Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya

Hellen Meme; Evans Amukoye; Cressida Bowyer; Jeremiah Chakaya; Darpan Das; Ruaraidh Dobson; Ulrike Dragosits; Jonathan Fuld; Cindy Gray; Matthew Hahn; Richard Kiplimo; Maia Lesosky; Miranda M. Loh; Jean McKendree; Kevin Mortimer; Amos Ndombi; Louis Netter; Angela Obasi; Fred Orina; Clare Pearson; Heather Price; Jennifer K. Quint; Sean Semple; Marsailidh Twigg; Charlotte Waelde; Anna Walnycki; Melaneia Warwick; Jana Wendler; Sarah E. West; Michael Wilson; Lindsay Zurba; Graham Devereux

doi:10.1136/thorax-2023-220057

Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya

Hellen Meme, Evans Amukoye, Cressida Bowyer, Jeremiah Chakaya, Darpan Das, Ruaraidh Dobson, Ulrike Dragosits, Jonathan Fuld, Cindy Gray, Matthew Hahn, Richard Kiplimo, Maia Lesosky, Miranda M. Loh, Jean McKendree, Kevin Mortimer, Amos Ndombi, Louis Netter, Angela Obasi, Fred Orina, Clare PearsonHeather Price, Jennifer K. Quint, Sean Semple, Marsailidh Twigg, Charlotte Waelde, Anna Walnycki, Melaneia Warwick, Jana Wendler, Sarah E. West, Michael Wilson, Lindsay Zurba, Graham Devereux^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms. Methods: Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM2.5) was estimated. Results: 2373 children participated, 1277 in Mukuru (median age, IQR 11, 9-13 years, 53% girls), and 1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM2.5. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, € current wheeze' (9.5% vs 6.4%, p=0.007) and € trouble breathing' (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to € vapours, dusts, gases, fumes', mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads. Conclusion: Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.

Original language	English
Article number	220057
Number of pages	8
Journal	Thorax
Early online date	6 Jun 2023
DOIs	https://doi.org/10.1136/thorax-2023-220057
Publication status	E-pub ahead of print - 6 Jun 2023

Bibliographical note

Funding Information:
Funded by UKRI MRC/Kenya National Research Fund (NRF) UK-Kenya Joint Partnership on Non-Communicable Disease programme under the Newton fund MR/S009027/1. Sensitisation activities additionally funded by Wellcome Public Engagement Fund 218935/Z/19/Z. For the purpose of open access, the author has applied a CC BY public copyright licence (where permitted by UKRI, ‘Open Government Licence’ or ‘CC BY-ND public copyright licence may be stated instead) to any Author Accepted Manuscript version arising’.

Publisher Copyright:
© Author(s) (or their employer(s)) 2023

Keywords

asthma
asthma epidemiology
paediatric asthma

Access to Document

10.1136/thorax-2023-220057Licence: CC BY

Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya
© Author(s) (or their employer(s)) 2023
Final published version, 406 KBLicence: CC BY

Cite this

Meme, H., Amukoye, E., Bowyer, C., Chakaya, J., Das, D., Dobson, R., Dragosits, U., Fuld, J., Gray, C., Hahn, M., Kiplimo, R., Lesosky, M., Loh, M. M., McKendree, J., Mortimer, K., Ndombi, A., Netter, L., Obasi, A., Orina, F., ... Devereux, G. (2023). Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya. Thorax, Article 220057. Advance online publication. https://doi.org/10.1136/thorax-2023-220057

@article{3971c5df616b408d8d79156c3d960a4c,

title = "Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya",

abstract = "Background: Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms. Methods: Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM2.5) was estimated. Results: 2373 children participated, 1277 in Mukuru (median age, IQR 11, 9-13 years, 53% girls), and 1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM2.5. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, € current wheeze' (9.5% vs 6.4%, p=0.007) and € trouble breathing' (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to € vapours, dusts, gases, fumes', mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads. Conclusion: Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.",

keywords = "asthma, asthma epidemiology, paediatric asthma",

author = "Hellen Meme and Evans Amukoye and Cressida Bowyer and Jeremiah Chakaya and Darpan Das and Ruaraidh Dobson and Ulrike Dragosits and Jonathan Fuld and Cindy Gray and Matthew Hahn and Richard Kiplimo and Maia Lesosky and Loh, {Miranda M.} and Jean McKendree and Kevin Mortimer and Amos Ndombi and Louis Netter and Angela Obasi and Fred Orina and Clare Pearson and Heather Price and Quint, {Jennifer K.} and Sean Semple and Marsailidh Twigg and Charlotte Waelde and Anna Walnycki and Melaneia Warwick and Jana Wendler and West, {Sarah E.} and Michael Wilson and Lindsay Zurba and Graham Devereux",

note = "Funding Information: Funded by UKRI MRC/Kenya National Research Fund (NRF) UK-Kenya Joint Partnership on Non-Communicable Disease programme under the Newton fund MR/S009027/1. Sensitisation activities additionally funded by Wellcome Public Engagement Fund 218935/Z/19/Z. For the purpose of open access, the author has applied a CC BY public copyright licence (where permitted by UKRI, {\textquoteleft}Open Government Licence{\textquoteright} or {\textquoteleft}CC BY-ND public copyright licence may be stated instead) to any Author Accepted Manuscript version arising{\textquoteright}. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023",

year = "2023",

month = jun,

day = "6",

doi = "10.1136/thorax-2023-220057",

language = "English",

journal = "Thorax",

issn = "0040-6376",

publisher = "BMJ",

}

Meme, H, Amukoye, E, Bowyer, C, Chakaya, J, Das, D, Dobson, R, Dragosits, U, Fuld, J, Gray, C, Hahn, M, Kiplimo, R, Lesosky, M, Loh, MM, McKendree, J, Mortimer, K, Ndombi, A, Netter, L, Obasi, A, Orina, F, Pearson, C, Price, H, Quint, JK, Semple, S, Twigg, M, Waelde, C, Walnycki, A, Warwick, M, Wendler, J, West, SE, Wilson, M, Zurba, L & Devereux, G 2023, 'Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya', Thorax. https://doi.org/10.1136/thorax-2023-220057

TY - JOUR

T1 - Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya

AU - Meme, Hellen

AU - Amukoye, Evans

AU - Bowyer, Cressida

AU - Chakaya, Jeremiah

AU - Das, Darpan

AU - Dobson, Ruaraidh

AU - Dragosits, Ulrike

AU - Fuld, Jonathan

AU - Gray, Cindy

AU - Hahn, Matthew

AU - Kiplimo, Richard

AU - Lesosky, Maia

AU - Loh, Miranda M.

AU - McKendree, Jean

AU - Mortimer, Kevin

AU - Ndombi, Amos

AU - Netter, Louis

AU - Obasi, Angela

AU - Orina, Fred

AU - Pearson, Clare

AU - Price, Heather

AU - Quint, Jennifer K.

AU - Semple, Sean

AU - Twigg, Marsailidh

AU - Waelde, Charlotte

AU - Walnycki, Anna

AU - Warwick, Melaneia

AU - Wendler, Jana

AU - West, Sarah E.

AU - Wilson, Michael

AU - Zurba, Lindsay

AU - Devereux, Graham

N1 - Funding Information: Funded by UKRI MRC/Kenya National Research Fund (NRF) UK-Kenya Joint Partnership on Non-Communicable Disease programme under the Newton fund MR/S009027/1. Sensitisation activities additionally funded by Wellcome Public Engagement Fund 218935/Z/19/Z. For the purpose of open access, the author has applied a CC BY public copyright licence (where permitted by UKRI, ‘Open Government Licence’ or ‘CC BY-ND public copyright licence may be stated instead) to any Author Accepted Manuscript version arising’. Publisher Copyright: © Author(s) (or their employer(s)) 2023

PY - 2023/6/6

Y1 - 2023/6/6

N2 - Background: Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms. Methods: Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM2.5) was estimated. Results: 2373 children participated, 1277 in Mukuru (median age, IQR 11, 9-13 years, 53% girls), and 1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM2.5. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, € current wheeze' (9.5% vs 6.4%, p=0.007) and € trouble breathing' (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to € vapours, dusts, gases, fumes', mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads. Conclusion: Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.

AB - Background: Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms. Methods: Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM2.5) was estimated. Results: 2373 children participated, 1277 in Mukuru (median age, IQR 11, 9-13 years, 53% girls), and 1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM2.5. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, € current wheeze' (9.5% vs 6.4%, p=0.007) and € trouble breathing' (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to € vapours, dusts, gases, fumes', mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads. Conclusion: Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.

KW - asthma

KW - asthma epidemiology

KW - paediatric asthma

UR - http://www.scopus.com/inward/record.url?scp=85164376880&partnerID=8YFLogxK

U2 - 10.1136/thorax-2023-220057

DO - 10.1136/thorax-2023-220057

M3 - Article

C2 - 37280096

AN - SCOPUS:85164376880

SN - 0040-6376

JO - Thorax

JF - Thorax

M1 - 220057

ER -

Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

Cite this