Asthma and indoor environment in Nepal
- aInstitute of Community Medicine, University of Tromsø, Norway, bEnvironmental Health Sciences, University of California, Berkeley, USA, cDepartment of Thoracic Medicine, University of Bergen, Norway, dMrigendra Samjhana Medical Trust, Nepal
- Dr T Melsom, Utsikten 15 nr 1, 1604 Fredrikstad, Norway
- Received 1 August 2000
- Revision requested 1 November 2000
- Revised 1 February 2001
- Accepted 26 February 2001
BACKGROUND The development of asthma seems to be influenced by the adoption of a Western lifestyle. A study was undertaken to assess the importance of indoor environmental factors in Nepal where the lifestyle and home environment differ from that in the West.
METHODS The home environment of 121 schoolchildren with asthma and 126 controls aged 11–17 years was studied. The homes of all participants were investigated and the children and their mothers were interviewed using a standardised questionnaire. Cases and controls were identified from an ISAAC (International Study of Asthma and Allergy in Childhood) based population study of 2330 schoolchildren in Kathmandu, Nepal.
RESULTS Keeping cattle inside the house during the night was related to a lower risk for having asthma (adjusted odds ratio (OR) 0.2 (95% CI 0.1 to 0.5)) while there was no association between asthma and cattle kept outside. Asthma was associated with cigarette smoking by two or more family members (OR 1.9 (95% CI 1.0 to 3.9)) and with the domestic use of smoky fuels (OR 2.2 (95% CI 1.0 to 4.5)). In analyses stratified by sex, passive smoking and the use of smoky fuels were significantly associated with asthma only in boys.
CONCLUSIONS The risk of asthma in Nepalese children was lower in subjects exposed to cattle kept inside the house and higher in subjects exposed to passive smoking and indoor use of smoky fuels. Childhood exposure to microorganisms or allergens from cattle may protect against the development of atopic disease.