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Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda

  1. Harriet Mpairwe  Is a corresponding author
  2. Milly Namutebi
  3. Gyaviira Nkurunungi
  4. Pius Tumwesige
  5. Irene Nambuya
  6. Mike Mukasa
  7. Caroline Onen
  8. Marble Nnaluwooza
  9. Barbara Apule
  10. Tonny Katongole
  11. Gloria Oduru
  12. Joseph Kahwa
  13. Emily L Webb
  14. Lawrence Lubyayi
  15. Neil Pearce
  16. Alison M Elliott
  1. Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Uganda
  2. London School of Hygiene and Tropical Medicine, United Kingdom
Research Article
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Cite this article as: eLife 2019;8:e49496 doi: 10.7554/eLife.49496

Abstract

Data on asthma aetiology in Africa are scarce. We investigated the risk factors for asthma among schoolchildren (5-17years) in urban Uganda. We conducted a case-control study, among 555 cases and 1,115 controls. Asthma was diagnosed by study clinicians. The main risk factors for asthma were tertiary education for fathers [adjusted OR (95% CI); 2.32 (1.71-3.16)] and mothers [1.85 (1.38-2.48)]; area of residence at birth, with children born in a small town or in the city having an increased asthma risk compared to schoolchildren born in rural areas [2.16 (1.60-2.92)] and [2.79 (1.79-4.35)], respectively; father's and mother's history of asthma; children's own allergic conditions; atopy; and cooking on gas/electricity. In conclusion, asthma was associated with a strong rural-town-city risk gradient, higher parental socio-economic status and urbanicity. This work provides the basis for future studies to identify specific environmental/lifestyle factors responsible for increasing asthma risk among children in urban areas in LMICs.

Data availability

Data is available at https://datacompass.lshtm.ac.uk/1369/

The following data sets were generated
    1. Webb E
    2. Mpairwe H
    (2019) SONA project - Asthma risk factors data
    London School of Hygiene & Tropical Medicine (LSHTM) Data Compass, https://doi.org/10.17037/DATA.00001369.

Article and author information

Author details

  1. Harriet Mpairwe

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    For correspondence
    Harriet.Mpairwe@mrcuganda.org
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-1199-4859
  2. Milly Namutebi

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  3. Gyaviira Nkurunungi

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0003-4062-9105
  4. Pius Tumwesige

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  5. Irene Nambuya

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  6. Mike Mukasa

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  7. Caroline Onen

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  8. Marble Nnaluwooza

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  9. Barbara Apule

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  10. Tonny Katongole

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  11. Gloria Oduru

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  12. Joseph Kahwa

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  13. Emily L Webb

    Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
    Competing interests
    The authors declare that no competing interests exist.
  14. Lawrence Lubyayi

    Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
    Competing interests
    The authors declare that no competing interests exist.
  15. Neil Pearce

    Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
    Competing interests
    The authors declare that no competing interests exist.
  16. Alison M Elliott

    Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
    Competing interests
    The authors declare that no competing interests exist.

Funding

Wellcome (Training fellowship 102512)

  • Harriet Mpairwe

Wellcome (Senior fellowship 095778)

  • Alison M Elliott

European research council (Project grant 668954)

  • Neil Pearce

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Ethics

Human subjects: Parents or guardians of the children provided written informed consent, and children eight years or older provided written informed assent. This consent was to participate in the study, and to publish anonymous results.The study was approved by the Uganda Virus Research Institute Research and Ethics Committee, and the Uganda National Council for Science and Technology [reference number HS 1707]. The two bodies follow Good Clinical Practice guidelines.

Reviewing Editor

  1. Belinda Nicolau, McGill University, Canada

Publication history

  1. Received: June 19, 2019
  2. Accepted: November 13, 2019
  3. Accepted Manuscript published: November 15, 2019 (version 1)
  4. Version of Record published: December 16, 2019 (version 2)

Copyright

© 2019, Mpairwe et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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Further reading

    1. Epidemiology and Global Health
    2. Microbiology and Infectious Disease
    Mark Ferris et al.
    Research Advance Updated

    Background:

    Respiratory protective equipment recommended in the UK for healthcare workers (HCWs) caring for patients with COVID-19 comprises a fluid-resistant surgical mask (FRSM), except in the context of aerosol generating procedures (AGPs). We previously demonstrated frequent pauci- and asymptomatic severe acute respiratory syndrome coronavirus 2 infection HCWs during the first wave of the COVID-19 pandemic in the UK, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020).

    Methods:

    Here, we use observational data and mathematical modelling to analyse infection rates amongst HCWs working on ‘red’ (coronavirus disease 2019, COVID-19) and ‘green’ (non-COVID-19) wards during the second wave of the pandemic, before and after the substitution of filtering face piece 3 (FFP3) respirators for FRSMs.

    Results:

    Whilst using FRSMs, HCWs working on red wards faced an approximately 31-fold (and at least fivefold) increased risk of direct, ward-based infection. Conversely, after changing to FFP3 respirators, this risk was significantly reduced (52–100% protection).

    Conclusions:

    FFP3 respirators may therefore provide more effective protection than FRSMs for HCWs caring for patients with COVID-19, whether or not AGPs are undertaken.

    Funding:

    Wellcome Trust, Medical Research Council, Addenbrooke’s Charitable Trust, NIHR Cambridge Biomedical Research Centre, NHS Blood and Transfusion, UKRI.

    1. Epidemiology and Global Health
    Andria Mousa et al.
    Research Article

    Background: Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focussed on high-income settings.

    Methods: Here, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys we explored how contact characteristics (number, location, duration and whether physical) vary across income settings.

    Results: Contact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age-groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, with low-income settings characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income-strata on the frequency, duration and type of contacts individuals made.

    Conclusions: These differences in contact patterns between settings have material consequences for both spread of respiratory pathogens, as well as the effectiveness of different non-pharmaceutical interventions.

    Funding: This work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1).