Prenatal risk factors of wheezing at the age of four years in Tanzania
J Sunyera, C Mendendezb, P J Venturab, J J Aponteb, D Schellenbergc, E Kahigwac d, C Acostab c, J M Antóa, P L Alonsob
a Unitat de Recerca
Respiratòria I Ambiental, Institut Municipal d'Investigació
Mèdica (IMIM), Doctor Aiguader 80, E-08003 Barcelona, Spain, b Unidad de
Epidemiologia y Bioestadistica, Institut Investigació Biomèdica
August Pi-Sunyer (IDIBAPS), Hospital Clinic, Barcelona, Spain, c Ifakara Health Research and
Development Centre, Ifakara, Tanzania, d St
Francis Designated District Hospital, Ifakara, Tanzania
Correspondence to: Dr J Sunyer jsunyer{at}imim.es
Received 24 May 2000; Returned to authors 9 August 2000; Revised version received 8 January 2001; Accepted for publication 12 January 2001
BACKGROUND
A study was
undertaken to assess the interactions between prenatal exposures, early
life infections, atopic predisposition, and allergen exposures in the
development of wheezing up to the age of 4 years in a tropical region
of Africa.
METHODSThe study
subjects comprised children born at the district hospital in Ifakara,
Tanzania during a 1 year period who were participating in a trial of
iron supplementation and malaria chemoprophylaxis during the first year
of life and followed for up to 4 years. From this group of subjects,
658 (79%) participated in the interview at 18 months and 528 (64%) in
a second interview at 4 years. Wheezing was measured with the ISAAC
questionnaire. A hospital based inpatient and outpatient surveillance
system was set up to document all attendance by study children for any
cause, including episodes of clinical malaria and lower respiratory
tract infections. Total IgE levels and malaria parasites were measured
in maternal and cord blood. Total IgE was also measured at 18 months of
age. Indoor environmental levels of Der p I
and Fel d I were determined using an enzyme
linked immunosorbent assay at the same time as the interview at the age
of 18 months.
RESULTSThe prevalence
of wheezing at 4 years is common in Ifakara (14%, range 13-15%). The
presence of malaria parasites in cord blood (odds ratio, OR = 6.84, 95% CI 1.84 to 24.0) and maternal asthma (OR = 8.47, 95% CI 2.72 to
26.2) were positively associated with wheezing at the age of 4 years,
and cord blood total IgE was negatively associated (OR = 0.24, 95% CI
0.07 to 0.85) (all p<0.05). Parasitaemia at birth was not related to
total IgE levels in cord blood (p=0.6). Clinical episodes of malaria
during infancy were not associated with wheezing, and nor were levels
of indoor aeroallergens.
CONCLUSIONThese
findings suggest that events occurring during pregnancy may play a role
in the future appearance of wheezing, although the results must be
interpreted with caution because of the small numbers studied.
Keywords: Africa; asthma; atopy; malaria; total IgE; wheezing
© 2001 by Thorax
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This article has been cited by other articles:
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BRABIN, B J, RIZWAN, S, SUNYER, J, MENENDEZ, C
(2001). Prenatal risk factors of wheezing at the age of four years in Tanzania. Thorax
56: 897a-897
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