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Kokori E, Olatunji G, Mustapha MJ, Fawehinmi P, Onyia A, Omoworare O, Akinmeji O, Solomon S, Olafimihan A, Ologbe D, Aderinto N. The potential of smart inhaler for asthma management in Sub-Saharan Africa. Ann Med Surg (Lond) 2024; 86:2408-2410. [PMID: 38694290 PMCID: PMC11060201 DOI: 10.1097/ms9.0000000000002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | | | | | | | - Adrian Onyia
- College of Medicine, University of Nigeria, Nsukka
| | - Oluwatobi Omoworare
- Department of Medicine and Surgery, Lagos State University College of Medicine, Lagos
| | - Olufemi Akinmeji
- Department of Medicine and Surgery, Olabisi Onabanjo University Teaching Hospital, Ogun
| | - Samuel Solomon
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | | | - Damilola Ologbe
- William Harvey Hospital, Kennington Rd, Willesborough, Ashford, Kent, UK
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
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2
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Katumba JD, Kirenga B, Muwagga Mugagga A, Kalyango JN, Nantanda R, Karamagi C. MICROS: Asthma Control App for School Adolescents in a Low Resource Setting - A Cluster Randomized Controlled Trial Protocol. Patient Prefer Adherence 2023; 17:3125-3133. [PMID: 38053534 PMCID: PMC10695141 DOI: 10.2147/ppa.s438549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction Poor asthma control in adolescents is partly attributed to inadequate asthma education for self-management. This study is set to determine the effectiveness of the "KmAsthma" self-management app in improving the control of asthma among adolescents in a low-resource setting. Methods The two-arm 6-month cluster randomized controlled trial, will aim at enrolling 120 day scholars aged 12-19 years in secondary schools with a clinician's diagnosis and self-reported uncontrolled asthma in Kampala City Uganda. The primary endpoint of asthma control will be measured as a change in mean Asthma Control Test (ACT) scores. Asthma quality of life, adherence to medications, and self-efficacy will also be assessed. The iMprovIng the ContROl of aSthma (MICROS) study will employ the "KmAsthma" app for self-management education. The intervention group will receive the app on their smartphones and training on its eight sections: the profile, asthma history, goals, inspirations, reminders, connect, information about asthma, and emergency support. Participants will navigate these sections to set asthma control goals, schedule medication reminders, log daily symptoms, and receive guidance for attacks. All participants will be encouraged to seek routine care. A study nurse will follow up with each participant via the phone six weeks post-intervention. The MICROS study was approved by the Makerere University School of Medicine Research and Ethics Committee and the Uganda National Council of Science and Technology. This protocol is registered on Clinicaltrials.gov (NCT05850806). Conclusion The MICROS study will provide comprehensive insights into how effective a mHealth intervention can be an aid for adolescents in a low-resource setting in managing their asthma. The findings of this study will contribute to filling the gap leading to unsatisfactory asthma control in adolescents.
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Affiliation(s)
- James Davis Katumba
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bruce Kirenga
- Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Joan N Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rebecca Nantanda
- Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Karamagi
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
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3
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Naidoo KL, Dladla S, Mphahlele RE, Mosler G, Muyemayema S, Ssemata AS, Mkutumula E, Adeyeye OO, Moyo M, Goodman O, Kuyinu Y, Nantanda R, Ticklay I, Mujuru HA, Grigg J, Masekela R. Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers. BMJ Open 2023; 13:e070784. [PMID: 37657839 PMCID: PMC10476107 DOI: 10.1136/bmjopen-2022-070784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates. DESIGN One of the aims of our National Institute for Health Research global health research group 'Achieving Control of Asthma in Children in Africa' was to use qualitative thematic analysis of transcribed audio recordings from focus group discussions (FGDs) to describe barriers to achieving good asthma control. SETTING Schools in Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda) and Harare (Zimbabwe). PARTICIPANTS Children (n=136), 12-14 years with either asthma symptoms or a diagnosis and their caregivers participated in 39 FGDs. All were recruited using asthma control questions from the Global Asthma Network survey. RESULTS There were four key themes identified: (1) Poor understanding, (2) difficulties experienced with being diagnosed, (3) challenges with caring for children experiencing an acute asthma episode and (4) suboptimal uptake and use of prescribed medicines. An inadequate understanding of environmental triggers, a hesitancy in using metred dose inhalers and a preference for oral and alternate medications were identified as barriers. In addition, limited access to healthcare with delays in diagnosis and an inability to cope with expected lifestyle changes was reported. Based on these findings, we recommend tailored education to promote access to and acceptance of metred dose inhalers, including advocating for access to a single therapeutic, preventative and treatment option. Furthermore, healthcare systems should have simpler diagnostic pathways and easier emergency access for asthma. CONCLUSIONS In a continent with rapidly increasing levels of poorly controlled asthma, we identified multiple barriers to achieving good asthma control along the trajectory of care. Exploration of these barriers reveals several generalisable recommendations that should modify asthma care plans and potentially transform asthma care in Africa. TRIAL REGISTRATION NUMBER 269211.
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Affiliation(s)
- Kimesh Loganathan Naidoo
- Paediatrics and Child health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
- Department of Paediatrics, King Edward VIII Hospital, Congella, South Africa
| | - Sindiswa Dladla
- Paediatrics and Child health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Reratilwe Ephenia Mphahlele
- Paediatrics and Child health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Gioia Mosler
- Centre for Genomics and Child Health, Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
| | - Sophie Muyemayema
- Child and Adolescent Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Elizabeth Mkutumula
- Malawi Liverpool Wellcome Programme, College of Medicine, Queen Elizabeth Central Hospital,College of Medicine, Chichiri, Malawi
| | - Olayinka Olufunke Adeyeye
- Lagos State University Teaching Hospital, Lagos State University College of Medicine, Ikeje, Lagos State, Nigeria
| | - Melinda Moyo
- Child and Adolescent Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Olayinka Goodman
- Lagos State University Teaching Hospital, Lagos State University College of Medicine, Ikeje, Lagos State, Nigeria
| | - Yetunde Kuyinu
- Lagos State University Teaching Hospital, Lagos State University College of Medicine, Ikeje, Lagos State, Nigeria
| | - Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ismail Ticklay
- Child and Adolescent Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
- Medical School Parirenyatwa Hospital, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Hilda Angela Mujuru
- Child and Adolescent Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Queen Mary University of London Faculty of Medicine and Dentistry, London, UK
| | - Refiloe Masekela
- Paediatrics and Child health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
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4
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Mphahlele RE, Kitchin O, Masekela R. Barriers and determinants of asthma control in children and adolescents in Africa: a systematic review. BMJ Open 2021; 11:e053100. [PMID: 34706960 PMCID: PMC8552165 DOI: 10.1136/bmjopen-2021-053100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To identify reasons for poor asthma control in African children and adolescents. DESIGN Systematic review DATA SOURCES: PubMed, Scopus, CINHAL, PsycINFO, MEDLINE and Web of Science databases were systematically searched up to 31 May 2020. Hand searching was done on Sabinet, African Journal online and Google Scholar. ELIGIBILITY CRITERIA Studies identifying barriers to asthma control, where asthma control was assessed by the validated Asthma Control Test/Child Asthma Control Test and/or Asthma Control Questionnaire were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently selected studies for inclusion with disagreements resolved by a research team discussion, including a third reviewer. Data were extracted using the Cochrane Effective Practice and Organization of Care data collection form. The quality of the included studies was assessed using the modified Newcastle-Ottawa quality assessment scale. Identified barriers were reported in a thematic narrative synthesis. PRIMARY OUTCOMES Poorly controlled asthma and associated factors. RESULTS From 914 records, three studies conducted between 2014 and 2019 in Nigeria, Uganda and South Africa met the inclusion criteria. A total of 883 children aged 4-19 years were analysed. Older age, concurrent allergy and city-dwelling significantly impacted asthma control. Few children with asthma symptoms in the community had ever used inhaled corticosteroids (6.7%) and identified reasons included lack of asthma diagnosis (38.8%) and no prescribed treatment (47.6%). CONCLUSION Asthma control in African children is impacted by age, allergy, urbanisation and lack of access to asthma diagnosis and treatment. More studies focusing on identifying barriers to asthma control in Africa are needed. PROSPERO Registration no: CRD42020196755).
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Affiliation(s)
- Reratilwe Ephenia Mphahlele
- Department of Paediatrics and Child Health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Omolemo Kitchin
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - R Masekela
- Department of Paediatrics and Child Health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
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5
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Ozoh OB, Mbatchou Ngahane BH, Zar HJ, Masekela R, Chakaya J, Aluoch J. Lung health in Africa: challenges and opportunities in the context of COVID-19. Am J Physiol Lung Cell Mol Physiol 2021; 321:L619-L623. [PMID: 34378415 PMCID: PMC8435940 DOI: 10.1152/ajplung.00322.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, and The Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Jeremiah Chakaya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Medicine, Dermatology and Therapeutics, Kenyatta University, Nairobi, Kenya
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Mpairwe H, Mpango RS, Sembajjwe W, Webb EL, Elliott AM, Pearce N, Kinyanda E. Anxiety disorders and asthma among adolescents in Uganda: role of early-life exposures. ERJ Open Res 2021; 7:00749-2020. [PMID: 33898614 PMCID: PMC8053906 DOI: 10.1183/23120541.00749-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
The reasons for the positive association between anxiety disorders and asthma are unknown. We investigated the possible role of shared exposures in early life. We conducted a case-control study among adolescents (age 12-17 years) with and without asthma in urban Uganda, as part of a larger asthma case-control study. Anxiety disorders were diagnosed by psychiatric clinical officers. We focused on generalised anxiety disorder (GAD), panic disorder and social anxiety disorder. Asthma was doctor-diagnosed by study clinicians. We used questionnaires to collect data on early-life exposures. The data were analysed using multiple logistic regression. We enrolled 162 adolescents; 73 of them had asthma. Adolescents with asthma were more likely to have any of the three anxiety disorders studied (46.6%) than adolescents without asthma (21.4%) (adjusted OR (aOR) 2.68, 95% CI 1.30-5.53). The association was strong for GAD (aOR 4.49, 95% CI 1.48-13.56) and panic disorder (aOR 5.43, 95% CI 2.11-14.02), but not for social anxiety disorder. The early-life risk factors associated with anxiety disorders among adolescents were similar to asthma risk factors previously published, including urban residence at birth (aOR 3.42, 95% CI 1.29-9.09) and during most of the first 5 years of life (aOR 2.87, 95% CI 1.07-7.66), father's tertiary education (aOR 2.09, 95% CI 1.00-4.37), and adolescent's history of other allergy-related diseases (aOR 4.64, 95% CI 1.66-13.00). We confirm a positive association between anxiety disorders and asthma among adolescents in urban Uganda. The early-life risk factors associated with anxiety disorders among adolescents were similar to those for asthma in the same age group, suggesting shared underlying environmental exposures.
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Affiliation(s)
- Harriet Mpairwe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Richard Stephen Mpango
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Wilber Sembajjwe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, London, UK
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- London School of Hygiene and Tropical Medicine, London, UK
| | - Eugene Kinyanda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Nkurunungi G, Nassuuna J, Mpairwe H, Kabagenyi J, Nampijja M, Sanya RE, Webb EL, Elliott AM. Allergen skin test reactivity and asthma are inversely associated with ratios of IgG4/IgE and total IgE/allergen-specific IgE in Ugandan communities. Clin Exp Allergy 2021; 51:703-715. [PMID: 33512036 PMCID: PMC7610822 DOI: 10.1111/cea.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 11/28/2022]
Abstract
Background Serum inhibition of allergen‐specific IgE has been associated with competing IgG4 and non‐specific polyclonal IgE. In allergen immunotherapy, beneficial responses have been associated with high IgG4/IgE ratios. Helminths potentiate antibody class switching to IgG4 and stimulate polyclonal IgE synthesis; therefore, we hypothesized a role for helminth‐associated IgG4 and total IgE in protection against atopic sensitization and clinical allergy (asthma) in tropical low‐income countries. Methods Among community residents of Ugandan rural Schistosoma mansoni (Sm)–endemic islands and a mainland urban setting with lower helminth exposure, and among urban asthmatic schoolchildren and non‐asthmatic controls, we measured total, Schistosoma adult worm antigen (SWA)–specific, Schistosoma egg antigen (SEA)–specific and allergen (house dust mite [HDM] and German cockroach)–specific IgE and IgG4 by ImmunoCAP® and/or ELISA. We assessed associations between these antibody profiles and current Sm infection, the rural‐urban environment, HDM and cockroach skin prick test (SPT) reactivity, and asthma. Results Total IgE, total IgG4 and SWA‐, SEA‐ and allergen‐specific IgE and IgG4 levels were significantly higher in the rural, compared to the urban setting. In both community settings, both Sm infection and SPT reactivity were positively associated with allergen‐specific and total IgE responses. SPT reactivity was inversely associated with Schistosoma‐specific IgG4, allergen‐specific IgG4/IgE ratios and total IgE/allergen‐specific IgE ratios. Asthmatic schoolchildren, compared with non‐asthmatic controls, had significantly higher levels of total and allergen‐specific IgE, but lower ratios of allergen‐specific IgG4/IgE and total IgE/allergen‐specific IgE. Conclusions and clinical relevance Our immuno‐epidemiological data support the hypothesis that the IgG4–IgE balance and the total IgE–allergen‐specific IgE balance are more important than absolute total, helminth‐ or allergen‐specific antibody levels in inhibition of allergies in the tropics.
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Affiliation(s)
- Gyaviira Nkurunungi
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Jacent Nassuuna
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Harriet Mpairwe
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda.,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Joyce Kabagenyi
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Margaret Nampijja
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Richard E Sanya
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda.,College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emily L Webb
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison M Elliott
- Immunomodulation and Vaccines Programme, Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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8
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Nkurunungi G, Mpairwe H, Versteeg SA, Diepen A, Nassuuna J, Kabagenyi J, Nambuya I, Sanya RE, Nampijja M, Serna S, Reichardt N, Hokke CH, Webb EL, Ree R, Yazdanbakhsh M, Elliott AM. Cross-reactive carbohydrate determinant-specific IgE obscures true atopy and exhibits ⍺-1,3-fucose epitope-specific inverse associations with asthma. Allergy 2021; 76:233-246. [PMID: 32568414 PMCID: PMC7610925 DOI: 10.1111/all.14469] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/03/2020] [Accepted: 06/03/2020] [Indexed: 12/22/2022]
Abstract
Background In high-income, temperate countries, IgE to allergen extracts is a risk factor for, and mediator of, allergy-related diseases (ARDs). In the tropics, positive IgE tests are also prevalent, but rarely associated with ARD. Instead, IgE responses to ubiquitous cross-reactive carbohydrate determinants (CCDs) on plant, insect and parasite glycoproteins, rather than to established major allergens, are dominant. Because anti-CCD IgE has limited clinical relevance, it may impact ARD phenotyping and assessment of contribution of atopy to ARD. Methods Using an allergen extract-based test, a glycan and an allergen (glyco)protein microarray, we mapped IgE fine specificity among Ugandan rural Schistosoma mansoni (Sm)-endemic communities, proximate urban communities, and importantly in asthmatic and nonasthmatic schoolchildren. Results Overall, IgE sensitization to extracts was highly prevalent (43%-73%) but allergen arrays indicated that this was not attributable to established major allergenic components of the extracts (0%-36%); instead, over 40% of all participants recognized CCD-bearing components. Using glycan arrays, we dissected IgE responses to specific glycan moieties and found that reactivity to classical CCD epitopes (core β-1,2-xylose, α-1,3-fucose) was positively associated with sensitization to extracts, rural environment and Sm infection, but not with skin reactivity to extracts or sensitization to their major allergenic components. Interestingly, we discovered that reactivity to only a subset of core α-1,3-fucose-carrying N-glycans was inversely associated with asthma. Conclusions CCD reactivity is not just an epiphenomenon of parasite exposure hampering specificity of allergy diagnostics; mechanistic studies should investigate whether specific CCD moieties identified here are implicated in the protective effect of certain environmental exposures against asthma.
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Affiliation(s)
- Gyaviira Nkurunungi
- Immunomodulation and Vaccines Programme Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit Entebbe Uganda
- Department of Clinical Research London School of Hygiene and Tropical Medicine London UK
| | - Harriet Mpairwe
- Immunomodulation and Vaccines Programme Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit Entebbe Uganda
| | - Serge A. Versteeg
- Departments of Experimental Immunology and of Otorhinolaryngology Amsterdam University Medical Centers (AMC) Amsterdam The Netherlands
| | - Angela Diepen
- Department of Parasitology Leiden University Medical Center Leiden The Netherlands
| | - Jacent Nassuuna
- Immunomodulation and Vaccines Programme Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit Entebbe Uganda
| | - Joyce Kabagenyi
- Immunomodulation and Vaccines Programme Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit Entebbe Uganda
| | - Irene Nambuya
- Immunomodulation and Vaccines Programme Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit Entebbe Uganda
| | - Richard E. Sanya
- Immunomodulation and Vaccines Programme Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit Entebbe Uganda
- College of Health Sciences Makerere University Kampala Uganda
| | - Margaret Nampijja
- Immunomodulation and Vaccines Programme Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit Entebbe Uganda
| | - Sonia Serna
- Glycotechnology Laboratory Centro de Investigación Cooperativa en Biomateriales (CIC biomaGUNE) San Sebastián Spain
| | - Niels‐Christian Reichardt
- Glycotechnology Laboratory Centro de Investigación Cooperativa en Biomateriales (CIC biomaGUNE) San Sebastián Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER‐BBN) San Sebastián Spain
| | - Cornelis H. Hokke
- Department of Parasitology Leiden University Medical Center Leiden The Netherlands
| | - Emily L. Webb
- Department of Infectious Disease Epidemiology London School of Hygiene and Tropical Medicine MRC Tropical Epidemiology Group London UK
| | - Ronald Ree
- Departments of Experimental Immunology and of Otorhinolaryngology Amsterdam University Medical Centers (AMC) Amsterdam The Netherlands
| | - Maria Yazdanbakhsh
- Department of Parasitology Leiden University Medical Center Leiden The Netherlands
| | - Alison M. Elliott
- Immunomodulation and Vaccines Programme Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit Entebbe Uganda
- Department of Clinical Research London School of Hygiene and Tropical Medicine London UK
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9
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Mpairwe H, Nkurunungi G, Tumwesige P, Akurut H, Namutebi M, Nambuya I, Nnaluwooza M, Apule B, Onen C, Katongole T, Niwagaba E, Mukasa M, Webb EL, Elliott AM, Pearce N. Risk factors associated with rhinitis, allergic conjunctivitis and eczema among schoolchildren in Uganda. Clin Exp Allergy 2020; 51:108-119. [PMID: 33098716 PMCID: PMC7612100 DOI: 10.1111/cea.13769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/31/2020] [Accepted: 10/19/2020] [Indexed: 01/19/2023]
Abstract
Background The prevalence of allergy-related diseases (ARDs), including rhinitis, allergic conjunctivitis and eczema, is on the increase globally. The causes of this increase are not well established. Objectives To investigate the risk factors associated with ARDs among schoolchildren in Uganda. Methods We conducted a secondary data analysis of a large asthma case–control study involving 1700 schoolchildren, 5–17 years, in urban Uganda. ARDs were defined according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick testing (SPT) was conducted using standard procedures and allergen-specific IgE (asIgE) using ImmunoCAP®. We employed inverse probability weighted analysis to generate estimated prevalence data and weighted odds ratios. Results The lifetime estimated weighted prevalence of reported rhinitis, allergic conjunctivitis and eczema was 43.3%, 39.5% and 13.5%; weighted prevalence in 12 months was 10.1%, 9.1% and 2.3%, respectively. There was overlap of ARDs, with 66.3% of 1193 schoolchildren who reported having ever an ARDs (including asthma) reporting two or more. Risk factors associated with reported rhinitis in the last 12 months were city residence at birth [adjusted odds ratio (95% confidence interval) 2.66 (1.42–4.99) compared to rural]; father’s [2.62 (1.79–3.83)] and mother’s history of allergic disease [2.12 (1.48–3.02)]; frequent de-worming in the last 12 months [2.01 (1.30–3.11), ≥2 versus none]; current high frequency of ‘trucks passing on the street near home’ [2.59 (1.48–4.52), ‘almost all the time’ versus rarely] and positive SPT [1.54 (1.09–2.18)] but not asIgE [1.38 (0.60–3.15)]. The same pattern of risk factors was observed for allergic conjunctivitis and eczema. Conclusion We found extensive multi-morbidity of, and overlap in the risk factors for, rhinitis, conjunctivitis and eczema—similar to asthma risk factors—among schoolchildren in urban Uganda. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda.
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Affiliation(s)
- Harriet Mpairwe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Gyaviira Nkurunungi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Pius Tumwesige
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Hellen Akurut
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Milly Namutebi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Irene Nambuya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Marble Nnaluwooza
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Barbara Apule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Caroline Onen
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Tonny Katongole
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emmanuel Niwagaba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Mike Mukasa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emily L Webb
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
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Namutebi M, Nnaluwooza M, Tumwesige P, Mukasa M, Apule B, Onen C, Katongole T, Tumusiime J, Akurut H, Elliott A, Mpairwe H. Lessons learnt in recruiting schoolchildren into a large asthma case-control study in urban Uganda. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.16371.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Schools present an excellent opportunity for research among children and adolescents. We share our experiences and lessons learnt in enrolling schoolchildren into a large asthma case-control study from schools in urban Uganda, and make recommendations for best practices. Our key lessons were as follows: working closely with the school administration and teachers was vital in gaining timely access to parents of the schoolchildren; having a meeting with parents, within their children’s school premises, was a cost-effective way of reaching a wide audience of potential research participants with our message and an opportunity to seek their participation; allowing flexibility within our processes enabled us to fit our research activities within the school schedule, and with minimal disruptions; however, obtaining informed written consent from parents of children in the boarding section of school remained a challenge. In conclusion, conducting research in schools in Uganda is feasible and may be a cost-effective way to make the most of limited resources to remedy the research and data deficiencies among school-age children in sub-Saharan Africa.
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