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Rural Malagasy children: High prevalence of wheezing and atopy

      Rationale

      Knowledge of atopic diseases in Africa is limited. For half of the Sub-Saharan African (SSA) countries, there are several studies concerning allergies in children. For the other 24 SAA-countries and Madagascar, no data is available regarding the impact of allergies.

      Methods

      The cross-sectional Malagasy Kids with Asthma and Allergy (MAKI)-Study focused on the rural highland north of Antananarivo, an area dominated by farming enterprises with extremely poor infrastructure. A modified questionnaire from the International Study of Asthma and Allergy in Childhood (ISAAC) was completed in Malagasy language, along with spirometry and skin prick tests (SPT). Stepwise logistic regression models were used to predict the odds of wheezing.

      Results

      We collected data from 212 Malagasy children (8-15 years) in eight villages. Wheezing ever was reported in 76 children (36%), current wheeze in 28.2%. Sensitization to inhalant allergens was found in 27.5%, with cockroach having the highest prevalence (20.8%) followed by Blomia tropicalis (8,1%). Sensitization to Dermatophagoides pteronyssinus (4.3%) was associated with the risk of wheezing (OR=7.00, 95%-CI 1.41-34.64, p=0.017; wheeze ever) as was cockroach (OR=2.67, 95%-CI 1.32-5.41, p=0.006, current wheeze). Of the current wheezers, 39% were sensitized to inhalant allergens. Another risk factor for wheeze was the child’s having had pneumonia (OR=5.00, 95%-CI 1.52-16.43, p=0.008) indicating household air pollution (HAP). As all households used biomass fuel for cooking and heating statistical analysis was impeded.

      Conclusions

      Prevalence of wheezing in rural Malagasy children is remarkably high. Allergy to house dust mite and cockroach as well as HAP seem to be the major factors.