Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya.
Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK.
Thorax. 2023 Nov;78(11):1118-1125. doi: 10.1136/thorax-2023-220057. Epub 2023 Jun 6.
Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms.
Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM) was estimated.
2373 children participated, 1277 in Mukuru (median age, IQR 11, 9-13 years, 53% girls), and 1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, 'current wheeze' (9.5% vs 6.4%, p=0.007) and 'trouble breathing' (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to 'vapours, dusts, gases, fumes', mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads.
Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.
尽管有 10 亿人生活在非正式（贫民窟）住区，但这些住区对呼吸健康的影响在很大程度上仍不清楚。本研究调查了肯尼亚内罗毕一个非正式住区的儿童是否有患哮喘症状的风险增加。
比较了在内罗毕的穆库鲁（一个非正式住区）和一个较富裕地区（布鲁布鲁）上学的儿童。问卷量化了呼吸症状和环境暴露情况；进行了肺活量测定；估计了个人对颗粒物（PM）的暴露情况。
共有 2373 名儿童参与了研究，其中 1277 名在穆库鲁（中位数年龄，IQR11，9-13 岁，女孩占 53%），1096 名在布鲁布鲁（10 岁，8-12 岁，女孩占 52%）。穆库鲁的学童来自经济条件较差的家庭，接触污染源和 PM 的机会更多。与布鲁布鲁的学童相比，穆库鲁的学童出现症状的比例更高，“当前喘息”（9.5%比 6.4%，p=0.007）和“呼吸困难”（16.3%比 12.6%，p=0.01），这些症状更为严重和麻烦。布鲁布鲁被诊断为哮喘的比例更高（2.8%比 1.2%，p=0.004）。穆库鲁和布鲁布鲁的肺活量测定结果没有差异。无论在哪个社区，都观察到与自我报告的“蒸气、灰尘、气体、烟雾”暴露、燃烧蚊香、家中有成年吸烟者、在家附近燃烧垃圾和居住靠近道路等因素有显著的不良关联。
生活在非正式住区的儿童更有可能出现与哮喘一致的喘息症状，这些症状更严重，但被诊断为哮喘的可能性更小。自我报告的但不是客观测量的空气污染暴露与哮喘症状风险增加有关。
