Environmental risk factors for asthma in 13-14 year old African children

Background Asthma prevalence in African children is high. Factors driving the prevalence or disease severity are poorly understood. This study aims to investigate environmental factors associated with asthma and severity in African children. Methods Population based cross-sectional study of children aged 13-14 years from 10 African centers who participated in ISAAC III. Self-reported environmental exposures included engaging in physical exercise, television watching, various biomass and ETS exposure, consumption of paracetamol, large family sizes and having pets in the home. Univariable and multivariable analyses were done adjusting for center variations. Prevalences, odds ratio and 95% confidence intervals (CI) were calculated. Results There were 258267 children recruited among the 13-14-year-old participants. Of these, 28,391 respondents from 232 schools completed both the written questionnaire (WQ) and environmental questionnaire (EQ). The prevalence of asthma and severe asthma were 12.8% (CI 12.4-13.2), and 8.7% (CI 8.4-8.0) respectively. Factors strongly associated with asthma were maternal smoking (OR=1.41; 95%CI: 1.23-1.64), open fire heating (OR=1.28; 95%CI: 1.08-1.51) electric heating (OR=1.13; 95%CI: 1.01-1.28), physical exercise (OR=1.29; 95%CI: 1.11-1.50), monthly paracetamol use (OR 1.23; 95%CI 1.13-1.33), having an elder sibling (OR=0.87; 95%CI 0.77-0.98). Factors associated with severe asthma were maternal smoking (OR=1.61; 95%CI: 1.38-1.89), cat pet (OR=1.14; 95%CI: 1.04-1.25), frequent physical exercise (OR=1.42; 95%CI: 1.23-1.64) and monthly paracetamol use (OR=1.20; 95%CI 1.07, 1.34). Conclusion Several environmental exposures were associated with asthma and severe disease.