Prevalence, severity and risk factors for asthma in school-going adolescents in KwaZulu Natal, South Africa

Abstract

BackgroundAsthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and risk factors for asthma in adolescents in an LMIC.MethodsA cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021.ResultsA total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01.ConclusionAsthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.

Association between Outdoor and Indoor Air Pollution Sources and Atopic Eczema among Preschool Children in South Africa

“…Another cross-sectional study following the Phase I ISAAC protocol conducted in the air pollution priority area (City of Ekurhuleni Metropolitan Municipality) in Gauteng Province, South Africa, reported a higher prevalence of EE (14%) among 3424 adolescents aged 13 and 14 years old; however, the study reported a lower prevalence of current ESs (9.6%) compared to our findings [40]. Subsequently, a recent Global Asthma Network (GAN) study, including 3957 adolescents aged 13 to 14 years old in KwaZulu Natal Province, South Africa, reported a lower prevalence of AE (7.1%) compared to our study [61].…”

Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers

“…Multiple studies have corroborated the poor usage and non-adherence to metred dose inhalers in childhood asthma as a major barrier to care 11 17. This is further seen with the low levels of inhaled corticosteroids (6.7–17%) and 73% of doctor-diagnosed/suspected asthma not using any inhaler documented 6 31. Over-reliance on short-acting beta agonist inhalers per se is also a barrier to appropriate care 32.…”