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Epidemiology of wheeze among preschool children: a population-based cross-sectional study from rural Sri Lanka
Shashanka Indeevara Rajapakse Rajapakse Mudiyanselage1, Wadu Arachchige Dharshika Lakmali Amarasiri2, Bannek Mudiyanselage Gedara Duminda Yasaratne3
1Department of Physiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka shashanka1015@gmail.com.
Insights
Wheezing affects about 30% of preschool children in rural Sri Lanka. Key risk factors for severe wheeze include allergic rhinitis, dog exposure, and passive smoking, with cement floors showing a protective effect.
Area of Science:
- Pediatric respiratory health
- Epidemiology of childhood wheeze
Background:
- Wheezing is a common respiratory symptom in preschool children.
- Understanding its prevalence and associated factors is crucial for early intervention.
Purpose of the Study:
- To determine the prevalence of wheeze in 3-6 year old children in rural Sri Lanka.
- To identify factors associated with the severity of wheezing episodes.
Main Methods:
- A population-based, cross-sectional study involving 1060 preschool children aged 3-6 years.
- Utilized the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire.
- Employed WHO 30 cluster methodology with probability proportionate to size sampling.
Main Results:
- Prevalence of ever wheezing was 30.47%, with 23.30% experiencing wheezing in the past year.
- Severe wheezing episodes occurred in 7.17% of children, with only 35.53% diagnosed with asthma.
- Independent risk factors for severe wheeze included allergic rhinitis, domestic dogs, skipjack tuna consumption, and passive smoking. Cement flooring was protective.
Conclusions:
- Wheezing is prevalent in Sri Lankan preschoolers, often undiagnosed as asthma.
- Allergic rhinitis, pet ownership, dietary factors, and passive smoking are significant risk factors for severe wheeze.
Objectives:
To assess the prevalence of wheeze and factors associated with its severity among 3-6 years old children.
Methodology:
DESIGN: A population-based, cross-sectional study using the WHO 30 cluster methodology with probability proportionate to size sampling.
Setting:
36 preschools registered at the divisional secretariat offices of Anuradhapura district, Sri Lanka.
Participants:
We recruited 1060 preschool children from 36 preschools aged 3-6 years.
Main Outcome Measurements:
We used the International Study of Asthma and Allergy in Childhood questionnaire to assess the prevalence, symptomatology and associated factors of wheeze.
Results:
The study sample consisted of 548 (51.70%) male and 512 (48.30%) female children with a mean age of 4.41 (±0.66) years. At least one wheezing episode ever was reported in 323 (30.47%; 95% CI 27.71% to 33.34%) children and 247 (23.30%; 95% CI 20.79% to 25.97%) children had a wheezing attack in the preceding year. Severe episodes of wheezing were reported in 76 (7.17%; 95% CI 5.69% to 8.89%) participants. However, only 27 (35.53%; 95% CI 24.88% to 47.34%) children with severe wheezing had been diagnosed as asthmatics by a clinician. The identified independent risk factors for severe wheeze were allergic rhinitis (OR 6.90; 95% CI 3.84 to 12.40), domestic dog(s) (OR 2.34; 95% CI 1.01 to 5.40), frequent consumption of skipjack tuna (OR 1.94; 95% CI 1.11 to 3.39) and passive smoking (OR 1.70; 95% CI 0.93 to 3.11) while living in a house with a cement floor is a protective factor (OR 0.41; 95% CI 0.21 to 0.80).
Conclusion:
Wheezing commonly affects one-fourth of preschool children in rural Sri Lanka. Severe wheezing is often not diagnosed as asthma despite frequent symptoms, probably due to hesitancy in labelling preschool children as asthmatics. Allergic rhinitis, domestic dogs, frequent consumption of Skipjack tuna fish and exposure to passive smoking were independent risk factors for severe wheeze.
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