was administered to the caretakers. A physical examination and, laboratory and radiological investigations were done. Asthma was defined according to GINA (Global Initiative for Asthma) guidelines which were modified by excluding the symptom of “chest tightness”, spirometry/peak expiratory flow measurements and by adding chest x-ray findings to distinguish asthma from pneumonia. A panel of three paediatricians reviewed the participants’ case reports and, guided by the study definitions, made a diagnosis of asthma or other. Multivariable logistic regression analysis was done to determine factors independently associated with asthma.ResultsOf the 614 children, 128 (20.8%) had asthma, 125 (20.4%) bronchiolitis, 167 (27.2%) bacterial pneumonia only, 163 (26.5%) viral pneumonia while 31 (5.1%) had other diagnoses including pulmonary tuberculosis. The majority (71.1%) of children with asthma were aged ≥ 12 months. Factors associated with asthma included maternal asthma (AOR 2.4, 95% CI 1.2, 4.6), a history of allergy in the patient (AOR 2.6, 95% CI 1.2, 5.4,), use of gas for cooking (AOR 3.8, 95% CI 1.2, 13.3), prematurity (AOR 9.3, 95% CI 1.2, 83.3) and high level of education of caretaker (AOR 9.1, 95% CI 1.1, 72.8).ConclusionMaternal asthma, a history of allergy in the patient, use of gas for cooking, prematurity and high level of education of caretaker were significantly associated with asthma. There is need for studies to explore the role of the above factors in development and exacerbation of childhood asthma to provide information that can be used to design strategies for asthma prevention and control.

Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda

“…Our observation that children with asthma were more likely to have parents with tertiary education and to use gas or electricity for indoor cooking (as opposed to charcoal stoves) has been made by an earlier study in Uganda (14). Similarly, our finding that children with asthma reported the highest frequency of 'trucks passing on the street near their home' has been reported elsewhere (34)(35)(36).…”

“…The few studies reported have suggested that current residence in urban areas is associated with a higher risk of asthma than rural residence (10,11). Other risk factors, similar to those in HICs, include maternal smoking (12,13), maternal history of asthma (14), childhood atopic sensitisation (11,15) and history of allergy (14,16). Previous reports suggest no association between biomass fuels and asthma risk (17,18), but increased asthma symptoms (18,19).…”

Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study

“…The children who had chest in-drawing were admitted and followed up to determine outcomes. The details of the laboratory methods have been described elsewhere [ 27 ]. Briefly; blood culture, total and differential white cell counts, and serum C-reactive protein (CRP) titres were done.…”

Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda

“…The association between helminth infections and asthma has been investigated in Africa and other LMICs, but the findings have been inconsistent across studies (Leonardi-Bee et al, 2006; Mpairwe and Amoah, 2019). Other risk factors for asthma in Africa and other LMICs, similar to those in HICs, include maternal smoking (Ayuk et al, 2018; Arrais et al, 2019), maternal history of asthma (Nantanda et al, 2013), childhood atopic sensitisation (Addo-Yobo et al, 2001; Nyembue et al, 2012) and history of allergy (Nantanda et al, 2013; Mehanna et al, 2018). Previous reports suggest no association between biomass fuels and asthma risk (Thacher et al, 2013; Oluwole et al, 2017a), but increased asthma symptoms (Oluwole et al, 2017a; Oluwole et al, 2017b).…”

“…Previous reports suggest no association between biomass fuels and asthma risk (Thacher et al, 2013; Oluwole et al, 2017a), but increased asthma symptoms (Oluwole et al, 2017a; Oluwole et al, 2017b). Unlike in HICs, higher parental education and socioeconomic status has been associated with asthma among children in Africa (Addo-Yobo et al, 2007; Nantanda et al, 2013; Wolff et al, 2012).…”