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Global health
Original research
Prevalence of atopic dermatitis, asthma and rhinitis from infancy through adulthood in rural Bangladesh: a population-based, cross-sectional survey
  1. Courtney J Pedersen1,
  2. Mohammad J Uddin2,
  3. Samir K Saha2,
  4. Gary L Darmstadt1
  1. 1Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
  2. 2Child Health Research Foundation, Dhaka, Bangladesh
  1. Correspondence to Dr Gary L Darmstadt; gdarmsta{at}stanford.edu

Abstract

Objective Describe the pattern of atopic disease prevalence from infancy to adulthood.

Design Cross-sectional household survey.

Setting Community-based demographic surveillance site, Mirzapur, Bangladesh.

Participants 7275 individuals in randomly selected clusters within 156 villages.

Primary and secondary outcome measures The 12-month prevalence of atopic dermatitis (by UK Working Party Criteria (UK criteria) and International Study of Asthma and Allergies in Childhood (ISAAC)), asthma and rhinitis (by ISAAC); disease severity (by ISAAC); history of ever receiving a medical diagnosis.

Results Children aged 2 years had the highest prevalence of atopic dermatitis—18.8% (95% CI 15.2% to 22.4%) by UK criteria and 14.9% (95% CI 11.6% to 18.1%) by ISAAC— and asthma (20.1%, 95% CI 16.4% to 23.8%). Prevalence of rhinitis was highest among 25–29 year olds (6.0%, (95% CI% 4.5 to 7.4%). History of a medical diagnosis was lowest for atopic dermatitis (4.0%) and highest for rhinitis (27.3%) and was significantly associated with severe disease compared with those without severe disease for all three conditions (atopic dermatitis: 30.0% vs 11.7%, p=0.015; asthma; 85.0% vs 60.4%, p<0.001; rhinitis: 34.2% vs 7.3%, p<0.001) and having a higher asset-based wealth score for asthma (29.7% (highest quintile) vs 7.5% (lowest quintile), p<0.001) and rhinitis (39.8% vs 12.5%, p=0.003). Prevalence of having >1 condition was highest (36.2%) at 2 years and decreased with age. Having atopic dermatitis (ISAAC) was associated with significantly increased odds ratios (OR) for comorbid asthma (OR 5.56 (95% CI 4.26 to 7.26)] and rhinitis (3.68 (95% CI 2.73 to 4.96)). Asthma and rhinitis were also strongly associated with each other (OR 8.39 (95% CI 6.48 to 10.86)).

Conclusions Atopic disease burden was high in this rural Bangladeshi population. Having one atopic condition was significantly associated with the presence of another. Low incidence of ever obtaining a medical diagnosis highlights an important opportunity to increase availability of affordable diagnosis and treatment options for all age groups.

  • community child health
  • public health
  • eczema
  • dermatological epidemiology
  • asthma
  • allergy
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-042380

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    Footnotes

    • Twitter @gdarmsta

    • Contributors CP and GLD conceptualised and designed the study, interpreted the data, drafted the initial manuscript and reviewed and revised the manuscript. CP also designed the data collection instruments, participated in oversight of data collection and conducted the analysis of the data. MJU and SKS participated in designing the study and the data collection instruments, supervised data collection and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

    • Funding CP received a Medical Scholars award from the Stanford University School of Medicine, and a Benjamin H Kean Travel Fellowship from the American Society of Tropical Medicine and Hygiene. REDCap platform services are made possible by the Stanford University School of Medicine Research Office. The REDCap platform services at Stanford are subsidised by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (NIH).

    • Disclaimer The data content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was obtained from the Institutional Review Boards at both the Stanford University School of Medicine (protocol #41405) and the Bangladesh Institute of Child Health in Dhaka.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request to the senior author through a data sharing agreement.