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ORIGINAL ARTICLE
Year : 2022  |  Volume : 66  |  Issue : 5  |  Page : 22-26  

Prevalence of bronchial asthma in school going children: A cross-sectional study from Uttar Pradesh


1 Senior Resident, Department of Community Medicine, VIMSAR, Burla, Odisha, India
2 Professor, Department of Community Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University, Aligarh, UP, India
3 Professor, Department of TBRD, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University, Aligarh, UP, India
4 Assistant Professor, Department of Community Medicine, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University, Aligarh, UP, India

Date of Submission09-Aug-2022
Date of Decision22-Aug-2022
Date of Acceptance23-Aug-2022
Date of Web Publication11-Nov-2022

Correspondence Address:
Tazeen Shamshad
Motijharan, Raza Nagar, Sambalpur, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1067_22

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   Abstract 


Background: Asthma is coined as a chronic inflammatory disorder and disarrays of the airways and respiratory tract which manifests as recurrent episodes of wheezing, breathlessness, chest tightness, and cough. The World Health Organization recognizes asthma as a major health problem. Although asthma can occur at any age, children and young adults are the age groups which are affected more commonly. Objectives: The objective of this study is to find the prevalence of bronchial asthma in school-going children (6–16 years) and its associated factors. Materials and Methods: A cross-sectional study among the school-going children in the age group of 6–16 years was done in the field practice areas of urban health and training center and rural health and training center of the Department of Community Medicine, JNMCH, A. M. U., Aligarh, U.P. the study done for a period of one year. The validated questionnaire (International Study on Allergy and Asthma in Childhood) was used. The sample size was taken as 902. The data were entered and analyzed in the SPSS statistical software version 20.0. Chi-square was used. Results: The prevalence of asthma among the study population was found to be 26.9%. Family history of smoking and history of allergy in an individual came out to be a significant factor associated with asthma. The association is also significant between asthma and the diet of an individual. Conclusions: Asthma among school children is a public health problem in urban and rural areas. There was a rising pattern in the prevalence of asthma at national and subnational levels.

Keywords: Asthma, children, factors, prevalence, school, smoking


How to cite this article:
Shamshad T, Khalique N, Shameem M, Shah MS, Nawab T. Prevalence of bronchial asthma in school going children: A cross-sectional study from Uttar Pradesh. Indian J Public Health 2022;66, Suppl S1:22-6

How to cite this URL:
Shamshad T, Khalique N, Shameem M, Shah MS, Nawab T. Prevalence of bronchial asthma in school going children: A cross-sectional study from Uttar Pradesh. Indian J Public Health [serial online] 2022 [cited 2022 Dec 1];66, Suppl S1:22-6. Available from: https://www.ijph.in/text.asp?2022/66/5/22/360640




   Introduction Top


Asthma is coined as a chronic inflammatory disorder and disarrays of the airways and respiratory tract which manifests as recurrent episodes of wheezing, breathlessness, chest tightness, and cough. It is characterized by bronchial hyperresponsiveness and variable airflow obstruction that is often protean either spontaneously with treatment or preventive measures.[1] It is a common malady worldwide with significant ethnic and regional variations. It could partly be the genetic and partly environmental milieu in origin.[2] Although a combination of risk factors is responsible for its development, the exact cause of asthma still remains unknown, and probing still going worldwide.

According to Paramesh, various studies from India have reported a prevalence of asthma varying from 3.5% to 29.5%.[3]

The World Health Organization (WHO) recognizes asthma as a major health problem. Although asthma can occur at any age, children and young adults are the age groups which are affected more commonly.[4]

The diagnosis of asthma is suspected in children with recurrent episodes of airflow obstruction characterized by recurrent wheeze/recurrent isolated cough/recurrent breathlessness/nocturnal cough/tightness of the chest. The diagnosis of asthma may become sometimes difficult for the clinician as it is characteristically episodic, i.e., there may be no indication at the time of evaluation. Pulmonary function testing such as spirometry and peak flow meter can be used as an aid in the diagnosis, provided the child is able to perform the test.[5] The Director-General of the WHO at the 61st World Health Assembly, 2008 stated that heart diseases and cancers are the leading killers, whereas diabetes and asthma are on the upsurge and incremental index and warns asthma is on the rise everywhere.[6] Around 14% of the world's children and 8.6% of young adults have experienced the symptoms of asthma.[7]

There is a paucity of data on the prevalence of asthma among school children in India. Therefore, this study was conducted with the following objectives:

  1. To find the prevalence of bronchial asthma in school going children (6–16 years) and
  2. To find out the factors associated with it.



   Materials and Methods Top


Ethical consideration: consent taken by the institutional ethical committee [Annexure]. Informed consent was also taken by principles of respective schools, parents (<12 years of age), and children (>12 years of age), and the World Medical Association (WMA) Declaration of Helsinki.[8]

A cross-sectional study among the school going children in the age group of 6–16 years was done in the field practice areas of urban health and training center and rural health and training center of the Department of Community Medicine, JNMCH, Aligarh, for 1 year (2019–2020). In the International Study on Allergy and Asthma in Childhood and some other questions related to the risk factor of asthma, a modified questionnaire was formulated after the pilot study to fulfill the aims of the study.

Enrolled school going children in the age group of 6–16 years were included in the study who were present on the day of the visit. Consent was taken from the students (>12 years), parents/guardians (<12 years), principals, and class teachers of the respective schools and classes at the beginning of the study.

Students having any known chronic respiratory illness were excluded from the study.

Purposive selection of schools was done followed by systematic random sampling with a population proportionate to sample size (PPS) in a selection of children. All the students of 6–16 years from class 1st to 10th were enlisted from each school by attendance register. After selecting the first student from the class then the Kth student was selected (k = 2),

For calculating the sample size, the prevalence rate was taken as 17.14%.[9] The sample size was calculated as per the formula:

N = Z2 PQ/L2

where, N = sample size

Z = Value of the standard normal variable at 0.05 level of significance (1.96)

P = Prevalence of asthma as 17.14[9]

Q = 1-P

L = 15% of P (relative error)

The sample size (N) came out to be approximately 900 (along with a 10% nonresponse rate).

A total of 912 students participated in this study, 10 students were excluded because they had not given consent and some were diagnosed with cardiac heart disease, whereas others were operated cases of cardiac disease and spinal cord deformity. Hence, the final sample size is 902 students.

The questionnaire includes the screening questions which are used for obtaining the history related to asthma and its risk factors. After recording the responses, relevant physical examination and systemic examination were done and spirometry was done by the expert technician.

The data was entered in Microsoft Excel 2007 and analyzed in International Business Machines Statistical Package for Social Sciences Data analysis was performed using IBM statistical version 20 (IBM Corp.,Armonk,NY,USA) for the data management and statistical analysis. The value of P < 0.05 was considered statistically significant. The respondents were informed of the study and the data were strictly kept confidential.


   Results Top


The distribution of children according to their age, majority of the children lie above the age group of 10 years, i.e., 672/902 (74.5%), whereas the rest 230/902 (25.5%) lies below 10 years of age (between the age group of 6 and 10 years).

According to the distribution among the children in the study population, 558/902 (61.9%) were boys and 344/902 (38.1%) were girls and belonged to different age groups.

One school each from urban and rural areas was selected according to the population PPS. About 47.2% of students belonged to urban areas, whereas 52.8% of students belonged to rural areas.

According to the present study done prevalence of bronchial asthma was 243/902 (26.9%) among the children in the age group of 6–16 years as shown in [Figure 1]. For the purpose of analysis, they are categorized as definite asthma, physician-diagnosed asthma, probable asthma, and nonasthmatics (shown in [Figure 2]).[10]
Figure 1: Prevalence of asthmatics among the study population (N=902)

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Figure 2: Distribution of proportion of asthmatics according to the categories

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Definite asthmatics

Those children who had *asthma-like symptoms (ALS) and reversible airway disease or auscultatory wheeze (in the absence of other causes of wheeze) were labeled as definite asthmatics.

In the present study, the prevalence of definite asthma was 4.87% (44/902) and among the total asthmatics, the prevalence of definite asthma was calculated as 18.10% (44/243).

Physician-diagnosed asthmatics

Those children who had been labeled asthmatic by physicians and had corroborative evidence of the personal or family history of asthma/atopy or clinical response to bronchodilators at the time of ALS episodes, but with normal spirometry and chest examination were labeled as physician-diagnosed asthmatics.

In the present study, the prevalence of physician-diagnosed asthma was 4.98% (45/902) and among the total asthmatics, the prevalence was 18.51% (45/243).

Probable asthma

Those who had ALS with normal spirometry and chest examination in the absence of physician-diagnosed asthma were labeled as probable asthma.

In the present study, their overall prevalence was 17.07% (154/902) and among the total asthmatics, the prevalence was 63.37% (154/243).

Nonasthmatics

Children with no symptoms or supportive spirometry/peak flowmetry or relevant physical findings were labeled as nonasthmatic. Their prevalence was calculated as 73.4% (659/902).

*ALS was defined as the presence of cough + whistling sounds in the chest + breathlessness or cough + whistling sounds in the chest/breathlessness or whistling sounds + breathlessness or presence of only asthma-like cough.

Various studies from India have reported a prevalence of asthma varying from 3.5% to 29.5%.[3]

The prevalence of asthma in our study 243/902 (26.9) was found to be higher than in many of the previous studies. One of the reasons for this increasing trend of prevalence of asthma can be due to environmental smoke and air pollution. Moreover, there is no recent study done in the nearby area due to underdiagnosis and undertreatment in the early phase of life.

Gupta et al. (2018) conducted a cross-sectional study among 2925 urban school children (5–15 years) of Jaipur. Among 2925 children screened, 24% (702) were labeled as probable asthmatics of which 18.2% (532) were diagnosed to have asthma, and only 6.2% had previously been diagnosed with asthma by a physician which is higher than our study.[11]

Vyankatesh et al., Amir et al., and Sharma et al. conducted a study where the prevalence of asthma is less than the present study.[12],[13],[14] [Table 1] shows the relation of bronchial asthma with some of the associated factors.
Table 1: Relation of bronchial asthma with some of the associated factors

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Association of asthma and family history of smoking (passive smoking)

As shown in [Table 1], the majority (30.8%) of asthmatics gave a positive history of smoking, and the association between smoking in the family and the presence of asthma was found to be significant (P < 0.02).

A similar study conducted by Sun et al. and Agrawal et al. reported the effect of smoking of a family member has a significant (P < 0.001) positive impact on asthma prevalence rate among asthmatic children (39.0%) compared to nonasthmatic (8%).[15],[16]

Association of asthma and smoking in a study population

Among the total sample size, 5.5% (50/902) were found to be smokers as shown in [Table 1]. Among the total smokers, only 18/50 (36%) were asthmatics and lie between the age group of 11 and 16 years. Although the association between smoker and asthmatics were nonsignificant.

Relation of asthma with indoor pollution

In our study, the prevalence of asthmatic was found more in homes whose kitchen was placed indoors than when it was outdoors. This is because it adds to indoor pollution as a source of passive smoking, although the association remains insignificant (P = 0.58). Similar results were reported by Pokharel et al. who showed no significant association between indoor pollutants and acute illness[17] [Table 1].

Association of asthma and personal history of allergy in an individual

Out of total students of 221 (as mentioned in [Table 1]) who gave the history of allergic rhinitis, 69.2% of students were asthmatics and after applying chi square the association between asthma and personal history of allergic rhinitis were found to be significant (P value= 000).

Association of asthma and personal diet history of an individual

The proportion of asthmatics were found higher in vegetarian & eggetarian students, followed by nonvegetarians [Figure 3]. The association between them were also significant (P = 0.006). A study comparing school children showed that the prevalence of bronchial asthma in nonvegetarian children was twice that of vegetarian children. This association was highly significant in Amir et al.[13]
Figure 3: Association of asthma and diet

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   Conclusions Top


Asthma among school children is a public health problem in urban and rural areas. There was a rising pattern in the prevalence of asthma at national and subnational levels as well. The burden of asthma affects the quality of life among children, and an increased risk of school absenteeism affects individuals, families, and society in terms of lost work and schools. There were various risk factors associated with asthma: sociodemographic, environmental, personal habits and behavior, family history, etc. Our study provides valuable information on the magnitude of the problem and certain risk factors, which can be utilized for preventive measures to be taken in future.

Asthma cannot be cured but can be prevented by lifestyle modifications and by avoiding contact with the factors responsible for the occurrence of asthma. Intervention on exposure to various modifiable risk factors such as passive smoking, indoor placed kitchen in the houses, and smoking habits in an individual may be helpful in reduction of the burden of disease at the community level.

This call for greater emphasis and wider reach of the ongoing program such as providing clean fuel for cooking purposes in the houses, creating awareness among the societies, especially in children about the risk factors of smoking and passive smoking so that it would be helpful in preventing the disease and also its progression, thus improving their quality of life of living. As most of them remained underdiagnosed and undertreated, encouraging the government to strengthen up their ongoing programs and also the initiation of new programs for better and proper medical facilities in outreached areas. Further studies are required to explore the prevalence and the risk factors of bronchial asthma among children and there is a need for more public health research.

Limitations

As the study subjects are drawn only from the students of the restricted area, it would have been a good scientific idea to draw a sample considering various other places to draw a better scientific conclusion to diversify the study.

Acknowledgment

I am exceptionally thankful to Almighty Lord for His blessings upon me. I am grateful to my parents and family who supported me always and throughout. I will be forever grateful to them. I also want to thank my teachers Dr. Nafis Faizi and Dr. Tabassum Nawab, Dr. Smita Panda, and Dr. Aliva for their motivation and support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Updated 2017. http://www.ginasthma.org. [Last accessed on 09 Mar 2020].  Back to cited text no. 1
    
2.
Mukherjee AB, Zhang Z. Allergic asthma: Influence of genetic and environmental factors. J Biol Chem 2011;286:32883-9.  Back to cited text no. 2
    
3.
Paramesh H. Epidemiology of asthma in India. Indian J Pediatr 2002;69:309-12.  Back to cited text no. 3
    
4.
Asthma. Available from: https://www.who.int/news-room/fact-sheets/detail/Asthma. [Last accessed on 2020 Sep 05].  Back to cited text no. 4
    
5.
Global Initiative of Asthma, Global Strategy of Asthma Management and Prevention; 2019. Available from: https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf. [Last accessed on 2020 Mar 09].  Back to cited text no. 5
    
6.
61st World Health Assembly (19-24 May 2008). Available from: https://www.who.int/respiratory/asthma/WHA_2008/en/. [Last accessed on 2018 Jul 06].  Back to cited text no. 6
    
7.
Kumar GS, Roy G, Subitha L, Sahu SK. Prevalence of bronchial asthma and its associated factors among school children in urban Puducherry, India. J Nat Sci Biol Med 2014;5:59-62.  Back to cited text no. 7
    
8.
*WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects. Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/. [Last accessed on 2018 Aug 01].  Back to cited text no. 8
    
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Sanjana JM, Mahesh PA, Jayaraj BS, Lokesh KS. Changing trends in the prevalence of asthma and allergic rhinitis in children in Mysore, South India. European Respiratory Journal 2014;44(Suppl 58).  Back to cited text no. 9
    
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Qureshi UA, Bilques S, Ul Haq I, Khan MS, Qurieshi MA, Qureshi UA. Epidemiology of bronchial asthma in school children (10-16 years) in Srinagar. Lung India 2016;33:167-73.  Back to cited text no. 10
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11.
Gupta MK, Patodia J, Chaudhary P, Kakkar M. The rising trend of asthma prevalence in urban school children of Jaipur: A questionnaire based study. Indian Journal of Allergy, Asthma and Immunology 2018;32:10.  Back to cited text no. 11
    
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Vyankatesh AA, Bharat PS, Kush A. Prevalence of Asthma in School going Children of Semi-Urban Area in the State of Madhya Pradesh. International Journal of Medicine and Public Health 2017;7.  Back to cited text no. 12
    
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Amir M, Kumar S, Gupta RK, Singh GV, Kumar R, Anand S, et al. An observational study of bronchial asthma in 6-12 years school going children of Agra district. Indian J Allergy Asthma Immunol 2015;29:62.  Back to cited text no. 13
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Sharma CM, Bhatia SS, Sharma D, Agrawal RP, Meghwani MK, Kumar B. Prevalence of asthma in school children of rural areas of Kanpur, Uttar Pradesh. J Evol Med Dent Sci 2013;2:5298-301.  Back to cited text no. 14
    
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Sun Y, Hou J, Sheng Y, Kong X, Weschler LB, Sundell J. Modern life makes children allergic. A cross-sectional study: Associations of home environment and lifestyles with asthma and allergy among children in Tianjin region, China. Int Arch Occup Environ Health 2019;92:587-98.  Back to cited text no. 15
    
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Agrawal N. Prevalence of bronchial asthma among school going children in ujjain city. International Journal of Medical Science And Diagnosis Research 2019;3(12).  Back to cited text no. 16
    
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Pokharel PK, Kabra SK, Kapoor SK, Pandey RM. Risk factors associated with bronchial asthma in school going children of rural Haryana. Indian J Pediatr 2001;68:103-6.  Back to cited text no. 17
    


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