Prevalence of exercise induced bronchospasm in Kenyan school children: an urban-rural comparison
- L W Ng’ang’aa,
- J A Odhiamboa,
- M W Mungaia,
- C M Gichehaa,
- P Nderitua,
- B Maingia,
- P T Macklemb,
- M R Becklakeb,c
- aRespiratory Disease Research Unit, Kenya Medical Research Institute, P.O. Box 47855, Nairobi, Kenya, bInternational Respiratory Disease Research Unit, International Union Against Tuberculosis and Lung Disease (IUATLD), Montréal, Québec, Canada, cRespiratory Epidemiology Unit, Joint Departments of Epidemiology and Biostatistics and of Occupational Health, McGill University, Montréal, Québec, Canada
- Dr M R Becklake, Respiratory Epidemiology Unit, Joint Departments of Epidemiology and Biostatistics, and of Occupational Health, McGill University, 1110 Pine Ave West, Montréal, Québec, Canada H3A 1A3.
- Received 22 December 1997
- Revision requested 6 March 1998
- Revised 15 June 1998
- Accepted 17 June 1998
BACKGROUND Higher rates of exercise induced bronchospasm (EIB) have been reported for urban than for rural African schoolchildren. The change from a traditional to a westernised lifestyle has been implicated. This study was undertaken to examine the impact of various features of urban living on the prevalence of EIB in Kenyan school children.
METHODS A total of 1226 children aged 8–17 years attending grade 4 at five randomly selected schools in Nairobi (urban) and five in Muranga district (rural) underwent an exercise challenge test. A respiratory health and home environment questionnaire was also administered to parents/guardians. This report is limited to 1071 children aged ⩽12 years. Prevalence rates of EIB for the two areas were compared and the differences analysed to model the respective contributions of personal characteristics, host and environmental factors implicated in childhood asthma.
RESULTS A fall in forced expiratory volume in one second (FEV1) after exercise of ⩾10% occurred in 22.9% of urban children and 13.2% of rural children (OR 1.96, 95% CI 1.41 to 2.71). The OR decreased to 1.65 (95% CI 1.10 to 2.47) after accounting for age, sex, and host factors (a family history of asthma and breast feeding for less than six months), and to 1.21 (95% CI 0.69 to 2.11) after further adjustment for environmental factors (parental education, use of biomass fuel and kerosene for cooking, and exposure to motor vehicle fumes).
CONCLUSIONS The EIB rates in this study are higher than any other reported for African children, even using more rigorous criteria for EIB. The study findings support a view which is gaining increasing credence that the increase in prevalence of childhood asthma associated with urbanisation is the consequence of various harmful environmental exposures acting on increasingly susceptible populations.