Prevalence of asthma and characteristics of primary school children with asthma in Kampala distict
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Introduction/Background: Asthma is a global problem, with an estimated 300 million people affected including 50 million Africans. On the whole, Asthma and allergic diseases have increased in the developed countries and the trend is increasing in Africa and other developing countries. High prevalence of asthma is mostly seen among children especially those in the urban areas. When not effectively treated, asthma often leads to hospitalisation, missed school, limitations on physical activity, sleepless nights and in some cases death. Objective: Objective was to determine the prevalence and describe characteristics of children with asthma among day primary school children aged 8 to 14 years in Kampala district. Methods: Study design Cross sectional descriptive study Study setting: The study was carried out in fifteen Kampala district day primary schools. Study population: Children aged 8-14 years attending Kampala district day primary schools fulfilling the study eligibility criteria. Study Procedure: Children aged 8-14 years from 15 selected schools within the five divisions of Kampala district were assessed. The five divisions are divided into three Peri-Urban and two Urban. Those meeting eligibility criteria took a consent form and parent self administered questionnaire home to their parent/guardian who were expected to fill and return it within a period of three days. Children who returned consent forms and questionnaires were re- assessed for eligibility at the schools by the study principal investigator and research assistants. Spirometry was done for those children that had completely filled questionnaire. Asthma was defined as demonstrated exercise induced bronchospasm (EIB). Results: A total of 355 children age 8-14 years (median age 11years) were studied between 28th May 2009 and 12th June 2009. The ratio of Female to Male ratio was 1:1. The overall prevalence of asthma was 13.8 %. The prevalence of asthma was 18.8% and 9.2% in peri-urban and urban divisions respectively. The divisions with the highest prevalence were Kawempe and Makindye with a prevalence of 21.7% and 21.3% respectively. Amongst host characteristics, full term birth 47/49(96%), normal BMI 44/49(90%), Breastfeeding for over 6 months 44/49(90%) were the most frequent among children with asthma and also among those without asthma. Family history of asthma 14/49(29%) and history of food allergies 13/49(26%) were the least frequent characteristics among children with asthma. However; family history of asthma was more predominant 14/49(29%) among children with asthma as compared to those without 9/306(3%). Overall, the majority of the children with asthma 38/49(78%) were from government schools as compared to those without asthma 211/306(69%). The number of children with asthma 23/49(47%) that had a parent/guardian with at least tertiary education was higher than the non asthmatic children133/306(43%). Amongst environmental characteristics there were more children with asthma using charcoal as cooking fuel 45/49(92%), firewood as cooking fuel 9/49(18%) compared to those without 259/306(85%) and 37/306 (12%) respectively. Lighting using kerosene was more frequent among children with asthma 27/49(55%) compared to those without asthma 137/306(44%). A higher number of children with asthma 11/49(22%) compared to those without asthma 44/306(14%) used candles for lighting. A higher number of children with asthma 9/49(18%) as compared to non asthmatics 36/306(12%) came from homes where an animal was kept in the house overnight. The overall prevalence of wheeze in the past 12 months (recent) among study children was 56/355(15.8%) and wheeze at any time in the past was 73/355(20.6%).The most frequent symptoms among children with asthma were wheezing anytime in the past and night cough other than that due to common cold while the least frequent symptoms were sleep disturbance by wheeze and severe attacks of wheezing occurring at least one night per week. Conclusion: 1. The prevalence of asthma was 13.8% among day primary school children in Kampala district. 2. The characteristics frequently common among children with asthma included: use of charcoal as cooking fuel, attendance of school in the Peri-urban divisions, family history of asthma and keeping an animal in the house overnight. Recommendations: 1. Deliberate efforts should be made to routinely screen for asthma among Kampala district primary school children. 2. Further studies to determine the risk factors for childhood asthma in Kampala district should be conducted preferably using case control study design.