title: Household biomass fuel use, asthma symptoms severity, and asthma underdiagnosis in rural schoolchildren in Nigeria: a cross-sectional observational study.
abstract: In 2014, the International Study of Asthma and Allergies in Childhood (ISAAC) reported that the highest prevalence of symptoms of severe asthma was found in the low- and middle-income countries (LMICs), including Nigeria. While exposure to biomass fuel use may be an important risk factor in the development of asthma, its association with asthma symptoms severity has not been well-established. The aim of this study is to extend the spectrum of environmental risk factors that may be contributing towards increasing asthma morbidity, especially asthma symptoms severity in rural schoolchildren in Nigeria and to examine possible asthma underdiagnosis among this population.
  
  
  
  Authors conducted a cross-sectional survey in three rural communities in Nigeria. Asthma symptoms were defined according to the ISAAC criteria. Information on the types of household fuel used for cooking was used to determine household cooking fuel status. Asthma symptoms severity was defined based on frequencies of wheeze, day- and night-time symptoms, and speech limitations. Logistic regression analyses were used to explore associations.
  
  
  
  A total of 1,690 Nigerian schoolchildren participated in the study. Overall, 37 (2.2%) had diagnosed asthma and 413 (24.4%) had possible asthma (asthma-related symptoms but not diagnosed asthma). Children from biomass fuel households had higher proportion of possible asthma (27.7 vs. 22.2%; p < 0.05) and symptoms of severe asthma (18.2 vs. 7.6%; p = 0.048). In adjusted analyses, biomass fuel use was associated with increased odds of severe symptoms of asthma [odds ratios (OR) = 2.37; 95% CI: 1.16-4.84], but not with possible asthma (OR = 1.22; 95% CI: 0.95-1.56).
  
  
  
  In rural Nigerian children with asthma symptoms, the use of biomass fuel for cooking is associated with an increased risk of severe asthma symptoms. There is additional evidence that rural children might be underdiagnosed for asthma.
authors.affiliation: Department of Community Health and Epidemiology and the Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.|Department of Medicine and The Center for Global Health, University of Chicago, 5841 S Maryland Avenue, MC 6076, Chicago, IL, 60637, USA.
authors.forename: Oluwafemi
authors.initials: O
authors.lastname: Oluwole
authors.affiliation: College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.
authors.forename: Ganiyu O
authors.initials: GO
authors.lastname: Arinola
authors.affiliation: Department of Public Health Science, University of Chicago, Chicago, IL, USA.
authors.forename: Dezheng
authors.initials: D
authors.lastname: Huo
authors.affiliation: Department of Medicine and The Center for Global Health, University of Chicago, 5841 S Maryland Avenue, MC 6076, Chicago, IL, 60637, USA. solopade@bsd.uchicago.edu.
authors.forename: Christopher O
authors.initials: CO
authors.lastname: Olopade
mesh_terms: D000293:Adolescent; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D001249:Asthma / Q000453:epidemiology*; D018533:Biomass; D002648:Child; D003296:Cooking; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D009549:Nigeria / Q000453:epidemiology; D012135:Respiratory Sounds / Q000209:etiology; D012307:Risk Factors; D012424:Rural Population
keywords: Asthma severity; Biomass fuel; Nigeria; Possible asthma; Rural children; Underdiagnosis