肯尼亚内罗毕一个非正式居住区和富裕地区学龄儿童的哮喘症状、肺活量测定和空气污染暴露
2023/06/25
摘要
背景：虽然有10亿人生活在非正式居住区(贫民窟)，但居住在这些非正式居住区对呼吸系统健康的影响在很大程度上仍然未知。本研究调查了生活在肯尼亚内罗毕非正式居住区的儿童患哮喘症状的风险是否增加。
方法：对穆库鲁(内罗毕的一个非正式定居点)和较富裕地区(布鲁布鲁)上学的儿童进行了比较。问卷量化呼吸道症状和环境暴露;进行肺活量测定;对个人接触颗粒物(PM(2.5))进行了估计。
结果：2373名儿童参与其中，穆库鲁1277名(中位年龄，IQR为11,9-13岁，53%的女孩)，布鲁布鲁1096名(10,8-12岁，52%的女孩)。穆库鲁学童来自不太富裕的家庭，更多地暴露于污染源和PM2.5。与布鲁布鲁学龄儿童相比，穆库鲁学龄儿童出现“当前喘息”(9.5% vs 6.4%，p=0.007)和“呼吸困难”(16.3% vs 12.6%，p=0.01)等症状的比例更高，而且这些症状更严重，问题更大。布鲁布鲁确诊的哮喘更为常见(2.8% vs 1.2%，p=0.004)。穆库鲁和布鲁布鲁的肺量测定没有差异。无论在哪个社区，自我报告暴露于“蒸汽、灰尘、气体、烟雾”、蚊香燃烧、家中成年吸烟者、房屋附近焚烧垃圾和靠近道路的住宅都观察到显著的不良关联。
结论：生活在非正式定居点的儿童更有可能出现与哮喘相关的喘息症状，这些症状更严重，但不太可能被诊断为哮喘。自我报告但未客观测量的空气污染暴露与哮喘症状风险增加有关。
Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya
H. Meme, E. Amukoye, C. Bowyer, J. Chakaya, D. Das, R. Dobson, et al.
Abtract
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 (PM(2.5)) 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 PM(2.5). 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.
CONCLUSIONS: 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.
背景：虽然有10亿人生活在非正式居住区(贫民窟)，但居住在这些非正式居住区对呼吸系统健康的影响在很大程度上仍然未知。本研究调查了生活在肯尼亚内罗毕非正式居住区的儿童患哮喘症状的风险是否增加。
方法：对穆库鲁(内罗毕的一个非正式定居点)和较富裕地区(布鲁布鲁)上学的儿童进行了比较。问卷量化呼吸道症状和环境暴露;进行肺活量测定;对个人接触颗粒物(PM(2.5))进行了估计。
结果：2373名儿童参与其中，穆库鲁1277名(中位年龄，IQR为11,9-13岁，53%的女孩)，布鲁布鲁1096名(10,8-12岁，52%的女孩)。穆库鲁学童来自不太富裕的家庭，更多地暴露于污染源和PM2.5。与布鲁布鲁学龄儿童相比，穆库鲁学龄儿童出现“当前喘息”(9.5% vs 6.4%，p=0.007)和“呼吸困难”(16.3% vs 12.6%，p=0.01)等症状的比例更高，而且这些症状更严重，问题更大。布鲁布鲁确诊的哮喘更为常见(2.8% vs 1.2%，p=0.004)。穆库鲁和布鲁布鲁的肺量测定没有差异。无论在哪个社区，自我报告暴露于“蒸汽、灰尘、气体、烟雾”、蚊香燃烧、家中成年吸烟者、房屋附近焚烧垃圾和靠近道路的住宅都观察到显著的不良关联。
结论：生活在非正式定居点的儿童更有可能出现与哮喘相关的喘息症状，这些症状更严重，但不太可能被诊断为哮喘。自我报告但未客观测量的空气污染暴露与哮喘症状风险增加有关。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（Thorax 2023 DOI: 10.1136/thorax-2023-220057）
（Thorax 2023 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
H. Meme, E. Amukoye, C. Bowyer, J. Chakaya, D. Das, R. Dobson, et al.
Abtract
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 (PM(2.5)) 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 PM(2.5). 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.
CONCLUSIONS: 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.
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