Article Text

Original article
Hygiene, atopy and wheeze–eczema–rhinitis symptoms in schoolchildren from urban and rural Ecuador
  1. Philip J Cooper1,2,3,
  2. Maritza Vaca1,
  3. Alejandro Rodriguez1,
  4. Martha E Chico1,
  5. Darci N Santos4,
  6. Laura C Rodrigues5,
  7. Mauricio L Barreto4
  1. 1Laboratorio de Investigaciones FEPIS, Quinindé, Esmeraldas Province, Ecuador
  2. 2Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
  3. 3Escuela de Biología, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
  4. 4Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Brazil
  5. 5Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr P J Cooper, Casilla 17-22-20418, Quito, Ecuador; P.J.Cooper{at}


Background Rural residence is protective against atopy and wheeze–rhinitis–eczema symptoms in developed countries, an effect attributed to farming and poor hygiene exposures. There are few data from developing countries addressing this question. We compared atopy and wheeze–rhinitis–eczema symptoms between urban and rural Ecuador, and explored the effects of farming and poor hygiene exposures.

Methods We performed cross sectional studies of schoolchildren living in rural and urban Ecuador. Data on symptoms and farming/hygiene exposures were collected by parental questionnaire, atopy by allergen skin prick test reactivity and geohelminth infections by stool examinations.

Results Among 2526 urban and 4295 rural schoolchildren, prevalence was: atopy (10.0% vs 12.5%, p=0.06), wheeze (9.4% vs 10.1%, p=0.05), rhinitis (8.1% vs 6.4%, p=0.02) and eczema (5.9% vs 4.7%, p=0.06). A small proportion of symptoms were attributable to atopy (range 3.9–10.7%) with greater attributable fractions for respiratory symptoms observed in urban schoolchildren. Respiratory symptoms were associated with poor hygiene/farming exposures: wheeze with lack of access to potable water; and rhinitis with household pets, no bathroom facilities and contact with large farm animals. Birth order was inversely associated with respiratory symptoms. Area of residence and atopy had few effects on these associations.

Conclusions Urban schoolchildren living in Ecuador have a similar prevalence of atopy, eczema and wheeze but a higher prevalence of rhinitis compared with rural children. Some farming and poor hygiene exposures were associated with an increase in the prevalence of wheeze or rhinitis while birth order was inversely associated with these symptoms.

  • Wheeze-Rhinitis-Eczema
  • Atopy
  • Hygiene
  • Farming
  • Urban-Rural

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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