|Year : 2017 | Volume
| Issue : 2 | Page : 56-60
Study of prevalence of bronchial asthma in school children of 6–12 years of age in rural schools of Tumakuru district
Priyadarshini Bai Govinda Naik1, Puttaswamy Ravikumar2
1 Department of Pulmonary Medicine, Sri Siddhartha Medical College, Tumakuru, Karnataka, India
2 Department of Pharmacology, Sri Siddhartha Medical College, Tumakuru, Karnataka, India
|Date of Web Publication||29-Sep-2017|
Department of Pulmonary Medicine, Sri Siddhartha Medical College, Tumakuru - 572 107, Karnataka
Source of Support: None, Conflict of Interest: None
Context: Pediatric asthma is a serious global health problem. The recent rise in the prevalence of asthma was associated with environmental pollution, urbanization, and the change in demography.
Aims: The present study was undertaken to determine the prevalence of asthma in school children of rural parts of Tumakuru district and to study its association with different epidemiological factors.
Settings And Design: This study is a questionnaire-based study (International Study of Asthma and Allergies in Childhood-Questionnaire) carried out in four randomly selected rural schools of Tumakuru district.
Subjects And Methods: The questionnaire was distributed to all the children (n = 1750) and asked to fill the questionnaire with the help of their parents. These questionnaires were given standard scores to diagnose asthma. Other epidemiological factors were also recorded in the questionnaire and studied.
Statistical Analysis Used: The statistical analysis was done using MSTAT software. Chi-square test was used to get the P value. P < 0.05 was considered statistically significant.
Results: The prevalence of asthma in our study was 3.12% (n = 51). Boys had a slightly higher prevalence 3.36% (n = 32) than girls 2.8% (n = 19). We found 58.8% (n = 30) of these asthmatics had allergic rhinitis and 19.6% (n = 10) had a history of atopy. Overall prevalence of allergic rhinitis was 8.3% (n = 137) and atopy was 1.13% (n = 23).
Conclusions: The study showed 3.12% of children are affected with asthma, and its prevalence is significantly associated with epidemiological factors such as family history of allergy, high socioeconomic status, and use of fire wood for cooking.
Keywords: Allergic rhinitis, atopy, fire wood, passive smoking, prevalence, school children
|How to cite this article:|
Naik PB, Ravikumar P. Study of prevalence of bronchial asthma in school children of 6–12 years of age in rural schools of Tumakuru district. Indian J Allergy Asthma Immunol 2017;31:56-60
|How to cite this URL:|
Naik PB, Ravikumar P. Study of prevalence of bronchial asthma in school children of 6–12 years of age in rural schools of Tumakuru district. Indian J Allergy Asthma Immunol [serial online] 2017 [cited 2019 Jul 17];31:56-60. Available from: http://www.ijaai.in/text.asp?2017/31/2/56/215841
| Introduction|| |
Childhood bronchial asthma is a chronic disease with an increasing prevalence. It has also increased the number of preventable hospital emergency visits and admissions. Apart from being the leading cause of hospitalization for children, it is also one of the most important chronic conditions causing elementary school absenteeism. Furthermore, asthma can considerably impair the child's social interaction and academic achievement. It can affect child's ability to enjoy and partake in activities such as playing a musical instrument and sporting events, and even affect sleep patterns and their academic and career success because of poor school attendance associated with asthma attacks. Childhood bronchial asthma has multifactor causation. Geographical locations, environmental, racial as well as factors related to behavior and lifestyle are found to be associated with the disease. Its impact on the family and childhood is considerable due to the chronic nature of the disease. Three hundred million people are suffering from asthma. The WHO has estimated that 15 million disability-adjusted life years are lost annually due to asthma, representing 1% of the total global disease burden.
There are several epidemiological studies available, but comparisons among these studies are often limited by the lack of precise and universally accepted definition and differences in methodologies used. A standardized protocol has been developed by the International Study of Asthma and Allergies in Childhood (ISAAC) Committee that comprises a standardized written questionnaire for children. Jenkins et al. in a population-based study reported that questionnaire based survey had higher sensitivity, specificity, positive predictive value, and Youden's index which is the best single measure of validity. This method is cheap, widely acceptable, and convenient requiring no special equipment. Only a few epidemiological studies have been carried out in our country to study the prevalence of asthma because of large population, variable population density, climates, pollution, and lifestyle.
There are very few community-based studies on the prevalence of asthma in Indian children particularly more so in rural areas. As there is paucity of data on asthma among children in India, we conducted a community-based cross-sectional study in rural India to determine the prevalence of asthma symptoms, and its sociodemographic correlates among children of rural school going age (6–12 years).
| Subjects and Methods|| |
The present study was undertaken among school going children of four randomly selected rural schools of Tumakuru district. All school children in the age group of 6–12 years were included irrespective of their religion, ethnicity, socioeconomic status and culture. It is a questionnaire-based (ISAAC guidelines) study which is provided in both Kannada and English. The students were educated on asthma with the presentation of short movie of childhood asthma and a lecture on asthma causes, clinical picture, diagnosis, treatment, and self-management plans followed by an explanation in detail about the contents of the questionnaire. This was followed by complete general physical and systemic examination of the children. The questionnaire was distributed to all the students and asked to show their parents and fill up with appropriate answers and return it to their class teachers on the next day.
Along with questionnaire-based on ISAAC guidelines various factors that may influence the prevalence of asthma, such as age group, family history of allergic disorders, socioeconomic status, exposure to passive smoking, type of cooking fuel used, and presence of other allergic disorder were also included in the questionnaire. The socioeconomic status of the children were determined on the basis of monthly income in accordance to the cumulative square root value method  and divided into three groups: low socioeconomic group (income < Rs. 7035/month), middle socioeconomic group (income Rs. 7036–12,493/month), and high socioeconomic group (income more than Rs. 12,493/month). Passive smoking  was defined by exposure to smoking by either of the parents. The ISAAC questionnaire format was given standard scoring system as suggested by Solé, et al. In the 6–9 years age group, a global cutoff score of more than or equal to five and for the age group of 10–12; the cutoff score was six or more was the criteria for diagnosing asthma.
The statistical analysis was done using Statistical Package for the Social Sciences version 16 software for Windows (SPSS Inc, Chicago, IL, USA). Chi-square test was used to get the P value. A P< 0.05 was considered statistically significant.
| Results|| |
The questionnaires were distributed among 1750 children and asked to return on the next day. A total of 1631 children (93.2%) of them returned the questionnaire. All the epidemiological factors are depicted in [Table 1]. Out of the total 1631 students who responded, 952 (58.4%) were males and 679 (41.6%) were females. On the basis of ISAAC scoring, 51 (3.12%) were found to be the cases of asthma. Out of the total 952 males, 32 (3.36%) were positive for asthma while among the 679 females, 19 (2.8%) were positive for asthma. The prevalence of asthma is slightly more in male compared to female but not statistically significant (P = 0.51950).
This group was divided into age groups of 6–9 years and 10–12 years and analyzed. This showed 33 (3.58%) children had asthma in 6–9 age group and 18 (2.54%) had asthma in 10–12 age group. The difference of prevalence of asthma in these two groups was not statistically significant (P = 0.2314).
Among 1478 children with absent family history of allergic disorders, we found asthma in only 19 children (1.28%). Moreover, among 153 children with family history of asthma, we found 32 (20.9%) children suffering from asthma. The association of prevalence of asthma and family history was statistically significant (P< 0.000001).
The association of socioeconomic status of children showed 1159 in the low socioeconomic group, 320 in the middle-income group and 152 in the high-income group. The study revealed 9 (5.9%) children who belong to upper class family and 17 (5.31%) belongs to middle class and 25 (2.15%) belongs to lower class family. Our study revealed statistically significant difference in prevalence of asthma in upper class group (P = 0.00187).
In this study, 1015 were exposed to passive smoking, out of which 36 (3.55%) were found to have asthma. In the remaining 614 children who were not exposed to tobacco smoke, 15 (2.44%) were found to have asthma. However, the association between passive smoking and asthma was not statistically significant (P< 0.2150).
Our study on the type of fuel used for cooking at their houses revealed 486 were using liquid petroleum gas, 652 were using kerosene, and 493 were using fire wood. The prevalence among these three groups were 7 (1.44%), 12 (1.84%), and 32 (6.49%), respectively. The association of prevalence of asthma with cooking fuel was statistically significant; we found significant cases in children who are exposed to firewood cooking (P = 0.00000017).
We found 58.8% (n = 30) of these asthmatics had allergic rhinitis and 19.6% (n = 10) had a history of atopy. Overall prevalence of allergic rhinitis was 8.3% (n = 137) and atopy was 1.13% (n = 23). Among allergic rhinitis cases, the prevalence of asthma was 22.9% (30/137).
We found a significant association between asthma prevalence and family history of allergic disorders (P< 0.0000001), with high socioeconomic status (P = 0.00187), and who uses fire wood as cooking fuel (P< 0.00000017).
| Discussion|| |
Our study shows the prevalence of asthma in rural parts of Tumakuru district is 3.12%. Our study showed low prevalence in compared to study done by Jain et al., which showed asthma prevalence of 10.3% at rural parts of Mangalore, South India. The proportion of Indian school children suffering from bronchial asthma has increased to more than double in the past 10 years and has reached its highest level ever. There was a low prevalence of bronchial asthma (2.3%–3.3%) in the children surveyed in Lucknow, North India, but in urban Delhi, the prevalence of bronchial asthma was 11.6%. The prevalence of bronchial asthma in children from rural areas of Ludhiana and Punjab was 2.6% and 1%, respectively.
Our study shows more prevalence of asthma in male (3.3%) compared to female (2.9%). Many asthma prevalence studies done across the globe have reported a male predominance of the disease. According to Anuradha et al. in 2011, males (71.66%) outnumbered females (28.33%). According to Kumar et al., the prevalence of bronchial asthma in school girls in Delhi was found to be 8.78%. The prevalence of asthma is nearly twice in boys than girls before the age of 14. As a child gets older, the difference between the sexes narrows and by adulthood the prevalence of asthma is greater in women than in men. It may be explained as lung size is smaller in male than female at the time of birth and in childhood but larger in adulthood. Another study from the New Zealand showed higher rates of sensitivity to indoor allergens among males aged 13 years than their female counterparts as assessed by the skin prick test.
In our study, we found statistically significant association between the presence of family history of allergic disorders and the prevalence of asthma. There were seventy students have a family history of asthma, out of which 45 (64.2%) had asthma and 1850 students who did not have a family history of asthma, (0.9%) were found to have asthma (P< 0.001). Sibbald et al. showed that when both parents had asthma, 80% children developed the disease, compared to 40% of children when one parent had asthma, and when no parent had asthma, only 10% children developed asthma. Maternal influence is probably more than paternal influence, particularly in children <5 years of age possibly due to transplacental transfer of allergens or cytokines to the fetus.
The association between prevalence of asthma and high socioeconomic status was statistically significant in our study. Our finding is supported by the studies of Jain et al. and Prasad et al. A study from Singapore found the prevalence of parent-reported asthma to be greater among subjects of higher socioeconomic status. However, Georgy et al. in a study of prevalence and socioeconomic associations of asthma and allergic rhinitis in Egypt among 11–15-year-old children found a higher prevalence and increased the severity of asthma symptoms in children of lower socioeconomic groups.
Many studies have reported a significant association of asthma and exposure to smoking; our study did not show the significant association between exposure to smoking and asthma (P > 0.05). Exposure to tobacco smoking both prenatally and after birth is associated with measurable harmful effects including greater risk of developing asthma like symptoms in early childhood. However, evidence of the increased risk of allergic diseases is uncertain., It is possible that due to stigma, many children and parents did not report smoking.
The association with cooking fuel was not found to be significant in our study; we noticed high prevalence of asthma in subjects using coal as a fuel, limitation being small number of sample in this group.
We found 65% (n = 41) of these asthmatics had allergic rhinitis and 22.2% (n = 14) had a history of atopy suggesting a strong possibility of children suffering from other allergic manifestations to develop asthma. Overall prevalence of allergic rhinitis was 5.76% (n = 117) and atopy was 1.13% (n = 23). Among allergic rhinitis cases, prevalence of asthma was 35% (41/117). Similar studies showed 38% of rhinitis patients have been reported to have asthma, and 78% of asthmatics have rhinitis, and 44.9% of children with eczema have been found to have asthma children with eczema have been reported to have asthma or rhinitis frequently, at rates as high as 34.1% and 57.6%, respectively. In a study that followed 94 children with atopic dermatitis, it was found that rhinitis and asthma developed in 43% and 45%, respectively. In a study from southeast Turkey, 21% of children who visited a hospital with asthma were reported to have allergic eczema.
| Conclusions|| |
In the present study, the prevalence of bronchial asthma was 3.12%, allergic rhinitis was 8.3%, and atopy was 1.13% in children of rural parts of Tumakuru. Our study revealed asthma prevalence is significantly associated with epidemiological factors such as family history of allergy, high socioeconomic status, and use of fire wood for cooking. Our study will be the reference for the prevalence of asthma in Tumakuru city and any changes from baseline prevalence over time can be monitored.
I solemnly thank Sri Siddhartha Academy of Higher Education for their immense support and help in conducting this study. We also thank all the teaching and nonteaching staffs and parents of the school children for their invaluable support and participating and helping in completing this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gürkan F, Ece A, Haspolat K, Derman O, Bosnak M. Predictors for multiple hospital admissions in children with asthma. Can Respir J 2000;7:163-6.
von Mutius E. The burden of childhood asthma. Arch Dis Child 2000;82 Suppl 2:II2-5.
Lenney W, Wells NE, O'Neill BA. The burden of pediatric asthma. Eur Respir Rev 1994;4:49-62.
Singh D, Sobti PC, Arora V, Soni RK. Epidemiological study of asthma in rural children. Indian J Community Med 2002;27:167-70.
Jenkins MA, Clarke JR, Carlin JB, Robertson CF, Hopper JL, Dalton MF, et al.
Validation of questionnaire and bronchial hyperresponsiveness against respiratory physician assessment in the diagnosis of asthma. Int J Epidemiol 1996;25:609-16.
Jones A. Screening for asthma in children. Br J Gen Pract 1994;44:179-83.
Paramesh H. Epidemiology of asthma in india. Indian J Pediatr 2002;69:309-12.
Singh R, Mangat NS. Elements of Survey Sampling. Vol. 15. Springer Science, Business Media Dordrecht: Kluwer Acad Publishers; 1996. p. 133.
Kershaw CR. Passive smoking, potential atopy and asthma in the first five years. J R Soc Med 1987;80:683-8.
Solé D, Yamada E, Vana AT, Costa-Carvalho BT, Naspitz CK. Prevalence of asthma and related symptoms in school-age children in São Paulo, Brazil – international Study of Asthma and Allergies in Children (ISAAC). J Asthma 1999;36:205-12.
Jain A, Vinod Bhat H, Acharya D. Prevalence of bronchial asthma in rural Indian children: A cross sectional study from South India. Indian J Pediatr 2010;77:31-5.
Chhabra SK, Gupta CK, Chhabra P, Rajpal S. Risk factors for development of bronchial asthma in children in Delhi. Ann Allergy, Asthma Immunol1999;83:385-90.
Anuradha A, Kalpana VL, Narsingarao S. Epidemiological study on bronchial asthma. Indian J Allergy Asthma Immunology 2011;25:85-9.
Kumar R, Singhal P, Jain A, Raj N. Prevalence of bronchial asthma and allergic rhinitis in school girls in Delhi. Indian J Allergy Asthma Immunol 2008;22:104.
Horwood LJ, Fergusson DM, Shannon FT. Social and familial factors in the development of early childhood asthma. Pediatrics 1985;75:859-68.
Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ, et al.
Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N
Engl J Med 1995;332:133-8.
Sears MR, Burrows B, Flannery EM, Herbison GP, Holdaway MD. Atopy in childhood. I. Gender and allergen related risks for development of hay fever and asthma. Clin Exp Allergy 1993;23:941-8.
Sibbald B, Horn ME, Brain EA, Gregg I. Genetic factors in childhood asthma. Thorax 1980;35:671-4.
Litonjua AA, Carey VJ, Burge HA, Weiss ST, Gold DR. Parental history and the risk for childhood asthma. does mother confer more risk than father? Am J Respir Crit Care Med 1998;158:176-81.
Prasad R, Verma SK, Ojha S, Srivastava VK. A questionnaire based study of bronchial asthma in rural children of Lucknow. Indian J Allergy Asthma Immunol 2007;21:15-8.
Goh DY, Chew FT, Quek SC, Lee BW. Prevalence and severity of asthma, rhinitis, and eczema in Singapore schoolchildren. Arch Dis Child 1996;74:131-5.
Georgy V, Fahim HI, El-Gaafary M, Walters S. Prevalence and socioeconomic associations of asthma and allergic rhinitis in Northern [corrected] Africa. Eur Respir J 2006;28:756-62.
Strachan DP, Cook DG. Health effects of passive smoking. 5. Parental smoking and allergic sensitisation in children. Thorax 1998;53:117-23.
Kulig M, Luck W, Lau S, Niggemann B, Bergmann R, Klettke U, et al.
Effect of pre- and postnatal tobacco smoke exposure on specific sensitization to food and inhalant allergens during the first 3 years of life. Multicenter Allergy Study Group, Germany. Allergy 1999;54:220-8.
Gustafsson D, Sjöberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis – A prospective follow-up to 7 years of age. Allergy 2000;55:240-5.
Ricci G, Patrizi A, Baldi E, Menna G, Tabanelli M, Masi M, et al.
Long-term follow-up of atopic dermatitis: Retrospective analysis of related risk factors and association with concomitant allergic diseases. J Am Acad Dermatol 2006;55:765-71.
Gürkan F, Davutoglu M, Bilici M, Dagli A, Haspolat K. Asthmatic children and risk factors at a province in the Southeast of Turkey. Allergol Immunopathol (Madr) 2002;30:25-9.