Prevalence of asthma-like symptoms among schoolchildren in a rural district of Andhra Pradesh, India Open Access

Dutton, Nina (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/cr56n131q?locale=en
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Abstract

Background: The addition of new coal-fired power plants, such as those proposed in Nellore District (Andhra Pradesh), would result in an increase in emissions that would present health risks to exposed populations, particularly to children.

Purpose: The main aim was to estimate baseline prevalence of reported asthma-like symptoms among schoolchildren in the area expected to receive the most air pollution from the proposed power plants. Further aims involved investigation of the prevalences of reported symptoms and several personal, family, and environmental characteristics among schoolchildren in a location north of the area immediately around the plants, to determine whether the northern location could serve as a control site for possible future studies of the power plants' respiratory health impacts on children nearby. The final aim was to examine associations between reported symptoms and potential risk factors.

Methods: In a cross-sectional survey, a questionnaire concerning asthma-like symptoms, demographics, and potential exposures to air pollution was administered to public school students of the ages 10 to 14 in two areas of Nellore District - one set of schools less than 20 km from the clusters of proposed power plants and two schools at least 40 km north.

Results: In the south, 23% of subjects reported ever wheezing, compared to 13% in the north (p=0.001). Recent wheeze was reported by 18% of subjects in the south and 11% in the north (p=0.011). After adjustment for clustering by school, odds of ever wheeze differed significantly by location, but odds of recent wheeze did not. Univariate analyses showed associations between reported symptoms and male gender, family history of asthma, keeping chickens, and house roof type; negative associations were found for age and parental farming. Having a father working as a farmer appeared to be the only characteristic independently, negatively associated with reported recent wheeze.

Conclusions: Based on assessments of differences by location in prevalences of reported symptoms and certain characteristics of subjects, the northern location could be tentatively recommended as a negative control site for comparison with the southern location in future studies of children's respiratory health impacts of the power plants, should they become operational.

Table of Contents

Introduction ................................................................................................................1

Background .................................................................................................................4

Methods ....................................................................................................................16

Study location ............................................................................................................16

Site selection .............................................................................................................16

Study population .........................................................................................................18

Study design ..............................................................................................................18

Sampling ....................................................................................................................21

Data collection ............................................................................................................22

Data management ........................................................................................................23

Data analysis ..............................................................................................................27

Results ......................................................................................................................30

Discussion ..................................................................................................................36

Study strengths ..........................................................................................................44

Study limitations ..........................................................................................................46

Conclusions ................................................................................................................50

References .................................................................................................................52

Tables .......................................................................................................................63

Main:

Table 1: Demographics and family characteristics by location ................................................63

Table 2: Prevalence of symptoms by location .....................................................................64

Table 3: Relationships of environmental characteristics to location .........................................65

Table 4: Relationships of location, family characteristics, and environmental characteristics to ....66

ever wheeze and wheeze in the past 12 months

Table 5: Multivariable analysis showing relationships between symptoms, location, and potential ..68

confounding variables, after adjustment for effect by school

Supplemental:

Table 6: Sensitivity test results - relationships between location and symptoms .......................69

Table 7: Demographics and family characteristics by school ..................................................71

Table 8: Prevalence of symptoms by school .......................................................................73

Table 9: Environmental characteristics by school ................................................................74

Table 10: Missing values .................................................................................................76

Appendices ..................................................................................................................79

Appendix 1: Maps

Map A: Location of Nellore District in Andhra Pradesh, India ...................................................79

Map B: Approximate locations of school study sites in Nellore District .......................................80

Appendix 2: Isopleth maps for projected increases in ground-level concentrations of ...................81

PM10, NOX, and SOX

Appendix 3: Methodology for computing incremental ground level concentrations for villages .........85

in Nellore District

Appendix 4: Questionnaire in English and Telugu ....................................................................86

Appendix 5: Photographs of study site and rural road .............................................................91

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