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Mabelane T, Masekela R, Dandara C, Hadebe S. Immunogenetics and pharmacogenetics of allergic asthma in Africa. FRONTIERS IN ALLERGY 2023; 4:1165311. [PMID: 37228580 PMCID: PMC10203899 DOI: 10.3389/falgy.2023.1165311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Asthma is a common chronic condition in children and in an African setting is often highly prevalent in urban areas as compared to rural areas. Asthma is a heritable disease and the genetic risk is often exacerbated by unique localised environmental factors. The Global Initiative for Asthma (GINA) recommendation for the control of asthma includes inhaled corticosteroids (ICS) alone or together with short-acting β2-agonists (SABA) or long-acting β2-agonists (LABA). While these drugs can relieve asthma symptoms, there is evidence of reduced efficacy in people of African ancestry. Whether this is due to immunogenetics, genomic variability in drug metabolising genes (pharmacogenetics) or genetics of asthma-related traits is not well defined. Pharmacogenetic evidence of first-line asthma drugs in people of African ancestry is lacking and is further compounded by the lack of representative genetic association studies in the continent. In this review, we will discuss the paucity of data related to the pharmacogenetics of asthma drugs in people of African ancestry, mainly drawing from African American data. We will further discuss how this gap can be bridged to improve asthma health outcomes in Africa.
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Affiliation(s)
- Tshegofatso Mabelane
- Department of Medicine, Sefako Makgatho Health Science University, Ga-Rankuwa, South Africa
| | - Refiloe Masekela
- Department of Paediatrics, Nelson Mandela School of Medicine, Inkosi Albert Luthuli Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences and Institute of Infectious Diseases Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Platform for Pharmacogenomics Research and Translation, South African Medical Research Council, Cape Town, South Africa
| | - Sabelo Hadebe
- Division of Immunology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Arku RE, Brauer M, Duong M, Wei L, Hu B, Ah Tse L, Mony PK, Lakshmi PVM, Pillai RK, Mohan V, Yeates K, Kruger L, Rangarajan S, Koon T, Yusuf S, Hystad P. Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study. ENVIRONMENTAL RESEARCH 2020; 188:109851. [PMID: 32798956 PMCID: PMC7748391 DOI: 10.1016/j.envres.2020.109851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - MyLinh Duong
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Li Wei
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rajamohanan K Pillai
- School of Health Policy, Kerala University of Health Sciences, Trivandrum, India
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lanthe Kruger
- North-West University, Africa Unit for Transdisciplinary Health Research (AUTHeR), South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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Affiliation(s)
- Stephen Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre; and Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen Graham
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre; and Liverpool School of Tropical Medicine, Liverpool, UK
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Eldeirawi K, Kunzweiler C, Combs AMT, Persky VW. In utero exposure to pets is associated with asthma and wheezing in Mexican American children. J Asthma 2016; 53:374-81. [PMID: 26797097 DOI: 10.3109/02770903.2015.1104693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the associations of in utero and early life exposure to cats/dogs and birds with the risk of lifetime doctor-diagnosed asthma and other respiratory conditions in a sample of Mexican American (MA) children 4-18 years of age. METHODS This study is a population-based cross-sectional investigation of 1816 MA children. We conducted multiple logistic models examining the relationship of asthma and wheezing with exposures to cats/dogs and birds in utero, infancy and at the time of the survey adjusted for country of birth, family history of asthma/allergies, antibiotics use in infancy and other covariates. RESULTS In adjusted analyses, in utero exposure to cats/dogs and birds jointly was associated with increased odds of asthma (adjusted odds ratio (aOR): 2.89; 95% confidence interval (CI): 1.34-6.23), ever wheezing (aOR: 1.96; 95% CI: 1.11-3.46) and current exercise-induced wheezing (aOR: 3.16; 95% CI: 1.27-7.85) compared to children not exposed to these pets in utero. Children who were exposed to both cats/dogs and birds in utero had an elevated, albeit statistically non-significant, odds of current wheezing. Exposures in infancy and at the time of the survey to cats/dogs and birds were not associated with asthma or wheezing. CONCLUSIONS In utero exposure to pets might be associated with an increased risk of asthma and respiratory conditions in a sample of non-affluent MA children.
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Affiliation(s)
- Kamal Eldeirawi
- a Department of Health Systems Science , College of Nursing and
| | - Colin Kunzweiler
- b Division of Epidemiology and Biostatistics , School of Public Health, University of Illinois at Chicago , Chicago , IL , USA
| | | | - Victoria W Persky
- b Division of Epidemiology and Biostatistics , School of Public Health, University of Illinois at Chicago , Chicago , IL , USA
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Kelbore AG, Alemu W, Shumye A, Getachew S. Magnitude and associated factors of Atopic dermatitis among children in Ayder referral hospital, Mekelle, Ethiopia. BMC DERMATOLOGY 2015; 15:15. [PMID: 26303574 PMCID: PMC4548845 DOI: 10.1186/s12895-015-0034-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 08/05/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Atopic Dermatitis (AD) is now a day's increasing in prevalence globally. A Prevalence of 5-25 % have been reported in different country. Even if its prevalence is known in most countries especially in developing countries there is scarcity with regard to prevalence and associated risk factors of AD among children in Ethiopia settings. The aim of this study was to determine the magnitude and associated factors of atopic dermatitis among children in Ayder referral hospital, Mekelle, Ethiopia. METHODS A facility-based cross-sectional study design was conducted among 477 children aged from 3 months to 14 years in Ayder referral hospital from July to September, 2014. A systematic random sampling technique was used to identify study subjects. Descriptive analysis was done to characterize the study population. Bivariate and multivariate logistic regression was used to identify factors associated with AD. The OR with 95 % CI was used to show the strength of the association and a P value < 0.05 was used to declare the cut of point in determining the level of significance. RESULTS Among the total respondents, 237 (50.4 %) were males and 233 (49.6 %) were females. The magnitude of the atopic dermatitis was found to be 9.6 % (95 % CI: 7.2, 12.5). In multivariate logistic regression model, those who had maternal asthma (AOR: 11.5, 95 % CI:3.3-40.5), maternal hay fever history (AOR: 23.5, 95 % CI: 4.6-118.9) and atopic dermatitis history (AOR: 6.0, 95 % CI:1.0-35.6), Paternal asthma (AOR: 14.4, 95 % CI:4.0-51.7), Paternal hay fever history (AOR: 13.8, 95 % CI: 2.4-78.9) and personal asthma (AOR: 10.5, 95 % CI:1.3-85.6), and hay fever history (AOR: 12.9, 95 % CI:2.7-63.4), age at 3 months to 1 year (OR: 6.8, 95 % CI: 1.1-46.0) and weaning at 4 to 6 months age (AOR: 3.9, 95 % CI:1.2-13.3) were a significant predictors of atopic dermatitis. CONCLUSION In this study the magnitude of atopic dermatitis was high in relation to other studies conducted so far in the country. Maternal, paternal, personal asthma, hay fever histories, maternal atopic dermatitis history, age of child and age of weaning were independent predicators of atopic dermatitis. Hence, the finding alert a needs of strengthening the national skin diseases prevention and control services in particular in skin care of children related to atopic dermatitis and others. In avoiding early initiation of supplementary feeding specially with personal and families with atopic problem needs further attention of prevention activities.
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Affiliation(s)
| | - Workalemahu Alemu
- Dermatovenereology Department, Mekelle University, Mekelle, North Ethiopia.
| | - Ashenafi Shumye
- Public Health Department, Mekelle University, Mekelle, North Ethiopia.
| | - Sefonias Getachew
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia.
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Sanya RE, Kirenga BJ, Worodria W, Okot-Nwang M. Risk factors for asthma exacerbation in patients presenting to an emergency unit of a national referral hospital in Kampala, Uganda. Afr Health Sci 2014; 14:707-15. [PMID: 25352892 DOI: 10.4314/ahs.v14i3.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Asthma exacerbations are caused by a variety of risk factors. Reducing exposure to these risk factors improves the control of asthma and reduces medication needs. Knowledge of the particular risk factors is essential in formulating controlling and treatment protocols. This study set out to determine the risk factors for asthma exacerbations in patients presenting to the emergency unit of Mulago Hospital. METHODS An unmatched case-control study involving 43 cases and 43 controls was conducted from November 2011 through February 2012. Asthma patients with exacerbations presenting to Mulago hospital's emergency unit were chosen as cases. The controls were asthma patients recruited from the hospital's outpatient department who had not had an exacerbation in the past 7 days. The study variables were age, sex, level of education, adherence to treatment, exercise, upper respiratory tract infections, household pets, smoking, strong emotions, exposure to in house wood or charcoal burning, weather, use of corticosteroids, beta-blockers and non-steroidal anti-inflammatory drugs. Univariate and multivariate statistical analysis was done using SPSS version 16 to identify independent risk factors for exacerbations. RESULTS Lack of corticosteroid use (OR = 22.109; 95% Confidence interval 6.952 to 70.315; p < 0.001) and presence of upper respiratory tract infections (OR 4.516; CI 1.258-16.213; p = 0.018) were significantly associated with exacerbations. CONCLUSION Lack of corticosteroid use and upper respiratory tract infections are associated with exacerbations in asthma patients presenting to the Emergency unit of Mulago Hospital.
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Affiliation(s)
- Richard E Sanya
- Pulmonology unit, Department of Medicine, Makerere College of Health sciences/ Mulago Hospital
| | - Bruce J Kirenga
- Pulmonology unit, Department of Medicine, Makerere College of Health sciences/ Mulago Hospital
| | - William Worodria
- Pulmonology unit, Department of Medicine, Makerere College of Health sciences/ Mulago Hospital
| | - Martin Okot-Nwang
- Pulmonology unit, Department of Medicine, Makerere College of Health sciences/ Mulago Hospital
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van Gemert F, van der Molen T, Jones R, Chavannes N. The impact of asthma and COPD in sub-Saharan Africa. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 20:240-8. [PMID: 21509418 DOI: 10.4104/pcrj.2011.00027] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many countries in sub-Saharan Africa have the highest risk of developing chronic diseases and are the least able to cope with them. AIMS To assess the current knowledge of the prevalence and impact of asthma and chronic obstructive pulmonary disease (COPD) in sub- Saharan Africa. METHODS A literature search was conducted using Medline (1995-2010) and Google Scholar. RESULTS Eleven studies of the prevalence of asthma in sub-Saharan Africa were identified, all of which showed a consistent increase, particularly in urban regions. The data on asthma show a wide variation (5.7-20.3%), with the highest prevalence in 'westernised' urban areas. Only two studies of the prevalence of COPD in sub-Saharan Africa have been performed. Nevertheless, COPD has become an increasing health problem in sub-Saharan Africa due to tobacco smoking and exposure to biomass fuels. In most countries of sub-Saharan Africa, 90% of the rural households depend on biomass fuel for cooking and heating, affecting young children (acute lower respiratory infections) and women (COPD). This is the cause of significant mortality and morbidity in the region. CONCLUSIONS Asthma and COPD in sub-Saharan Africa are under-recognised, under-diagnosed, under-treated, and insufficiently prevented. A major priority is to increase the awareness of asthma and COPD and their risk factors, particularly the damage caused by biomass fuel. Surveys are needed to provide local healthcare workers with the possibility of controlling asthma and COPD.
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Affiliation(s)
- Frederik van Gemert
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands.
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Lam NL, Smith KR, Gauthier A, Bates MN. Kerosene: a review of household uses and their hazards in low- and middle-income countries. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2012; 15:396-432. [PMID: 22934567 PMCID: PMC3664014 DOI: 10.1080/10937404.2012.710134] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Kerosene has been an important household fuel since the mid-19th century. In developed countries its use has greatly declined because of electrification. However, in developing countries, kerosene use for cooking and lighting remains widespread. This review focuses on household kerosene uses, mainly in developing countries, their associated emissions, and their hazards. Kerosene is often advocated as a cleaner alternative to solid fuels, biomass and coal, for cooking, and kerosene lamps are frequently used when electricity is unavailable. Globally, an estimated 500 million households still use fuels, particularly kerosene, for lighting. However, there are few studies, study designs and quality are varied, and results are inconsistent. Well-documented kerosene hazards are poisonings, fires, and explosions. Less investigated are exposures to and risks from kerosene's combustion products. Some kerosene-using devices emit substantial amounts of fine particulates, carbon monoxide (CO), nitric oxides (NO(x)), and sulfur dioxide (SO(2)). Studies of kerosene used for cooking or lighting provide some evidence that emissions may impair lung function and increase infectious illness (including tuberculosis), asthma, and cancer risks. However, there are few study designs, quality is varied, and results are inconsistent. Considering the widespread use in the developing world of kerosene, the scarcity of adequate epidemiologic investigations, the potential for harm, and the implications for national energy policies, researchers are strongly encouraged to consider collecting data on household kerosene uses in studies of health in developing countries. Given the potential risks of kerosene, policymakers may consider alternatives to kerosene subsidies, such as shifting support to cleaner technologies for lighting and cooking.
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Affiliation(s)
- Nicholas L Lam
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California 94720-7367, USA
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Hulin M, Annesi-Maesano I. Allergies et asthme chez l’enfant en milieu rural agricole. Rev Mal Respir 2010; 27:1195-220. [DOI: 10.1016/j.rmr.2010.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 06/17/2010] [Indexed: 12/28/2022]
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Abstract
In Africa, the burden of some diseases has been a problem for centuries. The spectrum of African diseases includes allergies, infections, nutritional deficiencies, and natural disasters. Efforts made by scientists to search for possible means of disease control have been outstanding; however, in some infections, solutions are still out of reach. In disease control programs, it might be worthwhile to pay attention to the most striking diseases than merely follow a holistic approach. This short review tackles the problems of allergy and allergens in Africa as compared with other disease burdens that may suggest the need for a more balanced approach based on priority.
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Affiliation(s)
- Erasto Vitus Mbugi
- Muhimbili University of Health and Allied Sciences, Biochemistry Department, School of Medicine, Dar es Salaam, Tanzania
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Bröms K, Norbäck D, Eriksson M, Sundelin C, Svärdsudd K. Effect of degree of urbanisation on age and sex-specific asthma prevalence in Swedish preschool children. BMC Public Health 2009; 9:303. [PMID: 19695101 PMCID: PMC2741449 DOI: 10.1186/1471-2458-9-303] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 08/20/2009] [Indexed: 11/13/2022] Open
Abstract
Background There are few studies on age and sex-specific asthma prevalence in the age range 1–6 years. The purpose of this report was to estimate age and sex specific asthma prevalence in preschool children and to analyse the influence of possible demographic and geographic determinants. Methods All 70 allergen avoidance day-care centres and 140 matched ordinary day-care centres across Sweden were sampled. The parents of all 8,757 children attending these day-care centres received the International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire, supplemented with questions on medical treatment, physician assessed asthma diagnosis, and other asthma related questions. The response rate was 68%. Results The age specific asthma prevalence, adjusted for the underlying municipality population size, was among boys 9.7% at age 1, 11.1% at age 2, 11.4 at age 3, 10.5 at age 4, 8.7 at age 5, and 6.4 at age 6. The corresponding proportions among girls were 8.9%, 9.9%, 9.8%, 8.8%, 7.0%, and 5.0%, on average 9.6% for boys and 8.2% for girls, altogether 8.9%. In addition to age and sex the prevalence increased by municipality population density, a proxy for degree of urbanisation. Moreover, there was a remaining weak geographical gradient with increasing prevalence towards the north and the west. Conclusion The age-specific asthma prevalence was curvilinear with a peak around age 3 and somewhat higher for boys than for girls. The asthma prevalence increased in a slowly accelerating pace by municipality population density as a proxy for degree of urbanisation.
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Affiliation(s)
- Kristina Bröms
- Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
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Kinfu A, Erko B. Cockroaches as carriers of human intestinal parasites in two localities in Ethiopia. Trans R Soc Trop Med Hyg 2008; 102:1143-7. [PMID: 18579170 DOI: 10.1016/j.trstmh.2008.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Revised: 05/13/2008] [Accepted: 05/15/2008] [Indexed: 11/27/2022] Open
Abstract
A study was undertaken to assess the role of cockroaches as potential carriers of human intestinal parasites in Addis Ababa and Ziway, Ethiopia. A total of 6480 cockroaches were trapped from the two localities from October 2006 to March 2007. All the cockroaches trapped in Addis Ababa (n=2240) and almost 50% (2100/4240) of those trapped in Ziway were identified as Blattella germanica. The rest of the cockroaches trapped in Ziway were identified as Periplaneta brunnea (24.52%), Pycnoscelus surinamensis (16.03%) and Supella longipalpa (9.90%). Microscopic examination of the external body washes of pooled cockroaches and individual gut contents revealed that cockroaches are carriers of Entamoeba coli and Entamoeba histolytica/dispar cysts as well as Enterobius vermicularis, Trichuris trichiura, Taenia spp. and Ascaris lumbricoides ova. Besides their role as a nuisance, the present study further confirms that cockroaches serve as carriers of human intestinal parasites. The possible association of cockroaches with allergic conditions such as asthma is also discussed. Hence, appropriate control measures should be taken particularly to make hotels and residential areas free of cockroaches as they represent a health risk.
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Affiliation(s)
- Addisu Kinfu
- St Lideta Health Science College, P.O. Box 120004, Addis Ababa, Ethiopia
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Ait-Khaled N, Odhiambo J, Pearce N, Adjoh KS, Maesano IA, Benhabyles B, Bouhayad Z, Bahati E, Camara L, Catteau C, El Sony A, Esamai FO, Hypolite IE, Melaku K, Musa OA, Ng'ang'a L, Onadeko BO, Saad O, Jerray M, Kayembe JM, Koffi NB, Khaldi F, Kuaban C, Voyi K, M'Boussa J, Sow O, Tidjani O, Zar HJ. Prevalence of symptoms of asthma, rhinitis and eczema in 13- to 14-year-old children in Africa: the International Study of Asthma and Allergies in Childhood Phase III. Allergy 2007; 62:247-58. [PMID: 17298341 DOI: 10.1111/j.1398-9995.2007.01325.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Phase I of the International Study of Asthma and Allergies in Childhood has provided valuable information regarding international prevalence patterns and potential risk factors in the development of asthma, allergic rhinoconjunctivitis and eczema. However, in Phase I, only six African countries were involved (Algeria, Tunisia, Morocco, Kenya, South Africa and Ethiopia). Phase III, conducted 5-6 years later, enrolled 22 centres in 16 countries including the majority of the centres involved in Phase I and new centres in Morocco, Tunisia, Democratic Republic of Congo, Togo, Sudan, Cameroon, Gabon, Reunion Island and South Africa. There were considerable variations between the various centres of Africa in the prevalence of the main symptoms of the three conditions: wheeze (4.0-21.5%), allergic rhinoconjunctivitis (7.2-27.3%) and eczema (4.7-23.0%). There was a large variation both between countries and between centres in the same country. Several centres, including Cape Town (20.3%), Polokwane (18.0%), Reunion Island (21.5%), Brazzaville (19.9%), Nairobi (18.0%), Urban Ivory Coast (19.3%) and Conakry (18.6%) showed relatively high asthma symptom prevalences, similar to those in western Europe. There were also a number of centres showing high symptom prevalences for allergic rhinoconjunctivitis (Cape Town, Reunion Island, Brazzaville, Eldoret, Urban Ivory Coast, Conakry, Casablanca, Wilays of Algiers, Sousse and Eldoret) and eczema (Brazzaville, Eldoret, Addis Ababa, Urban Ivory Coast, Conakry, Marrakech and Casablanca).
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Affiliation(s)
- N Ait-Khaled
- International Union Against Tuberculosis and Lung Disease, Paris, France
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Addo-Yobo EOD, Woodcock A, Allotey A, Baffoe-Bonnie B, Strachan D, Custovic A. Exercise-induced bronchospasm and atopy in Ghana: two surveys ten years apart. PLoS Med 2007; 4:e70. [PMID: 17326711 PMCID: PMC1808098 DOI: 10.1371/journal.pmed.0040070] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 01/04/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Asthma and allergic diseases have increased in the developed countries. It is important to determine whether the same trends are occurring in the developing countries in Africa. We aimed to determine the time trend in the prevalence of exercise-induced bronchospasm (EIB) and atopic sensitisation over a ten-year period in Ghanaian schoolchildren. METHODS AND FINDINGS Two surveys conducted using the same methodology ten years apart (1993 and 2003) among schoolchildren aged 9-16 years attending urban rich (UR), urban poor (UP), and rural (R) schools. Exercise provocation consisted of free running for six minutes. Children were skin tested to mite, cat, and dog allergen. 1,095 children were exercised in 1993 and 1,848 in 2003; 916 were skin tested in 1993 and 1,861 in 2003. The prevalence of EIB increased from 3.1% (95% CI 2.2%-4.3%) to 5.2% (4.3%-6.3%); absolute percentage increase 2.1% (95% CI 0.6%-3.5%, p < 0.01); among UR, UP, and R children EIB had approximately doubled from 4.2%, 1.4%, and 2.2% to 8.3%, 3.0% and 3.9% respectively. The prevalence of sensitisation had also doubled from 10.6%, 4.7%, and 4.4% to 20.2%, 10.3%, and 9.9% (UR, UP, and R respectively). Mite sensitisation remained unchanged (5.6% versus 6.4%), but sensitisation to cat and dog increased considerably from 0.7% and 0.3% to 4.6% and 3.1%, respectively. In the multiple logistic regression analysis, sensitisation (odds ratio [OR] 1.77, 95% CI 1.12-2.81), age (OR 0.88, 95% CI 0.79-0.98), school (the risk being was significantly lower in UP and R schools: OR 0.40, 95% CI 0.23-0.68 and OR 0.54, 95% CI 0.34-0.86, respectively) and year of the study (OR 1.73, 95% CI 1.13-2.66) remained significant and independent associates of EIB. CONCLUSIONS The prevalence of both EIB and sensitisation has approximately doubled over the ten-year period amongst 9- to 16-year-old Ghanaian children irrespective of location, with both EIB and atopy being more common among the UR than the UP and R children.
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Affiliation(s)
| | - Ashley Woodcock
- North West Lung Centre, Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom
| | - Adorkor Allotey
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - David Strachan
- Department of Public Health Sciences, St George's Hospital Medical School, London, United Kingdom
| | - Adnan Custovic
- North West Lung Centre, Wythenshawe Hospital, University of Manchester, Manchester, United Kingdom
- * To whom correspondence should be addressed. E-mail:
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Alexander CJ. Asthma: a disuse contracture? Med Hypotheses 2005; 64:1102-4. [PMID: 15823694 DOI: 10.1016/j.mehy.2005.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Accepted: 01/01/2005] [Indexed: 11/21/2022]
Abstract
The incidence of asthma is increasing. There is no obvious explanation for this increase and current theory has no explanation for the occurrence of the disease in the non-allergic, the sudden onset of the asthma attack, the hyper-reactivity of the muscular wall, the association of the disease with obesity, or its precipitation by exercise. Biopsy studies have shown that the narrowing of air passages which characterises the disease is associated with thickening of their fibrous and muscular layers. As narrowing of air passages necessarily involves shortening of annular and helical components, this narrowing is in effect an annular contracture, analogous to those seen in underextended longitudinal structures such as muscles and tendons. The only common cause for such contractures is habitual underextension. As the only extending force in annular air passages is inspiration, this leads to the hypothesis that the basic cause of the disease is an insufficiency of aerobic exercise in childhood. Should the airways fail to develop their normal calibre, the narrowing will precipitate a sequence of events which can be predicted from the laws of physics. La Place's Law explains the instability of the muscle wall, the sudden onset of the attacks, reflecting episodes of critical collapse and the occurrence of the disease in the non-allergic. Bernoulli's Law explains the provocative effect of exercise and the postulated lack of exercise explains the increasing prevalence and the association with obesity. The hypothesis can be tested by comparative epidemiology. If it is correct, the disease should be preventable.
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Affiliation(s)
- C J Alexander
- Department of Anatomy with Radiology, School of Medicine, University of Auckland, PO Box 92019 Auckland, New Zealand.
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Haileamlak A, Dagoye D, Williams H, Venn AJ, Hubbard R, Britton J, Lewis SA. Early life risk factors for atopic dermatitis in Ethiopian children. J Allergy Clin Immunol 2005; 115:370-6. [PMID: 15696097 DOI: 10.1016/j.jaci.2004.10.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) has increased in prevalence in many countries in recent decades, but the risk factors for AD in developing countries are unknown. Helminthic parasites may play a role in protecting against allergic disease, but few studies have investigated the association of AD with parasitic infection. OBJECTIVE To establish the independent effects of parasitic infection and other early life factors on the risk of AD in Ethiopia. METHODS We conducted a cross-sectional survey and nested case-control study of children age 1 to 5 years in Jimma and surrounding rural areas in southwest Ethiopia. Cases were defined according to the International Study of Asthma and Allergies in Childhood criteria for AD and confirmed by clinical examination. Information on lifestyle and other potential risk factors was collected by parental questionnaire, and stool samples were analyzed for parasites. RESULTS Complete data were obtained on 306 AD cases defined by International Study of Asthma and Allergies in Childhood criteria (prevalence, 4.4%) and 426 controls. There was no reduction in the risk of AD in relation to intestinal parasite infection; in fact, AD was increased in subjects with Trichuris (1.61; 95% CI, 1.14-2.26). The risk of AD was also unrelated to family size, crowding in the home, or breast-feeding, but was related to previously unrecognized factors including malaria and access to piped drinking water. Similar findings were apparent in cases and controls confirmed by clinical examination. CONCLUSION Neither intestinal parasite infection nor other proposed risk factors for AD appear to be related to the presence of the condition in young children in Ethiopia, suggesting that other factors may be more important in this population.
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