Health Education Research, Vol. 18, No. 1, 119-121,
February 2003
© 2003 Oxford University Press
LETTER TO THE EDITOR |
Prevalence of asthma in schoolchildren underrepresents those from socially deprived areas
Portsmouth City Primary Care Trust, Finchdean House, Milton Road, Portsmouth PO3 6DP, UK. E-mail: M.D.S.Erlewyn-Lajeunesse{at}soton.ac.uk
We were interested to read the excellent study by McCann et al. in the February edition of Health Education Research (McCann et al., 2002
). We have recently conducted a similar, but smaller, study that sheds some light upon their results. Our study aimed to assess the impact of our local asthma health promotion scheme for schools [Asthma Friendly Schools (AFS) Initiative], which had been in place for 5 years and had been adopted by about half of all Portsmouth schools.
We conducted a postal questionnaire survey of all 6- to 7-year-old children (Year 2) attending school within two electoral wards in Portsmouth. The questionnaire comprised the respiratory symptom module of the parent-administered International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire (Asher et al., 1995), and further questions regarding the necessity and availability of asthma inhalers in school. This was performed in conjunction with an asthma treatment quiz, again distributed as a postal questionnaire, for Year 2 teaching staff at those schools. We chose the wards of Charles Dickens and Milton, within the City of Portsmouth, because they had contrasting socioeconomic indices and both contained schools that had not yet been AFS trained. A follow-up letter was distributed to all parents and staff 2 weeks later. The study had the approval of the local research ethics committee, and permission from the head teacher was sought before contacting parents and staff.
Seven of eight infant and primary schools in the two wards agreed to participate, giving a total sample of 339 children, and 30 Year 2 teachers and classroom assistants. Eighty-eight parents replied giving a return rate of 26%. The reported prevalence of disease was similar to that found by McCann et al. and other studies, with 28% of children having had a diagnosis of asthma and 18% having wheezed in the last 12 months (Fielder et al., 1999; Shamssain and Shamsian, 1999; Ng Man et al., 2001; McCann et al., 2002). Twenty-six percent of children currently had inhalers prescribed by their General Practitioner and 17% (n = 15) of children required inhalers to be kept in school.
Socioeconomic factors may play a role in questionnaire return. In our study, only 15% of parents from Charles Dickens returned questionnaires. This electoral ward had the worst socioeconomic indices of all Portsmouth wards using the Index of Multiple Deprivation (IMD) (Department of Environment, Transport and Regions, 2000). It is 23rd of over 8000 electoral wards in the country on the IMD 2000 index for child poverty, with 79% of children living in families who receive means-tested benefits. On this background, adult literacy is poor and approximately 30% of the population of this ward has low to very low literacy skills (Basic Skills Agency; www.basic-skills.co.uk/datasite/). This is above the national and local averages. Data is not available on the number of families within these wards who speak a language other than English within the home. We have demonstrated that areas of social deprivation will not be adequately represented by this type of survey and that other methods would be needed to describe disease within these communities.
McCann et al. showed that head teachers’ estimated asthma prevalences were less than those reported by parental questionnaire (McCann et al., 2002). They concluded that in part this could be due to parents concealing the child’s asthma from the school so that the child could have better access to their emergency inhalers. We found no parents suggested that this was the case in our anonymous survey. Twelve of 14 (86%) parents felt that their child had easy access to their inhaler at school and staff returns agreed. Although our study sampled Year 2 children (below the cut-off for junior school entry), we also found no differences between primary and infant schools in the ease with which they had access to inhalers. This is certainly an improvement on the earlier survey and may be a temporal phenomenon, as schools become more familiar with childhood asthma, or due to the AFS initiative within our area.
Only eight members of staff responded to our postal quiz on the emergency management of asthma (26%). Only one person got the quiz completely correct and there was some confusion over the use of spacer devices. Three-quarters of the respondents had previous first aid or asthma training not including the AFS, which half had received. These data shows that in spite of health promotion activities in school, teaching staff remain unsure of what to do in an emergency. We recommend that practical instruction perhaps using mannequins, and certainly demonstrating inhaler and spacer technique, becomes part of future health promotion activity for school staff.
In conclusion, ISAAC questionnaire surveys in the UK may be under-representing a proportion of our society. Access to inhalers in school has improved, but treatment of acute asthma remains a problem. Lastly, unless the health promotion activity is carefully constructed and audited, it will not be a panacea for the problems of childhood asthma currently facing our schools.
References
Asher, M. I., Keil, U., Anderson, H. R., Beasley, R., Crane, J., Martinez, F., Mitchell, E. A., Pearce, N., Sibbald, B., Stewart, A. W., Strachan, D. P., Weiland, S. K. and Williams, H. C. (1995) International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. European Respiratory Journal, 8, 483–491.[Abstract]
Department of Environment, Transport and Regions (2000) Indices of Deprivation 2000. Regeneration Research Summary 31. London, HMSO.
Fielder, H. M., Lyons, R. A., Heaven, M., Morgan, H., Govier, P. and Hooper, M. (1999) Effect of environmental tobacco smoke on peak flow variability. Archives of Diseases of Childhood, 80, 253–256.
McCann, D., McWhirter, J., Coleman, H., Devall, I., Calvert, M., Weare, K. and Warner, J. (2002) The prevalence and management of asthma in primary-aged schoolchildren in the south of England. Health Education Research, 17, 181–194.
Ng Man, K. G., Proctor, A., Billings, C., Duggan, R., Das, C., Whyte, M. K., Powell, C. V. and Primhak, R. (2001) Increasing prevalence of asthma diagnosis and symptoms in children is confined to mild symptoms. Thorax, 56, 312–314.
Shamssain, M. H. and Shamsian, N. (1999) Prevalence and severity of asthma, rhinitis, and atopic eczema: the north east study. Archives of Diseases of Childhood, 81, 313–317.
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