Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Uganda
- London School of Hygiene and Tropical Medicine, United Kingdom
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/
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SONA project - Asthma risk factors dataLondon School of Hygiene & Tropical Medicine (LSHTM) Data Compass, https://doi.org/10.17037/DATA.00001369.
Article and author information
Author details
Gyaviira Nkurunungi
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
- Belinda Nicolau, McGill University, Canada
Publication history
- Received: June 19, 2019
- Accepted: November 13, 2019
- Accepted Manuscript published: November 15, 2019 (version 1)
- 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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Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda
eLife 8:e49496.
https://doi.org/10.7554/eLife.49496
Further reading
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- Epidemiology and Global Health
Local cervical cancer epidemiological data essential to project the context-specific impact of cervical cancer preventive measures are often missing. We developed a framework, hereafter named Footprinting, to approximate missing data on sexual behaviour, human papillomavirus (HPV) prevalence, or cervical cancer incidence, and applied it to an Indian case study. With our framework, we (1) identified clusters of Indian states with similar cervical cancer incidence patterns, (2) classified states without incidence data to the identified clusters based on similarity in sexual behaviour, (3) approximated missing cervical cancer incidence and HPV prevalence data based on available data within each cluster. Two main patterns of cervical cancer incidence, characterized by high and low incidence, were identified. Based on the patterns in the sexual behaviour data, all Indian states with missing data on cervical cancer incidence were classified to the low-incidence cluster. Finally, missing data on cervical cancer incidence and HPV prevalence were approximated based on the mean of the available data within each cluster. With the Footprinting framework, we approximated missing cervical cancer epidemiological data and made context-specific impact projections for cervical cancer preventive measures, to assist public health decisions on cervical cancer prevention in India and other countries.
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- Epidemiology and Global Health
- Microbiology and Infectious Disease
Background:
Dog-mediated rabies is endemic across Africa causing thousands of human deaths annually. A One Health approach to rabies is advocated, comprising emergency post-exposure vaccination of bite victims and mass dog vaccination to break the transmission cycle. However, the impacts and cost-effectiveness of these components are difficult to disentangle.
Methods:
We combined contact tracing with whole-genome sequencing to track rabies transmission in the animal reservoir and spillover risk to humans from 2010-2020, investigating how the components of a One Health approach reduced the disease burden and eliminated rabies from Pemba Island, Tanzania. With the resulting high-resolution spatiotemporal and genomic data we inferred transmission chains and estimated case detection. Using a decision tree model we quantified the public health burden and evaluated the impact and cost-effectiveness of interventions over a ten-year time horizon.
Results:
We resolved five transmission chains co-circulating on Pemba from 2010 that were all eliminated by May 2014. During this period, rabid dogs, human rabies exposures and deaths all progressively declined following initiation and improved implementation of annual islandwide dog vaccination. We identified two introductions to Pemba in late 2016 that seeded re-emergence after dog vaccination had lapsed. The ensuing outbreak was eliminated in October 2018 through reinstated islandwide dog vaccination. While post-exposure vaccines were projected to be highly cost-effective ($256 per death averted), only dog vaccination interrupts transmission. A combined One Health approach of routine annual dog vaccination together with free post-exposure vaccines for bite victims, rapidly eliminates rabies, is highly cost-effective ($1657 per death averted) and by maintaining rabies freedom prevents over 30 families from suffering traumatic rabid dog bites annually on Pemba island.
Conclusions:
A One Health approach underpinned by dog vaccination is an efficient, cost-effective, equitable and feasible approach to rabies elimination, but needs scaling up across connected populations to sustain the benefits of elimination, as seen on Pemba, and for similar progress to be achieved elsewhere.
Funding:
Wellcome [207569/Z/17/Z, 095787/Z/11/Z, 103270/Z/13/Z], the UBS Optimus Foundation, the Department of Health and Human Services of the National Institutes of Health [R01AI141712] and the DELTAS Africa Initiative [Afrique One-ASPIRE/DEL-15-008] comprising a donor consortium of the African Academy of Sciences (AAS), Alliance for Accelerating Excellence in Science in Africa (AESA), the New Partnership for Africa's Development Planning and Coordinating (NEPAD) Agency, Wellcome [107753/A/15/Z], Royal Society of Tropical Medicine and Hygiene Small Grant 2017 [GR000892] and the UK government. The rabies elimination demonstration project from 2010-2015 was supported by the Bill & Melinda Gates Foundation [OPP49679]. Whole-genome sequencing was partially supported from APHA by funding from the UK Department for Environment, Food and Rural Affairs (Defra), Scottish government and Welsh government under projects SEV3500 & SE0421.
