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Anxiety disorders and asthma among adolescents in Uganda: role of early-life exposures

Harriet Mpairwe, Richard Stephen Mpango, Wilber Sembajjwe, Emily L. Webb, Alison M. Elliott, Neil Pearce, Eugene Kinyanda
ERJ Open Research 2021 7: 00749-2020; DOI: 10.1183/23120541.00749-2020
Harriet Mpairwe
1Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
2London School of Hygiene and Tropical Medicine, London, UK
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  • ORCID record for Harriet Mpairwe
  • For correspondence: Harriet.Mpaiwe@mrcuganda.org
Richard Stephen Mpango
1Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Wilber Sembajjwe
1Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Emily L. Webb
2London School of Hygiene and Tropical Medicine, London, UK
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Alison M. Elliott
1Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
2London School of Hygiene and Tropical Medicine, London, UK
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Neil Pearce
2London School of Hygiene and Tropical Medicine, London, UK
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Eugene Kinyanda
1Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Tables

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  • TABLE 1

    Anxiety disorders among adolescents with and without asthma in Uganda#

    Asthma casesNon-asthma controlsCrude OR (95% CI)Adjusted OR¶ (95% CI)Adjusted OR+ (95% CI)p-value
    Subjects7389
    Any of three anxiety disorders
     No (109)39 (53.4)70 (78.6)111
     Yes (53)34 (46.6)19 (21.4)3.21 (1.62–6.37)3.05 (1.50–6.21)2.68 (1.30–5.53)0.007
    Generalised anxiety disorder
     No (141)57 (78.1)84 (94.4)111
     Yes (21)16 (21.9)5 (5.6)4.71 (1.63–13.60)5.16 (1.71–15.55)4.49 (1.48–13.56)0.008
    Panic disorder
     No (130)49 (67.1)81 (91.0)111
     Yes (32)24 (32.9)8 (9.0)4.96 (2.07–11.90)5.92 (2.31–15.19)5.43 (2.11–14.02)<0.0001
    Social anxiety disorder
     No (131)55 (75.3)76 (85.4)111
     Yes (31)18 (24.7)13 (14.6)1.91 (0.86–4.23)1.68 (0.74–3.84)1.46 (0.63–3.37)0.38

    Data are presented as n or n (%), unless otherwise stated. #: n=162; ¶: adjusted for child's age, sex and father's highest education level attained; +: adjusted for child's age, sex, father's highest education level attained and child's residence at birth.

    • TABLE 2

      Anxiety disorders and asthma control among adolescents with asthma in Uganda#

      ACT scores¶
      Univariate analysisMultivariate analysis+
      Mean±sdp-valueAdjusted mean difference (95% CI)p-value
      Any of three anxiety disorders
       No (38)21.24±5.17Reference
       Yes (34)18.26±4.930.01−2.66 (−5.01– −0.30)§0.03
      Generalised anxiety disorder
       No (56)20.48±5.40Reference
       Yes (16)17.56±3.980.05−2.34 (−5.20–0.52)0.11
      Panic disorder
       No (48)20.77±5.47Reference
       Yes (24)17.96±4.260.03−2.06 (−4.70–0.58)0.12
      Social anxiety disorder
       No (54)20.24±5.02Reference
       Yes (18)18.61±5.840.26−1.39 (−4.21–1.43)0.33

      Data are presented as n, unless otherwise stated. ACT: Asthma Control Test. #: n=72; ¶: based on the childhood ACT and ACT (scores ranged from 8 to 34, low scores indicating poor asthma control and high scores indicating well controlled asthma); +: final models adjusted for child's age, sex and father's highest education level attained; §: adjusted linear regression model constant=36.05, R2=0.21, F(5,66)=3.46, p=0.008, n=72.

      • TABLE 3

        Risk factors associated with anxiety disorders among adolescents in Uganda#

        With anxietyWithout anxietyCrude OR (95% CI)Adjusted OR (95% CI)¶p-value
        Subjects53109
        Adolescent's residence at birth
         Rural (38)6 (11.3)32 (29.4)11
         Urban (124)47 (88.7)77 (70.6)3.25 (1.27–8.37)3.42 (1.29–9.09)0.01
        Adolescent's residence during most of 0–5 years
         Rural (35)6 (11.3)29 (26.6)11
         Urban (127)47 (88.7)80 (73.4)2.84 (1.10–7.34)2.87 (1.07–7.66)0.04
        Father's education status
         Secondary or less (119)34 (64.1)85 (78.0)11
         Tertiary (43)19 (35.9)24 (22.0)1.98 (0.96–4.07)2.09 (1.00–4.37)0.05
        Father's history of asthma+
         None (136)40 (83.3)96 (97.0)11
         Yes (11)8 (16.7)3 (3.0)6.40 (1.61–25.37)6.52 (1.59–26.76)0.005
        Adolescent's history of allergy-related diseases§
         None (39)5 (9.4)34 (31.2)11
         Yes (123)48 (90.6)75 (68.8)4.35 (1.59–11.90)4.64 (1.66–13.00)0.001
        Adolescent's positive SPT to any of seven allergensƒ
         None (101)32 (60.4)69 (63.9)11
         Yes (60)21 (39.6)39 (36.1)1.16 (0.59–2.28)1.31 (0.65–2.67)0.45

        Data are presented as n or n (%), unless otherwise stated. SPT: skin prick test. #: n=162 (missing data: father's history of asthma n=15 and adolescent's positive SPT n=1); ¶: adjusted for age, sex and father's education level; +: similar trend for mother's history of asthma, albeit small numbers; §: adolescent's history of any of rhinitis, allergic conjunctivitis and eczema; ƒ: allergens were crude extracts of Dermatophagoides mix, Blomia tropicalis, Blattella germanica, peanut, cat, pollen mix of weeds and mould mix of Aspergillus species.

        • TABLE 4

          Area of residence in early life and reported psychological triggers for asthma symptoms among adolescents with asthma in urban Uganda#

          Reported psychological triggerAdjusted OR (95% CI)¶p-value
          YesNo
          Subjects69206
          Adolescent's residence at birth
           Rural (48)10 (20.8)38 (79.2)1
           Town (186)43 (23.1)143 (76.9)1.07 (0.49–2.36)
           City (41)16 (39.0)25 (61.0)2.14 (0.82–5.61)0.17
           Test for trendptrend=0.11
          Adolescent's residence during most of 0–5 years
           Rural (42)6 (14.3)36 (85.7)1
           Town (200)51 (25.5)149 (74.5)2.28 (0.88–5.86)
           City (33)12 (36.4)21 (63.6)3.53 (1.12–11.18)0.08
           Test for trendptrend=0.03

          Data are presented as n or n (%), unless otherwise stated. #: n=275; ¶: adjusted for child's age, sex and father's highest education level.

          Supplementary Materials

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            Supplementary material 00749-2020.SUPPLEMENT

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          Anxiety disorders and asthma among adolescents in Uganda: role of early-life exposures
          Harriet Mpairwe, Richard Stephen Mpango, Wilber Sembajjwe, Emily L. Webb, Alison M. Elliott, Neil Pearce, Eugene Kinyanda
          ERJ Open Research Apr 2021, 7 (2) 00749-2020; DOI: 10.1183/23120541.00749-2020

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          Anxiety disorders and asthma among adolescents in Uganda: role of early-life exposures
          Harriet Mpairwe, Richard Stephen Mpango, Wilber Sembajjwe, Emily L. Webb, Alison M. Elliott, Neil Pearce, Eugene Kinyanda
          ERJ Open Research Apr 2021, 7 (2) 00749-2020; DOI: 10.1183/23120541.00749-2020
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