Prevalence of Asthma in School going Children of Semi-Urban Area in the State of Madhya Pradesh

Childhood asthma is the common chronic illness among school going children and is reportedly under diagnosed and undertreated.1 Increase in the rates of hospital admission and primary care contacts for asthma in childhood has led to concern regarding prevalence or severity of increasing wheezing illness in children. Rise in prevalence of childhood asthma is a matter of concern worldwide and in India also.2-5 The steady rise in prevalence is correlated with demographic changes in city like increase in number of industries, increased density of population from migration of rural population and increased number of automobiles to commute resulting in air pollution.5 Data on prevalence of asthma is now available from several countries. There is very limited data on asthma epidemiology from the developing countries including India. But, few Indian studies have reported prevalence of childhood asthma ranging from 3.5% to 29.5. Diagnosis of asthma is often missed or delayed due to the dynamic nature of the disease, unreliable past history or poor documentation of past episodes or lack of specific and relative diagnostic investigation.6 Children with poorly controlled, untreated or under diagnosed asthma can have problems, as exercise induced bronco spasm (EIB) can leave them breathless and unable to participate or sometimes it could be dangerous.3 In this regard training of the school teachers with health guides may be one of the most important strategies for promotion of school health.7 There is no data available regarding prevalence of asthma in school children in the state of Madhya Pradesh.


INTRODUCTION
Childhood asthma is the common chronic illness among school going children and is reportedly under diagnosed and undertreated. 1Increase in the rates of hospital admission and primary care contacts for asthma in childhood has led to concern regarding prevalence or severity of increasing wheezing illness in children.][4][5] The steady rise in prevalence is correlated with demographic changes in city like increase in number of industries, increased density of population from migration of rural population and increased number of automobiles to commute resulting in air pollution. 5ata on prevalence of asthma is now available from several countries.There is very limited data on asthma epidemiology from the developing countries including India.But, few Indian studies have reported prevalence of childhood asthma ranging from 3.5% to 29.5.Diagnosis of asthma is often missed or delayed due to the dynamic nature of the disease, unreliable past history or poor documentation of past episodes or lack of specific and relative diagnostic investigation. 6Children with poorly controlled, untreated or under diagnosed asthma can have problems, as exercise induced bronco spasm (EIB) can leave them breathless and unable to participate or sometimes it could be dangerous. 3In this regard training of the school teachers with health guides may be one of the most important strategies for promotion of school health. 7There is no data available regarding prevalence of asthma in school children in the state of Madhya Pradesh.

OBJECTIVES
To estimate the prevalence of asthma among school children of 7 th and 8 th standard in semi-urban area of Bhopal.To find the association of various factors with asthma in the study population.

Study design & Settings
It is a cross-sectional study which was done in all five higher secondary schools in Bairagarh area of Bhopal, Madhya Pradesh namely 1) Govt.Boys Middle School No.2, Bairagarh.2) Govt.Jaslok Girls Middle School, Bairagarh.3) Govt.Middle School No.1, Bairagarh.4) Govt.Middle school No.2, C.T.O.Bairagarh.5) Govt.Middle School, Bairagarh kala.331 children participated and 36 were absent on the day of data collection.The data was collected on scheduled dates with prior permission from the school authorities.

Study Period
The data collection was done in the month of August-September 2014.

Variables
Allergies, area of residence, childhood asthma, cooking fuel, cough at night, diet, living in farm, medication, playing, pets, school children, sex of the child, smoking, wheezing, whistling.

Study Tool
Study participants were asked to fill up the structured questionnaire as scheduled.Questionnaire was based on that used by International Study of Asthma and Allergies in Childhood (ISSAC). 22The final questionnaire was a modified version of this questionnaire with addition of questions related to environmental, lifestyle factors and questions regarding severity of asthma based on relevant literature search.The developed questionnaire was translated into local language (Hindi) and pilot tested on a sample of school children.The questionnaire consisted of a total of 24 items.The children were considered to have questionnaire diagnosed asthma if the answer to any of the following question was "yes" viz.Item 3: Has a doctor ever told you that you have asthma?;Item 5: Have you had any wheezing or whistling in the chest in the past 12 months?and Item 7: Have you used medication for the wheezing in last 12 month?.

Ethical Considerations
The study was conducted after the clearance from Institutional Ethical Committee (IEC) of Chirayu Medical College and Hospital (CMCH), Bhopal.Also, consent was sought from school authorities for the study.

Statistical Analysis
Entry of all the data was done on Microsoft office Excel 2007 and was analyzed on statistical package for Social Sciences (SPSS V.S 20.0).
The mean age of study subjects was 13.2 years with a range of 12-17years.

Prevalence of asthma
Table 2 depicts prevalence of asthma among school children by various criteria viz.already diagnosed by the physician, asthma like symptoms (wheezing and whistling) and use of asthma medication in last 12 months.There were 46 students out of the total who answered "yes" to any of the above criteria based questions.Thus, the prevalence of ques-tionnaire diagnosed asthma came out to be 13.9%.Out of these 40 (87%) were newly detected asthmatics by the study questionnaire, excluding those already diagnosed by the physician viz.6(1.8%).Out of the total asthmatics 44 (13.3%) children reported wheezing and/or whistling in past 12 months and 9 (2.7%) children used medication for wheezing and/or whistling in past 12 months.The prevalence ratio of Male: Female came out to be 1:1.55.

Risk factors associated with asthma
Table-4 shows the association of risk factors with asthma.With univariate and multivariate analysis, following variables were tested for association with asthma: sex, place of residence, history of asthma, smoking members in household, history of allergy, pets in household and type of diet.With univariate as well as multivariate analysis, out of these variables family history of asthma, history of allergy and presence of cough without cold showed a statistically significant association.Multivariate analysis shows significant association of asthma with family history of asthma, history of allergy.
The head of the school and faculty were explained about the purpose of the study.Before filling up the questionnaire children were guided through questionnaire to fill it up.The questionnaire was filled up under the supervision of Medical Officer of Urban Health and Training Centre situated in Bairagarh; which comes under administrative control of CMCH, Bhopal.Confidentiality of the data of participants of the study was maintained.The newly diagnosed asthmatics and those not receiving treatment were referred to nearby Chirayu Medical College and Hospital for further management.

Table 1 : Characteristics of study population Variable School children (n=331) n (%) Place of residence:
*Total percentage does not equal 100, as more than one type of cooking fuel is used by each household.