1. PREVALENCE OF ASTHMA AND CHARACTERISTICS OF PRIMARY SCHOOL CHILDREN WITH ASTHMA IN KAMPALA DISTRICT
Author: BITIMWINE HARRIET
Co-authors: DR.SABRINA BAKEERA-KITAKA
DR.E.A MWOROZI

2. INTRODUCTION
Asthma: Asthma is a chronic inflammatory condition of the airways resulting in episodic airflow obstruction.
In this study asthma was defined as demonstrated exercise induced bronchospasm (EIB)
Exercise Induced Bronchospasm (EIB): A syndrome of airway obstruction related to exercise in an individual as demonstrated by a 15% fall or more in FEV1 from the baseline following a six minute exercise.

3. INTRODUCTION
WHO estimates that 300 million people worldwide suffer from asthma
Asthma has increased in the developed countries and there is now considerable concern that the prevalence of asthma and allergic diseases is increasing in African cities
Prevalence data is lacking for many countries in Africa, but its estimated that nearly 50 million Africans currently have asthma.

4. INTRODUCTION
Lack of published data on the magnitude of asthma among children in Uganda
In 1981; it was found that asthma was 2nd to PTB as the commonest cause of chronic disease among children attending the chest clinic (Kataha et al).

5. STUDY OBJECTIVES Specific objectives Primary objective
To determine the prevalence of asthma among day primary school children aged 8 to 14 years in Kampala district
Secondary objective
To describe the characteristics of day primary school children aged 8 to 14 years with asthma in Kampala district?

6. METHODS Study design This was a cross sectional descriptive study
Time of study
Data collection took place between 28th May 2009 and 12th June 2009 which was a dry season
Study setting
The study was carried out in 15 day primary schools from the 5 divisions of Kampala district.

7. METHODS Study population
Children aged 8-14 years attending Kampala district day primary schools fulfilling the study eligibility criteria.
Study Procedure
Children aged 8-14 years from the 15 schools meeting eligibility criteria took a consent form and parent self administered questionnaire home
Parent/guardian filled and returned consent and questionnaire within a period of 3 days.
Children who returned consent forms and questionnaires were re- assessed for eligibility at the schools.
Spirometry was done for those children that had completely filled questionnaire

8. RESULTS
A total of 708 children were randomly selected from 15 Kampala day primary schools between the period 28th May 2009 and 12th June 2009
The number of children that had completely filled questionnaires and spirometry adequately done was 413 & 355 resp.

9. Baseline characteristics of study participants
Variable
Number (N=413)
Sex
Girls
Boys
230 (55.7%)
183(44.3%)
Age(yrs)
Mean(SD)
11.2 (2)
Height (cm)
142.4(7.1)
Weight(kg)
35(4.0)
BMI(kg/m2)
17.1(3.1)
School status
Government
Private/Community
296(71.7%)
117(28.3%)
House ownership
Own house
Rented
186(45%)
227(55%)

10. RESULTS The prevalence of asthma was 13.8 %(49/355)
Prevalence of asthma according to school and home geographical location
The prevalence of asthma in the Peri-Urban and Urban division schools was 18.8% and 9.2% respectively.
The children lived mainly within Kampala, Wakiso and Mukono districts and the prevalence of asthma by home location was 16/111(14.5%), 20/146(13.8%) and 13/98(13.3%) resp.

11. Prevalence of asthma (EIB) for each division
95% CI
Kawempe
10/46 (21.7%)
11.6, 35.3
Makindye
19/89 (21.3%)
13.8, 30.8
Nakawa
8/84 (9.5%)
4.5, 17.3
Rubaga
3/35 (9.3%)
2.2, 21.6
Central
9/101 (8.9%)
4.4, 15.7
Overall
49/355 (13.8%)
10.6, 17.7

12. Characteristics of children with asthma
Selected Socio-economic characteristics of study children (N = 355)
Variable
Category
Asthma
Yes
n = 49 No
n = 306
Parental level of education
> Tertiary
< Tertiary
23(47%)
26(53%)
133(43%)
173(57%)
House ownership
Rented
Own
167(54%)
139(46% )
School category
Private/community school
Government school
11(22%)
38(78%)
95(31%)
211(69% )
House hold crowding
> 3 persons/room
< 3 persons/room
17(34%)
32(66%)
102(33% )
204(67%)

13. Characteristics of children with asthma
Selected Personal/host characteristics of study children (N = 355)
Variable
Category
Asthma
Yes
n = 49 No
n = 306
Gender
Male
Female
22(45%)
27(55%)
142(46%)
164(54%)
BMI
Overweight & Obesity(>85thcentile)
Normal BMI
5(10%)
44(90%)
21(11%)
272(89%)
Breast feeding
<6 months
>6months
22(7%)
284(93%)
Birth weight
LBW (< 2.5 kg)
> 2.5 kg
4(13%)
27(87%)
25(13%)
166(87%)
Gestation age
Preterm birth
Full-term
2(4%)
47(96%)
20(7%)
286(93%)
Family history of asthma
14(29%)
35(71%)
9(3%)
297(97%)
History of food allergies
13(26%)
36(74%)
77(25%)
229(75%)
n= for Birth weight 31 for asthma and 191 for no asthma, the rest were unknown

14. Characteristics of children with asthma
Selected environmental characteristics of study children (N = 355)
Variable
Category
Asthma
Yes
n = 49 No
n = 306
Indoor exposure
Child’s room floor covered(mat, carpet)
21(43%)
28(57%)
159(52%)
147(48%)
Tobacco smoking by a member of the household
5(10%)
44(89%)
35(11%)
271(89%)
Cooking fuel: Charcoal
45(92%)
4(8%)
259(85%)
47(15%)
Cooking fuel: Firewood
9(18%)
40(82%)
37(12%)
269(88%)
Lighting fuel: Kerosene
27(55%)
22(45%)
136(44%)
170(66%)
Lighting fuel: Candle
11(22%)
38(78%)
44(14%)
262(86%)
Animals in homestead
18(37%)
31(63%)
103(34%)
203(66%)
Animals inside house overnight
36(12%)
270(88%)

15. Asthma symptoms among study children (N = 355)
Variable
Category
Asthma
Yes
n = 49 No
n = 306
Wheezing at anytime in the past
25(51%)
24(49%)
21(7%)
285(93%)
Wheezing in the past 12 months
22(45%)
27(55%)
17(6%)
289(94%)
Severe wheeze limiting speech to one or 2 words at a time between breaths.
13(26%)
36(74%)
4(1%)
302(99%)
Ever had asthma
8(16%)
41(84%)
15(5%)
291(95%)
Wheezing during or after exercise
20(41%)
29(59%)
22(7%)
284(93%)
Dry cough at night in past 12 months
62(20%)
244(80%)
Overall asthma symptoms were markedly more prevalent among children with asthma compared to those without.

16. Conclusion
The prevalence of asthma was 13.8% among day primary school children in Kampala district.
2. The characteristics frequently common among children with asthma included: use of charcoal as cooking fuel, attendance of school in the Peri-urban divisions, family history of asthma and keeping an animal in the house overnight.

17. Recommendations
Deliberate efforts should be made to routinely screen for asthma among Kampala district primary school children.
2. Further studies to determine the risk factors for childhood asthma in Kampala district should be conducted.

18. ACKNOWLEDGEMENT
Co-authors: Dr. E.A Mworozi and Dr. Sabrina Bakeera-Kitaka
Paediatricians in the department of Paediatrics and Child Health Makerere University
Research assistants
Centre for International Child Health- University of British Columbia
Mrs.Davidson Lindsay
Kampala City council Education office
School administrations, Teachers, parents/guardians & children.
My family
God Almighty