Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin.
ED 393 Pierre Louis de Santé Publique, Université Paris Cité, Paris, France.
Eur J Med Res. 2022 Dec 26;27(1):304. doi: 10.1186/s40001-022-00919-1.
The African continent is currently facing an epidemiological transition characterized by a shift from communicable to non-communicable diseases. Prominent amongst the latter are allergies and asthma. In that context, wheeze has multiple potential contributory factors that could include some of the endemic helminth infections, as well as environmental exposures, such as household air pollution. We sought to determine the relative importance of these risk factors among children in Benin.
We included 964 children aged 6-14 years living in the commune of Comé, south-west Benin. All children were participants in the longitudinal monitoring cohort of the DeWorm3 trial designed to evaluate multiple rounds of community mass treatment with albendazole for interruption of the transmission of soil transmitted helminths (STH). We administered a standard ISAAC questionnaire to determine the presence of wheeze. In addition, we assessed exposure to household air pollution and to other potential allergy-inducing factors, dietary intake and anthropometry. Using STH infection status assessed at the pretreatment baseline timepoint, we used multivariate statistical modelling, controlling for covariates, to investigate associations between wheeze and the different factors measured.
The prevalence of wheezing history was 5.2%, of current wheezing was 4.6% and of severe wheezing was 3.1%, while STH infections were found in 5.6% of children. These profiles did not vary as a function of either age or gender. Infection with Ascaris lumbricoides, but not hookworm species, was significantly associated with both current wheeze (adjusted Odds Ratio (aOR) = 4.3; 95% CI [1.5-12.0]) and severe wheeze (aOR = 9.2; 95% CI [3.1-27.8]). Significant positive associations with current wheeze, independent of each other and of STH infection status, were also found for (i) use of open cookstoves (aOR = 3.9; 95% CI [1.3-11.5]), (ii) use of palm cakes for fire lighting (aOR = 3.4; 95% CI [1.1-9.9]), (iii) contact with domestic animals and/or rodents (aOR = 2.5; 95% CI [1.1-6.0]), (iv) being overweight (aOR = 9.7; 95% CI [1.7-55.9]). Use of open cookstoves and being overweight were also independent risk factors for severe wheeze (aOR = 3.9; 95% CI [1.1-13.7]) and aOR = 10.3; 95% CI [1.8-60.0], respectively).
Children infected with A. lumbricoides appear to be at elevated risk of wheeze. Deworming may be an important intervention to reduce these symptoms. Improving cooking methods to reduce household air pollution, modifying dietary habits to avoid overweight, and keeping animals out of the house are all additional measures that could also contribute to reducing childrens' risk of wheeze. Policymakers in LMIC should consider tailoring public health measures to reflect the importance of these different risk factors.
非洲大陆目前正面临着从传染病向非传染性疾病转变的局面。后者中较为突出的是过敏和哮喘。在这种情况下，喘息有多种潜在的促成因素，其中包括一些地方性寄生虫感染，以及环境暴露，如家庭空气污染。我们试图确定这些危险因素在贝宁儿童中的相对重要性。
我们纳入了 964 名年龄在 6-14 岁之间的儿童，他们居住在贝宁西南部科梅市。所有儿童均为 DeWorm3 试验的纵向监测队列的参与者，该试验旨在评估多次社区大规模阿苯达唑治疗，以阻断土壤传播的蠕虫（STH）的传播。我们使用标准的 ISAAC 问卷来确定喘息的存在。此外，我们评估了与家庭空气污染以及其他潜在的过敏诱发因素、饮食摄入和人体测量学有关的暴露情况。利用治疗前基线时间点评估的 STH 感染状况，我们使用多变量统计模型，在控制了协变量的情况下，调查了喘息与测量的不同因素之间的关联。
喘息史的患病率为 5.2%，现患喘息的患病率为 4.6%，严重喘息的患病率为 3.1%，而儿童中 STH 感染的患病率为 5.6%。这些特征与年龄或性别无关。感染蛔虫（Ascaris lumbricoides），而不是钩虫物种，与现患喘息（调整后的优势比[aOR] = 4.3；95%置信区间[1.5-12.0]）和严重喘息（aOR = 9.2；95%置信区间[3.1-27.8]）均有显著相关性。与现患喘息相关的显著正相关，与 STH 感染状态无关，与以下因素独立相关：（i）使用开放式炉灶（aOR = 3.9；95%置信区间[1.3-11.5]），（ii）使用棕榈核作为点火燃料（aOR = 3.4；95%置信区间[1.1-9.9]），（iii）与家养动物和/或啮齿动物接触（aOR = 2.5；95%置信区间[1.1-6.0]），（iv）超重（aOR = 9.7；95%置信区间[1.7-55.9]）。使用开放式炉灶和超重也是严重喘息的独立危险因素（aOR = 3.9；95%置信区间[1.1-13.7]）和 aOR = 10.3；95%置信区间[1.8-60.0]）。
感染蛔虫的儿童似乎有更高的喘息风险。驱虫可能是减少这些症状的重要干预措施。改善烹饪方法以减少家庭空气污染、改变饮食习惯以避免超重以及将动物拒之门外，都是可以减少儿童喘息风险的额外措施。中等收入国家的决策者应该考虑调整公共卫生措施，以反映这些不同危险因素的重要性。
