|Year : 2016 | Volume
| Issue : 1 | Page : 89-94
The prevalence of bronchial asthma among primary school children in Menoufiya Governorate (El-Bagour Center)
Ghada M El-Mashad, Asmaa A Mahmoud, Ahmed A Abdel Hafez
Department of Pediatrics, Faculty of Medicine, Menoufiya University, Menoufia, Egypt
|Date of Submission||13-Nov-2014|
|Date of Acceptance||08-Feb-2015|
|Date of Web Publication||18-Mar-2016|
Ahmed A Abdel Hafez
MBBCh, 100 El-Galaa Street, El-Bagour City, 32821 Menoufia
Source of Support: None, Conflict of Interest: None
To study the prevalence of bronchial asthma among primary school children in Menoufiya Governorate (El-Bagour Center).
Asthma is a common disease in children that forms a major comorbidity illness. It is prevalent worldwide, especially in developed countries where its prevalence is increasing to epidemic proportions.
Patients and Methods
This is an observational study carried out on 2544 children from a representative sample of children attending eight primary schools in El-Menoufiya Governorate (El-Bagour Center): four schools were located inside El-Bagour Center, representing the urban locality, and the other four schools were located in villages around El-Bagour Center, representing the rural locality. Children were screened for chest symptoms by a questionnaire.
The prevalence of asthma in rural and urban schools was 5.34 and 6.58%, respectively, with a total prevalence of 6.09%. A low socioeconomic level, a positive family history of similar disease, and exposure to smoke showed a highly significant effect as risk factors for asthma. Bronchial asthma had a highly significant effect on delayed weight gain, disturbed sleep, missed school days, limited activity, and emergency room visits and had a significant effect on delayed growth.
The overall point prevalence of childhood bronchial asthma among primary school children in Menoufiya governorate was 6.5%, which reflects a significant increase over the last 20 years when compared with a previous prevalence rate of 2.2% in a similar study conducted more than 20 years ago. This reveals a significant increase in the magnitude of the problem of bronchial asthma in our community and the need for effective prevention and management programs.
Keywords: Bronchial asthma, El-Bajour center, Menoufiya governorate, prevalence, primary school children
|How to cite this article:|
El-Mashad GM, Mahmoud AA, Abdel Hafez AA. The prevalence of bronchial asthma among primary school children in Menoufiya Governorate (El-Bagour Center). Menoufia Med J 2016;29:89-94
|How to cite this URL:|
El-Mashad GM, Mahmoud AA, Abdel Hafez AA. The prevalence of bronchial asthma among primary school children in Menoufiya Governorate (El-Bagour Center). Menoufia Med J [serial online] 2016 [cited 2020 Jun 2];29:89-94. Available from: http://www.mmj.eg.net/text.asp?2016/29/1/89/178992
| Introduction|| |
Asthma is the most common chronic illness of children and adolescents. It has a major impact on the lifestyle and accounts for millions of missed school days each year. Thirty percent of the young people with asthma have limited activity, compared with 5% of youngsters without asthma .
Despite advances in the understanding of asthma, asthma morbidity has increased over the past decade. The reasons for this are unclear, but may be related to a combination of poor access to health care and environmental factors such as smoke and perennial allergen exposure .
The prevalence of asthma and exercise-induced asthma is increasing worldwide, and assessment for this condition is a common reason for referral to pulmonary function laboratories. With appropriate therapy, children with asthma should be able to participate in sports and maintain normal physical activity .
The aim of this work was to study the prevalence of bronchial asthma among primary school children in Menoufiya Governorate (El-Bagour Center).
| Patients and methods|| |
The current study is an epidemiological study that was carried out on primary school children in El-Bagour center, Menoufiya governorate. Eight primary schools in El-Bagour center were chosen as a representative sample of children for our study. Children were screened for chest symptoms by a questionnaire from October 2013 to September 2014.
Method of selection of schools
The schools were divided into two groups according to the locality of each group: the first group included four schools that were located inside El-Bagour city (urban locality) and the second group included four schools that were located in villages around the center (rural locality).
- Urban schools: El-Bagour city was divided into four quarters, and only one school was selected from each quarter randomly to represent all primary schools inside the city, and then one class was selected randomly per school year from each school.
- Rural schools: Four schools were selected randomly from four villages around the capital: Zawyet Garawan village, Kafer Elbagour village, Bai El arab village, and Kom El daba village. One class was selected randomly per school year from each school.
Protocol of assessment
Ethical approval and consent were obtained from formal educational, health authorities and from individual participants. The selected children were subjected to the following.
Detailed history taking from parents through a written questionnaire [Figure 1] including the personal history, patient complaints, aggravating factors, drug administration, the grade of asthma, absenteeism from school, family history, and social data.
|Figure 1: A written questionnaire for bronchial asthma diagnosis in primary school children.|
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Characteristic symptoms of asthma include cough, wheezing, and dyspnea. Dyspnea is the most common symptom of asthma.
A complete physical examination was performed to detect clinical signs of bronchial asthma and other allergic conditions; physical examination of the respiratory system may reveal no apparent abnormality if the patient is not in an asthmatic attack. Wheezing occurs predominantly on exhalation.
Chest radiography: both posteroanterior and lateral views of the chest were performed to exclude other pulmonary pathologies such as T.B, foreign body inhalation, etc.
Routine laboratory investigations
- Stool and urine examination was performed to exclude parasitic infestations that may be the cause of eosinophilia.
- A complete blood count, including the Hb%, and total leucocytic and differential counts from a blood film, including the absolute eosinophilic count, were obtained.
One hundred nonasthmatic children were selected randomly to serve as controls to be compared with asthmatic children regarding risk factors including the age, the sex, the residence, the socioeconomic level, a positive family history, exposure to smoke, damp housing, consanguinity, the educational level, contact with animals, and breastfeeding.
The asthmatic children were compared with controls to evaluate the effect of bronchial asthma on weight gain, height, sleep, activity, missed school days, emergency room visits, and overall growth.
| Results|| |
The current study included 2544 children representing 48 classes from eight schools. The studied children included 155 children diagnosed with bronchial asthma, distributed as 77 male (49.7%) and 50.3% female (50.3%) patients, with an age range of 6-12 years. The asthmatic children were distributed as 101 cases (65.2%) of urban residence against 54 cases (34.8%) of rural residence [Table 1].
|Table 1: Growth parameters and demographic data of asthmatic children in different age groups|
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The prevalence of asthma in rural and urban schools was 5.34 and 6.58%, respectively, with a total prevalence of 6.09% [Table 2]. There was no significant difference between asthmatic and control children regarding their age, sex, and residence as risk factors (P > 0.05 for all) [Table 3],[Table 4] and [Table 5].
|Table 2: Distribution of childhood asthma and its prevalence among the studied schools|
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|Table 4: Sex as a risk factor for the development of asthma in asthmatic children|
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|Table 5: Residence as a risk factor for the development of asthma in asthmatic children and controls|
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A low socioeconomic level, a positive family history of similar disease, and exposure to smoke had a highly significant effect as risk factors for asthma (P < 0.01 for all). Damp housing and positive consanguinity had a significant effect on the causation of asthma (P < 0.05). However, the educational level, contact with animals, and breastfeeding had no significant effect on the development of asthma (P > 0.05) [Table 6].
|Table 6: A comparison regarding the family and social history among asthmatic children and controls|
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Bronchial asthma had a highly significant effect on delayed weight gain and a significant effect on height retardation (P < 0.001 and P < 0.05, respectively) [Table 7]. Also, bronchial asthma had a highly significant effect on disturbed sleep, missed school days, limited activity, and emergency room visits (P < 001) for all and a significant effect on delayed growth (P < 0.05) [Table 8].
|Table 7: Effects of asthma on the growth of asthmatic children with regard to weight and height|
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|Table 8: A comparison between asthmatic children and controls with regard to the effect of asthma on the quality of life|
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| Discussion|| |
Asthma is a global health problem affecting around 300 million individuals of all ages, ethnic groups, and countries. It is estimated that around 250 000 people die prematurely each year as a result of asthma. Concepts of asthma severity and control are important in its evaluation .
Bronchial asthma is prevalent worldwide, especially in developed countries where its prevalence is increasing to epidemic proportions . In Egypt, the prevalence of asthma in children (2-12 years) is nearly 8.2% . In central and Eastern Europe countries, the prevalence of asthma appears to be lower than in Western Europe .
The current study was carried out to evaluate the prevalence of bronchial asthma among primary school children in El-Menoufiya governorate (El-Bagour Center) in a trial to assess the magnitude of the problem and the impact of the disease on affected children.
This study was carried out on 2544 children (distributed as 48 classes) from a representative sample of children attending eight primary schools in El-Menoufiya Governorate (El-Bagour Center) (one class per school year): four schools were located inside El-Bagour Center representing the urban locality and the other four schools were located in villages around El-Bagour Center representing the rural locality. Children were screened for chest symptoms by a written questionnaire. The overall point prevalence of bronchial asthma was found to be 6.09% and the prevalence was higher in urban areas than in rural areas (6.58 and 5.34%, respectively).
In contrast to this result, Eissa and colleagues studied the prevalence of bronchial asthma among primary school children in El-Menoufiya Governorate during the period from October 1986 to April 1987. They reported that the overall point prevalence of childhood asthma among 2958 school children in Shebin El-Koum city was found to be 2.20% . This difference can be attributed to the varying level of education and medical orientation across nearly three decades affecting the collection of data from parents. However, the results of our study show that bronchial asthma is a common condition in our school children in El-Menoufiya governorate and has increased in the last 30 years. This was in agreement with many authors who reported that asthma has increased in the last 30 years [9-13]. However, the reported prevalence in our study is still lower than the international prevalence, which is 10% worldwide .
The increase in the prevalence of pediatric asthma may be explained by the increasing exposure to exogenous factors such as outdoor pollutants, for example ozone, sulphur dioxide, and cigarette smoke, a reduction in host resistance, or a combination of both . It may also be due to the change in dietary habits, which may lead to a reduction in natural antioxidant defenses, with more susceptibility to the oxidant injurious effects on the respiratory system . Patricia et al.  found that the changes induced by human activities in indoor and outdoor environments as well as a westernized lifestyle might play important roles in the increased rate of atopic disease in the general population.
Schwartz and Berger  stated that factors associated with the increased prevalence of asthma in younger children include indoor pollution, overcrowding, an increased incidence of viral respiratory infection, allergens, cockroach allergy, and possibly, a decrease in breastfeeding. The current study showed that a low socioeconomic level, a positive family history of similar disease, and exposure to smoke had a highly significant effect as risk factors for asthma when compared with controls. Also, damp housing and positive consanguinity had a significant effect on the causation of asthma. However, the educational level, contact with animals, and breastfeeding had no significant effect on the development of asthma.
The current study showed no significant effect with regard to the age or the sex as risk factors for bronchial asthma. This is against a previous finding that asthma occurs predominantly in boys during childhood with a male-to-female ratio of 2 : 1 until puberty when the male-to-female ratio becomes 1 : 1 and symptoms are more likely to decrease in boys by adolescence . This finding was explained by the hypothesis that boys have a more severe airway hyper-responsiveness and this may contribute to the higher prevalence of asthma in boys .
Regarding residence, the current study showed that the prevalence was higher in the urban locality than in the rural locality, but there was no significant difference between asthmatic and control children regarding the residence as a risk factor. This higher prevalence in urban areas can be explained by the increased pollution and crowdedness in urban areas, as well as by the reduced early autoimmunization in urban areas as a result of more hygienic practices reducing early childhood infections.
This is in agreement with El Sharif et al. , who studied the prevalence of asthma in school children in Ramallah District in Palestine and found that the crude prevalence rates for 'wheezing-ever', 'wheezing in the previous 12 months', and 'physician-diagnosed asthma' were 17.1, 8.8, and 9.4%, respectively, with urban areas having higher prevalence rates than rural areas.
By following the impact of bronchial asthma on the quality of life of patients in the current study, bronchial asthma showed a highly significant effect on delayed weight gain and had a significant effect on height retardation. Also, bronchial asthma had a highly significant effect on disturbed sleep, missed school days, limited activity, and emergency room visits and a significant effect on delayed growth.
These findings agree with Umlawska and colleagues, who used anthropometric measurements and information on the severity and the course of the disease to study 261 children with bronchial asthma. The mean body height was lower than in healthy peers, and about 5% of the individuals were short . Regarding the relationship between bronchial asthma and sleep, Cukic et al.  stated that asthma is associated with a decreased subjective quality of sleep, difficulties inducing sleep fragmentation, early morning awakenings, and increased daytime sleepiness. The effect of asthma on missed school days was studied by Moonie et al. , who found that asthma puts children at risk of missing more days from school than those without asthma. In addition, a relationship was demonstrated between the asthma severity and the number of school days missed.
| Conclusion|| |
The overall point prevalence of childhood bronchial asthma among primary school children in El-Menoufiya governorate is 6.5%, which reflects a significant increase over the last 20 years when compared with a previous prevalence rate of 2.2% in a similar study conducted more than 20 years ago. This reveals a significant increase in the magnitude of the problem of bronchial asthma in our community and the need for effective prevention and management programs.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chulada PC, Arbes SJ Jr, Dunson D, Zeldin DC Breast-feeding and the prevalence of asthma and wheeze in children: analyses from the Third National Health and Nutrition Examination Survey, 1988-1994. J Allergy Clin Immunol 2003; 111
Boguniewiez M. Asthma, diagnosis & treatment
. 7th ed. New York: Lang Medical Books/McGraw-Hill; 2005. 1080-1091.
Stephen DA, Sphan J. The pharmacologic management of childhood asthma. Pediatr Clin North Am 2003; 50
Bousquet J, Mantzouranis E, Cruz AA, Aït-Khaled N, Baena-Cagnani CE, Bleecker ER, et al
. Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization Consultation on Severe Asthma. J Allergy Clin Immunol 2010; 126
Chen YQ, Shi HZ. CD28/CTLA-4 - CD80/CD86 and ICOS - B7RP-1 costimulatory pathway in bronchial asthma. Allergy 2006; 61
Zedan M, Settin A, Farag M, Ezz-Elregal M, Osman E, Fouda A. Prevalence of bronchial Asthma among Egyptian school children. Egypt J Bronchol 2009; 3
Baraldi E. Chronic respiratory diseases and sport in children. Int J Sports Med 2000; 21
Eissa AM, EL Sobky MK, Madkour MT.Prevalence of bronchial asthma among primary school children in EL Menoufiya province [MD Thesis]. Menoufiya, Egypt: Faculty of medicine, Menoufiya University; 1989
Liu A, Spahn J, Leung D. Childhood asthma. In: Behrman R, Kliegman RM, Jenson H, eds Nelson textbook of pediatrics
. 17th ed. Philadelphia: WB Saunders; 760-774.
Ronchetti R, Villa MP, Barreto M, Rota R, Pagani J, Martella S et al
. Is the increase in childhood asthma coming to an end? Findings from three surveys of schoolchildren in Rome, Italy. Eur Respir J 2001; 17
Smith SR, Strunk RC. Acute asthma in the pediatric emergency department. Pediatr Clin North Am 1999; 46
El-Lawindi M, Mostafa N, Abu Haashima F. Bronchial asthma among children: disease burden and exacerbation determinants. Egypt J Commun Med 2003; 21
El-Saify M, Deraz T, Soliman E.Effect of air pollution on pulmonary function test in school children [MD thesis]. Cairo, Egypt: Faculty of Medicine, Ain Shams University; 2002
Beasley R, Ellwood P, Asher I. International patterns of the prevalence of pediatric asthma the ISAAC program. Pediatr Clin North Am 2003; 50
Noreen C, Brown R, Paker E. Childhood asthma. Environ Health Perspect 1999; 107
Schwartz HJ, Berger M. Intravenous gamma-globulin therapy in bronchial asthma. Allergy Asthma Proc 2002; 23
El-Saify M, Malak A, Sahar M.A 10 years retrospective study of pediatric asthma in pediatric chest clinic Ain Shams University [MD thesis]. Cairo, Egypt: Faculty of medicine, Ain Shams University; 2005
Abd El-Khalek KA, Deraz TE, Rafik M. Assessment of urinary leukotriene E4 and pulmonary function tests before and after leukotriene antagonist modifying agents in asthmatic children. Egypt J Pediatr 2004; 7
El-Sharif NA, Nemery B, Barghuthy F, Mortaja S, Qasrawi R, Abdeen Z. Geographical variations of asthma and asthma symptoms among schoolchildren aged 5 to 8 years and 12 to 15 years in Palestine: the International Study of Asthma and Allergies in Childhood (ISAAC). Ann Allergy Asthma Immunol 2003; 90
Um³awska W, G¹szczyk G, Sands D. Physical development in children and adolescents with bronchial asthma. Respir Physiol Neurobiol 2013; 187
Cukic V, Lovre V, Dragisic D. Sleep disorders in patients with bronchial asthma. Mater Sociomed 2011; 23
Moonie SA, Sterling DA, Figgs L, Castro M. Asthma status and severity affects missed school days. J Sch Health 2006; 76
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]
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