Asthma in developing countries in the Asia-Pacific Region (APR)

There is growing interest in the epidemiology of asthma in developing countries, especially in the Asia-Pacific Region (APR). A number of reviews have been published in this field, but a comprehensive synthesis of overall data has not been reported. Here, we summarized the burden, risk factors and challenges of asthma management in developing countries with a specific emphasis on the APR by consolidating evidence from both systematic and narrative reviews published up until February 2023. We found that although asthma prevalence in low and low-middle-income countries (LMICs) is known to be generally lower compared to high-income countries, the burden is substantially greater. Studies conducted in APR LMIC have reported a range of risk factors, including pre- and post-natal factors, environmental considerations, lifestyle measures, individual features and genetics. The low and inequitable distribution of quality preventive and curative health care, a lack of advanced diagnostic measures, non-availability and non-affordability of novel therapeutics, cultural beliefs and practices, and diverse disease phenotypes make it challenging to achieve optimal asthma control in the region. Hence, we call for the development of a region-specific blueprint for action to mitigate this challenging situation, to help reduce the burden of asthma in APR LMIC.

Household use of biomass fuel, especially traditional stove is associated with childhood wheeze and eczema: a cross sectional study of rural communities in Kandy, Sri Lanka

BACKGROUND

Most households in low- and middle-income countries (LMICs) rely on biomass fuel for daily cooking. Studies investigating the association between early life exposure to household air pollution and health outcomes in children in LMICs are limited.

OBJECTIVE

To investigate the effects of biomass fuel for cooking and different types of stoves on wheeze and allergies in children of rural Sri Lankan communities.

METHODS

A cross-sectional study was conducted on 452 children aged 5 years and younger in Kandy, Sri Lanka. Mothers completed a questionnaire on the use of biomass fuel and respiratory and allergic outcomes in children. The associations between biomass fuel and outcomes were analyzed using logistic regression models, adjusting for potential confounders.

RESULTS

Use of biomass fuel for cooking was associated with increased risk of childhood wheeze (aOR 2.29; 95% CI 1.04-5.08) and eczema (aOR 4.57; 95% CI 1.24-16.89) compared with households that used clean fuel (liquid petroleum gas (LPG), electricity and/or biogas). Among households that used biomass fuel, use of traditional biomass stoves was associated with a higher risk of childhood wheeze (aOR 2.95; 95% CI 1.19-7.33), allergic rhinitis (aOR 3.01; 95% CI 1.42-6.39), and eczema (aOR 7.39; 95% CI 1.70-32.06) compared with households that used clean stoves.

CONCLUSION

Children living in households that use biomass fuel, especially traditional biomass cookstoves, have a higher risk of wheeze and allergic diseases. Access to affordable clean energy sources that reduce air pollution may help improve the health of children in rural LMICs.

Supplemental data for this article is available online at at www.tandfonline.com/ijas .

Temporal Variation and Factors Associated with Allergic Rhinitis in a Cohort of Rural Preschool Children from Sri Lanka

BACKGROUND

Allergic rhinitis is a common chronic childhood disease with a low diagnosis rate, causing poor quality of life, absenteeism, decreased school performance and significant healthcare cost. However, data on the prevalence of allergic rhinitis is sparse in preschoolers of rural geography, especially in developing countries.

AIM

To describe the epidemiology of allergic rhinitis in preschoolers from a rural geography of a developing country.

METHODS

A population-based cross-sectional study was conducted in Anuradhapura district, Sri Lanka using the WHO-30 cluster methodology with probability proportionate to size sampling. The International Study of Asthma and Allergy in Childhood questionnaire was used to assess symptomatology.

RESULTS

The response rate was 91.8%, with 548 (51.7%) male and 512 (48.3%) female participants. The mean age was 4.4 (± 0.7) years. Allergic rhinitis was reported in 123 (11.6%; 95% CI 9.7-13.5), and eye symptoms were reported in 41 (3.9%; 95% CI 2.8-5.2) children. Activities of daily living were disturbed due to nasal symptoms in 113 (10.7%; 95% CI 8.8-12.5). Allergic rhinitis was independently associated with severe asthma (OR 6.26; 95% CI 3.54-11.06), sleeping on the floor (OR 4.79; 95% CI 1.33-17.25) and having cats in the households (OR 1.86; 95% CI 1.18-2.91). Nasal symptoms were more common in January and August to October months. The standardized local highest monthly temperature, lowest monthly temperature, highest monthly humidity and dew point strongly predicted allergic rhinitis symptom exacerbation (F=4.8, p=0.036, adjusted R square=57.8%, VIF≤2.259, DW=2.1).

CONCLUSIONS

Allergic rhinitis affects 1 in 10 preschool children of rural Sri Lanka. The factors associated and environmental factor model developed to predict symptom exacerbation could be used to prevent allergic rhinitis exacerbations.

Household Air Pollution from Biomass Fuel for Cooking and Adverse Fetal Growth Outcomes in Rural Sri Lanka

The aim of this study was to investigate the impact of biomass fuel for cooking on adverse fetal growth outcomes in Sri Lanka. A cross-sectional study of mothers recruited at maternity clinics in rural communities in Sri Lanka’s Central Province was undertaken. Data pertaining to household air pollution and fetal growth parameters were collected using an interviewer-administered questionnaire. Logistic regression models, adjusted for potential confounders, were used to evaluate the impact of biomass fuel for cooking on low birth weight (LBW) and small for gestational age (SGA) parameters. Findings showed that exposure to biomass cooking fuels during pregnancy was associated with an increased risk of LBW adjusted odds ratio (aOR) 2.74 (95% CI 1.08–6.96) and SGA (aOR: 1.87, 95% CI 1.03–3.41) compared with the use of clean energy. The risk of LBW was highest for traditional biomass stoves compared to improved biomass stoves (aOR: 3.23, 95% 1.17–8.89) and biomass use in kitchens without a chimney compared to kitchens with a chimney (aOR: 4.63, 95% 1.54–13.93). Similar trends were observed for SGA.