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. 2018 Sep-Oct;6(5):1580-1587.e2.
doi: 10.1016/j.jaip.2017.11.032. Epub 2018 Feb 1.

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

Brooks W Morgan  1 , Trishul Siddharthan  1 , Matthew R Grigsby  1 , Suzanne L Pollard  1 , Robert Kalyesubula  2 , Robert A Wise  1 , Bruce Kirenga  2 , William Checkley  3
Affiliations

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

Brooks W Morgan et al. J Allergy Clin Immunol Pract. 2018 Sep-Oct.

Abstract

Background: Allergic diseases are increasing in sub-Saharan Africa, but few studies have characterized the burden among adults.

Objective: We conducted a study to evaluate the prevalence and risk factors of allergic disorders in urban and rural Uganda.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Allergies; Asthma; Eczema; Epidemiology; Population attributable fraction; Rhinitis; Risk factors; Sub-Saharan Africa; Uganda.

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Conflict of interest statement

Disclosure: The other authors declare they have no relevant conflicts of interest.

Figures

Figure 1
Figure 1
Crude and age-adjusted prevalence of allergic illness by site.
Figure 2
Figure 2
Population attributable fraction for factors related to asthma, rhinitis, and eczema. *Family history of asthma only modeled in Kampala (urban site) due to lack of positive responses in Nakaseke (rural site).
See this image and copyright information in PMC

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