Why many children in SA get asthma

New research suggests that children who grow up in urban areas and are exposed to violence and other psychological stressors are more likely to have asthma compared with their rural counterparts who are exposed to more outdoor and agricultural activities.

Cape Argus, 20 June 2016

The study was carried out the University of Oxford and Stellenbosch University on young children in the Western Cape, KwaZulu-Natal and Mpumalanga. Carried out on more than 6 000 children aged between 10 and 17, the study is the first large-scale investigation to probe whether socio-economic conditions pose any risk factors for childhood asthma or increased its prevalence.

Sub-Saharan Africa has over 50 million children under the age of 15 living with asthma, mostly in South Africa. While SA asthma prevalence rate ranks 25th in the world, the country ranks fourth for asthma mortality among five to 34-year-olds - suggesting a need for improved asthma management and prevention.

The latest study found that the prevalence of asthma among the surveyed children was about six percent with almost 39 percent of asthmatic children experiencing severe forms of the disease - more than one asthma attack a month. Participants were split between rural and urban children. Less frequent performance of outdoor tasks such as tending to animals or crops, fewer poorer households, widespread violence, and heightened anxiety among children were associated with an increased prevalence of asthma.

Domestic abuse and urban living were, however, associated with indirect effects on asthma occurrence. It is believed urban living created more asthma risk through decreased time on outdoor tasks such as agricultural activities and more exposure to indoor allergens. Greater prevalence of community violence, which in turn made urban children more anxious, was also blamed as an asthma trigger.

On the other hand, factors associated with higher prevalence of severe asthma were younger age, greater household poverty and depressive symptoms. Writing in the SA Medical Journal, lead researcher Alexa Yokubovich from University of Oxford, said the latest findings had tentative implications for the direction of public health policy and research.

She raised concerns about South Africa's childhood asthma management guidelines, which only focused on medical diagnosis and treatment, and largely ignored the social distribution of asthma. Yokubovich said this study suggests that successful asthma management may require consideration of the broader social factors that could affect asthma outcomes, such as violence. Psychological interventions may be beneficial for prevention and treatment.