Asthma and respiratory symptoms in urban and rural Saudi Arabia

The aim of this study was to contrast the prevalence of allergic symptoms in children living in urban and rural areas of Saudi Arabia and to investigate factors associated with any differences found. A cross-sectional questionnaire survey was conducted of a social class-stratified sample of 1,020 urban and 424 rural 12 yr old children, recording symptoms of current and past allergic disease and doctors' diagnoses, together with nationality and the fathers' educational level and occupations. A significantly greater prevalence of allergic symptoms was found in urban than in rural children and in Saudi than in non-Saudi Arab children. Males were more likely to have some respiratory symptoms and females had more eye and skin symptoms. Educational level and occupation of the father did not influence the likelihood of having symptoms. Logistic regression analyses showed that urban residence and Saudi nationality were the two main risk factors associated with asthmatic symptoms. There is likely to have been a recent increase in the prevalence of allergic disease in Saudi children associated with increased affluence, which has not affected non-Saudi migrants moving into the same environment to the same extent. This is consistent with the hypothesis that the environment, possibly through changes in lifestyle and patterns of infection, influences the expression of allergic disease.