Asthma and Allergic Disorders in Uganda: A Population-Based Study Across Urban and Rural Settings

• DOI: 10.1016/j.jaip.2017.11.032
• Publication Date: 2018-02-01T16:16:10Z
• Authors: Brooks W. Morgan; Trishul Siddharthan; Matthew R. Grigsby; Suzanne L. Pollard; Robert Kalyesubula; Robert A. Wise; Bruce Kirenga; William Checkley
• Keywords: Adult; Male; Rural Population; Urban Population; Middle Aged; Asthma; 3. Good health; Cohort Studies; 03 medical and health sciences; Cross-Sectional Studies; 0302 clinical medicine; Risk Factors; Spirometry; 11. Sustainability; Hypersensitivity; Prevalence; Humans; Female; Uganda

Allergic diseases are increasing in sub-Saharan Africa, but few studies have characterized the burden among adults.We conducted a study to evaluate the prevalence and risk factors of allergic disorders in urban and rural Uganda.We present a cross-sectional analysis of enrollment data from a population-based cohort study of adults aged ≥35 years in urban and rural Uganda. Sociodemographic and both lifetime and 12-month respiratory symptoms data were collected and spirometry was conducted following standard guidelines.In 1,308 adults (median age 43.8 years and 52.3% female), we found an age-adjusted prevalence of 6.8% for asthma (9.8% urban, 4.3% rural; P < .001), 11.9% for allergic rhinitis (16.4% urban, 7.8% rural; P < .001), and 8.2% for eczema (9.9% urban, 7.8% rural; P = .15). Urbanization was the primary driver of asthma, accounting for 61.4% of cases (95% confidence interval [CI] 22.0% to 83.4%), and was the strongest risk factor for any allergic illness (odds ratio [OR] = 1.87, 95% CI 1.39-2.51). Parental asthma was not associated with allergic illness. Asthma was associated with a lower forced expiratory volume in 1 second (FEV1) by 0.56 z scores (95% CI 0.33-0.80). We found a dose-response association between lower quintiles of the FEV1/forced vital capacity ratio and both hospitalization (OR = 1.77, 95% CI 1.21-2.59) and impairment in daily activities (1.65, 1.20-2.27).Asthma and allergic rhinitis were twice as prevalent in urban settings. Asthma was associated with greater impairment and worse lung function outcomes. We identified a high prevalence of allergic disorders in Uganda, which can be expected to increase due to urbanization and resultant exposures throughout early development.