1. Prevalence and Risk Factors of Asthma and Asthma Symptoms among Children
Aged 5 –15 Years in Esmeraldas Province, Ecuador: A Cross-Sectional Study Analysis
E.O. Evbuomwan1, C. Ardura-Garcia1, L. Melani2, J. Blakey1
1Liverpool School of Tropical Medicine - Liverpool/UK, 2Pontificia Universidad Católica del Ecuador Sede Esmeraldas - Esmeraldas/EC
 Previous studies from Latin America reported high prevalence of asthma among
schoolchildren, similar to Western countries including the UK and USA 1.
 There is a dearth of information on the factors determining the pathogenesis and
severity of asthma amongst Latin American children given the advancement in medical
science and research 2.
 Ecuador is one of the Latin America countries with a childhood asthma prevalence as
high as 10%, a figure that is rising most likely due to increased urbanization, migration
and environmental changes following exposures to allergens (e.g. dust mite) 3, 4.
The aim of this is study to estimate the prevalence of and explore the risk factors
associated asthma in children aged 5–15 years in Esmeraldas Province.
Data Source
 The Esmeraldas Household Survey (EHS) conducted between December 2014 and
January 2015 by the School of Nursing at Pontifical Catholic University, Ecuador using a
cross-sectional study design.
Study design
 Secondary data analysis using pooled data from EHS
 Inclusion criteria: Households with school-age children (5 to 15 years)
 Exclusion criteria: Households with no school-age children (children younger than 5
years and adults over 15 years).
Study variable definition
Dependent variable
Variables definitions were based on previous epidemiological studies (Table: 1).
Table 1: Dependent variables used in analysis
Statistical analysis
 Statistical Package for Social Sciences version 22 (SPSS 22)
 Performed descriptive analyses and compared distribution of variables in the study
population using chi-square test.
 Multiple logistic regression analyses were performed to determine individual and
collective association between risk factors and asthma outcomes.
 The strength of the relationship between the independent (exposure) variables and
asthma outcomes was evaluated by calculating Odds ratios (OR) and their confidence
interval (CI) for all the factors investigated.
We evaluated a total of 1,046 children aged 5 to 15 years who participated in the EHS.
Table 2: Esmeraldas Household Survey Sample Characteristics (n = 1046)
Independent variable
Independent variables were chosen based on a review of childhood asthma literature and
data available from the original study .
Asthma prevalence in the study population
The overall prevalence of ‘ever wheeze’, ‘current wheeze’, ‘severe asthma’ and ‘ever asthma’ as
reported by participants were 19.3%, 7.2%, 1.0% and 8.6%, respectively.
Multiple logistic regression analyses were performed for age, age, sex, building characteristics,
parental level of education, parental occupation, family size, number of siblings and the area of
residence in relation to asthma and asthma-related symptoms.
Ever asthma
Children living in San Mateo were 2.6 times as likely to have reported physician-diagnosed
asthma compared to children living in Atacames Centro (pOR = 2.670; 95% CI 1.132:6.299).
Ever wheeze
The odds of children living in houses made of cane walls suffering from ever wheeze are
approximately ten times higher than for children living in houses with concrete floors (pOR =
10.271; 95% CI 2.351:44.877).
Current wheeze
Children who have parents with primary education were 28% less likely to have reported
current wheeze compared to children with university-educated parents (pOR = 0.719; 95% CI
0.310:1.525).
Severe asthma
No variable was assessed in the multivariable models for severe asthma as a result of
insufficient data.
 This study found significant association between environmental and socioeconomic
factors with ever asthma, ever wheeze and current wheeze.
 Cane walls, area of residence, and parental primary and secondary education were
predictors for asthma and asthma-related symptoms among school-age children living
in Esmeralda Province.
 The cross-sectional design methodology of the original study makes it difficult to infer
causality and temporality. However, cross-sectional studies may indicate potential
associations between exposures and risk factors that could be beneficial in generating
hypothesis for future studies.
 A major challenge for this study was incomplete or missing data. Limited access to
quality data leads to insufficient facts being gathered and conclusions made on the
enormity of the burden and impact of asthma in Ecuador and Latin America 3, 5.
 The prevalence of asthma and asthma-related symptoms in school-age children in
Esmeraldas, Ecuador, is high and within the prevalence range of the Latin America
region.
 The study established a correlation between asthma outcome and environmental and
low socioeconomic factors.
 Cohort studies are needed to explore the roles played by these factors in the
development and exacerbation of asthma.
 Steps should be taken to improve asthma care through provision of asthma specialist
centres staffed with medical personnel who are adequately trained to identify early
asthma-related symptoms and provide information for management of the disease.
Introduction
We acknowledge the staff and students of School of Nursing at Pontifical Catholic
University of Ecuador, for collecting and permitting the use of their data.
1. MALLOL, J., SOLE, D., ASHER, I., CLAYTON, T., STEIN, R. & SOTO‐QUIROZ, M. 2000. Prevalence of asthma symptoms in
Latin America: the International Study of Asthma and Allergies in Childhood (ISAAC). Pediatric pulmonology, 30, 439-444.
2. NEFFEN, H., FRITSCHER, C., CUEVAS SCHACHT, F., LEVY, G., CHIARELLA, P., SORIANO, J. B. & MECHALI, D. 2005. Asthma
control in Latin America: the asthma insights and reality in Latin America (AIRLA) survey. Revista Panamericana de Salud
Pública, 17, 191-197.
3. COOPER, P., RODRIGUES, L., CRUZ, A. & BARRETO, M. 2009. Asthma in Latin America: a public heath challenge and
research opportunity. Allergy, 64, 5-17.
4. RODRIGUEZ, A., VACA, M., OVIEDO, G., ERAZO, S., CHICO, M. E., TELES, C., BARRETO, M. L., RODRIGUES, L. C. & COOPER,
P. J. 2011. Urbanisation is associated with prevalence of childhood asthma in diverse, small rural communities in Ecuador.
Thorax, thoraxjnl-2011- 200225.
5. FISCHER, G. B., CAMARGOS, P. A. M. & MOCELIN, H. T. 2005. The burden of asthma in children: a Latin American
perspective. Paediatric respiratory reviews, 6, 8-13.
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download a PDF version of this poster and more data.
Study Objectives
Method
Result Discussion
Conclusion
References
Acknowledgment
Further Information
*= Participants with missing or incomplete data were excluded
Table 3: Prevalence of asthma and asthma-related symptoms among investigated children
by age group
a = P value in Fisher exact test. P < 0.05 significant. * = Sample size differs from 1,046, as participants with missing data were excluded from the
analysis
Dependent Variable Question Used in analysis
“Ever wheeze” Has your child ever had wheezing or
whistling in the chest at any time in the
past?
Binary: (No= 0, yes = 1)
“Current wheeze” Has your child had wheezing or whistling
in the chest in the last 12 months?
Binary: (No= 0, yes = 1)
“Severe asthma” How many attacks of wheezing has your
child had in the last 12 months?’’ Severe
wheeze was assessed as if children
reported 4 or more attacks of wheeze
Binary: (None= 0, yes =
1)
Grouped into two
categories:
None = <4, yes = ≥4
“Ever asthma” Has your child ever had asthma? Binary: (No= 0, yes = 1)
Asthma and
asthma-related
symptoms
No. of
participants*
Prevalence stratified by age group (years), n (%)
Younger
(5 – 7)
Middle
(8 – 12)
Older
(13 – 15)
P a
Ever wheeze 941 54 (29.7) 88 (48.4) 40 (22.0) 0.031
Current wheeze 939 23 (33.8) 36 (52.9) 9 (13.2) 0.005
Severe asthma 906 0 (00.0) 8 (88.9) 1 (11.1) 0.039
Ever asthma 903 28 (35.9) 35 (44.9) 15 (19.2) 0.017
Factor
Demographics Number Percentage (%)
Sample size 1046
Sex
Female 491 46.9
Male 555 53.1
Age Group
Younger (5 – 7) 259 24.8
Middle (8 – 12) 485 46.4
Older (13 – 15) 302 28.9
Environmental Factors
Area of Residence
San Mateo 187 17.9
15 de Marzo Centro 201 19.2
15 de Marzo Norte 200 19.1
Atacames Sur 85 8.1
Atacames Norte 84 8.0
Atacames Centro 158 15.1
Others 131 12.5
Socioeconomic factors
Family size
Small 330 31.5
Large 716 68.5
Number of siblings
None 185 17.6
One sibling 322 30.8
Two or more siblings 539 51.6
Parental level of education*
None 14 1.3
Primary 275 26.4
Secondary 548 52.6
Tertiary 205 19.7
Parent Occupation*
Unskilled 462 46.2
Semi-skilled 366 36.6
Skilled 171 17.1
Building Characteristics
Roofing material*
Concrete 164 15.8
Asbestos 29 2.8
Zinc 834 80.4
Others 10 1.0
Flooring*
Wood 96 9.2
Tiles 380 36.5
Cement 546 52.4
Others 19 1.8
Wall*
Wood 65 6.2
Concrete 816 78.4
cane 74 7.1
others 86 8.3
General state*
Bad 82 8.0
Regular 391 38.2
Good 550 53.8