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a Institute of
Community Medicine, University of Tromsø, Norway, b Environmental Health Sciences,
University of California, Berkeley, USA, c Department of Thoracic Medicine, University of
Bergen, Norway, d Mrigendra
Samjhana Medical Trust, Nepal
Correspondence to: Dr T Melsom, Utsikten 15 nr 1, 1604 Fredrikstad, Norway toralfm{at}hotmail.com
Received 1 August 2000; Returned to authors 1 November 2000; Revised version received 1 February 2001; Accepted for publication 26 February 2001
BACKGROUND
The
development of asthma seems to be influenced by the adoption of a
Western lifestyle. A study was undertaken to assess the importance of
indoor environmental factors in Nepal where the lifestyle and home
environment differ from that in the West.
METHODSThe home
environment of 121 schoolchildren with asthma and 126 controls aged
11-17 years was studied. The homes of all participants were
investigated and the children and their mothers were interviewed using
a standardised questionnaire. Cases and controls were identified from
an ISAAC (International Study of Asthma and Allergy in Childhood) based
population study of 2330 schoolchildren in Kathmandu, Nepal.
RESULTSKeeping cattle
inside the house during the night was related to a lower risk for
having asthma (adjusted odds ratio (OR) 0.2 (95% CI 0.1 to 0.5)) while
there was no association between asthma and cattle kept outside. Asthma
was associated with cigarette smoking by two or more family members (OR
1.9 (95% CI 1.0 to 3.9)) and with the domestic use of smoky fuels (OR
2.2 (95% CI 1.0 to 4.5)). In analyses stratified by sex, passive
smoking and the use of smoky fuels were significantly associated with
asthma only in boys.
CONCLUSIONSThe risk
of asthma in Nepalese children was lower in subjects exposed to cattle
kept inside the house and higher in subjects exposed to passive smoking
and indoor use of smoky fuels. Childhood exposure to microorganisms or
allergens from cattle may protect against the development of atopic disease.
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