RESUMO
INTRODUCTION: Lung function abnormalities are common in sickle cell anaemia (SCA) but data from sub-Saharan Africa are limited. We hypothesised that children with SCA from West Africa had worse lung function than their counterparts from Europe. METHODS: This prospective cross-sectional study evaluated spirometry and anthropometry in black African individuals with SCA (haemoglobin phenotype SS) aged 6-18 years from Nigeria and the UK, when clinically stable. Age-matched controls were also included in Nigeria to validate the Global Lung Initiative spirometry reference values. RESULTS: Nigerian SCA patients (n=154) had significant reductions in both FEV1 and FVC of ~1 z-score compared with local controls (n=364) and ~0.5 z-scores compared with the UK patients (n=101). Wasting (body mass index z-score<-2) had a prevalence of 27% in Nigerian patients and 7% in the UK ones (p<0.001). Among children with SCA, being resident in Nigeria (OR 2.4, 95% CI 1.1 to 4.9), wasting (OR 2.3, 95% CI 1.1 to 5.0) and each additional year of age (OR 1.2, 95% CI 1.1 to 1.4) were independently associated with increased risk of restrictive spirometry (FVC z-score<-1.64+FEV1/FVC≥-1.64). CONCLUSIONS: This study showed that chronic respiratory impairment is more severe in children with SCA from West Africa than Europe. Our findings suggest the utility of implementing respiratory assessment in African children with SCA to early identify those with chronic lung injury, eligible for closer follow-up and more aggressive therapies.
Assuntos
Anemia Falciforme/complicações , Insuficiência Respiratória/etiologia , Adolescente , Anemia Falciforme/epidemiologia , Anemia Falciforme/fisiopatologia , Antropometria/métodos , Criança , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Nigéria/epidemiologia , Estado Nutricional , Prevalência , Estudos Prospectivos , Testes de Função Respiratória/métodos , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/fisiopatologia , Fatores de Risco , Espirometria , Capacidade Vital/fisiologia , Síndrome de Emaciação/epidemiologia , Síndrome de Emaciação/etiologia , Síndrome de Emaciação/fisiopatologiaRESUMO
The impact of socio-economic status on the risk of allergy in African children is not clear.This was a cross sectional study including children aged 6-14 years from urban and rural settings in north-central Nigeria. Participants underwent skin prick tests to house dust mite (HDM) and an interview investigating socio-economic status through the Family Affluence Scale (FAS) based on a score of 0-6.A total of 346 children were enrolled (52.8% boys; mean age ± SD 9.6 ± 2.0 years), including 142 (41% of total) rural and 204 (59% of total) urban pupils. Prevalence of HDM sensitivity was 2.8% (4/142) in the rural setting and 15.6% (32/204) in the urban setting (P < 0.001). Among urban children, frequency of HDM sensitization was 8.6% (7/81) in the lowest socio-economic group (FAS 0-1), 13.1% (8/61) in the intermediate one (FAS 2-3) and 27.4% (17/62) in the highest one (FAS ≥ 4).Urbanization and increasing wealth are associated with a higher frequency of sensitization to HDM in Nigerian children.