Effects of socio-demographic and nutritional status on Peak Expiratory Flow Rates of rural school children in Ilesa, Nigeria
Background: The Peak Expiratory Flow Rate (PEFR) measured using portable peak flow metres (PFM) is a simple, cheap, readily available and reproducible measure of lung functions, particularly in resource-poor settings.
Objective: To determine the effects of socio-demographic and nutritional factors on the PEFR of school children in rural areas of Ilesa, Nigeria.
Methods: Multi-stage sampling technique was used to select children from middle schools in rural Ilesa. Their socio-demographics, housing conditions and household cooking fuel used were obtained. Anthropometric parameters and nutritional statuses of the children were determined using the WHO reference growth chart. PEFR was measured using the mini Wright PFM. The factors influencing their PEFR were determined.
Results: A total of 250 school children aged 8 to 16 years with male-to-female ratio of 0.9:1 were studied. The mean (SD) age was 12.5 (1.5) years. Over 80.0% used unclean fuel for household cooking and one-half lived in overcrowded homes. The prevalence of stunting, underweight and overweight was 22.8%, 30.8% and 3.2% respectively. The mean ± SD PEFR was 248 ± 58.6 L/min which correlated positively with the weight, height, Body Mass Index and Body Surface Area. The mean PEFR was significantly lower among children exposed to unclean fuels (245.4 ± 59.7L/min vs. 292.0 ± 59.4L/min; p = 0.02), stunted males (220.6 ± 44.9L/min vs. 264.1 ± 62.9L/min; p = 0.009) and underweight females (213.2 ± 37.8L/min vs. 247.5 ± 62.6L/min; p < 0.001).
Conclusion: Undernutrition and exposure to noxious substances from unclean household cooking fuels adversely affected the PEFR of rural school children. Early detection and prompt treatment of undernutrition and avoidance of noxious substances from unclean fuels may ensure better lung health among the children in rural areas.
2. Cross D, aNelson HS. The role of the peak flow meter in the diagnosis and management of asthma. J Allergy Clin Immunol 1991; 87(1): 120-28.
3. Marchal F, Schweitzer C. Plethysmography and Gas dilution techniques. In: Hammer J, Eber E (eds): Paediatric Pulmonary Function Testing. Prog Respir Res, Karger, 2005; 33: 103 –17.
4. Adeniyi BO, Erhabor GE. The peak flow meter and its use in clinical practice. Afr J Respir Med 2011; 6: 5-8.
5. Pedersen OF. The Peak Flow Working Group: physiological determinants of peak expiratory flow. Eur Respir J Suppl 1997; 24: 11S-16S.
6. Mishra J, Mishra S, Satpathy S, Manjareeka M, Nayak PK, Mohanty P. Variations in PEFR among Males and Females With Respect To Anthropometric Parameters. IOSR-JDMS 2013; 5: 47-50.
7. Borse LJ, Modaki HK, Bansode DG, Yadav RD. Effect of Body Weight on Peak Expiratory Flow Rate in the First Year Medical College Male Students. Int J Health Sci Res 2014; 4(6): 62-70.
8. Schaible UE, Kaufmann SHE. Malnutrition and Infection: complex mechanisms and global impacts. PLoS Med 2007; 4 (5): 806–12.
9. Nigeria Demographic and Health Survey 2013. Preliminary Report Abuja and Calverton: NPC, MEASURES DHS and ICF Macro, 2013.
10. Lechner AJ. Perinatal age determines the severity of retarded lung development induced by starvation. Am Rev Resp Dis 1985; 131: 638–43.
11. Gaultier C. Malnutrition and lung growth. Pediatr Pulmonol 1991; 10: 278–86.
12. Faridi MM, Gupta P and Prakash A. Lung function in malnourished children aged 5-11 years. Indian Paediatr 1995; 32: 35-42.
13. Kaur R, Chauhan S, Bhardwaj S. Comparative spirometric studies in normal and malnourished children. Natl J Physiol Pharm Pharmacol 2012; 2: 134-39.
14. Ziora K, Ziora D, Oswiecimska J, Roczniak W, Machura E, Dworniczak S et al. Spirometric parameters in malnourished girls with anorexia nervosa. J Physiol Pharmacol 2008; 59(6): 801–07
15. Ilesa West Local Government Area. Available from: http://email@example.com. [Last accessed on 2017 Jan 05].
16. Schools in Ilesa West Local Government Area. Available from: http://www.vconnect.com/osun-ilesa_west/list-of-secondary-schools_c168 Updated 5th January 2016. [Last accessed 2nd April, 2017]
17. Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. Available at: http://www.OpenEpi.com Updated 6th April 2013. [Last accessed 2nd March, 2017]
18. Suganya S, Philominal V. Influence of body mass index on peak expiratory flow rate. Int J App Res 2016; 2(8): 518-21.
19. Park K. Environment and Health. In: Park JE, Park K, editor. Park's Textbook of Preventive and Social Medicine. Jabalpur, Banarasidas Bhanot and Company; 2006: p 521-36.
20. Oyedeji GA. Socioeconomic and cultural background of hospitalized children in Ilesa. Niger J Paediatr 1985; 13: 111-18.
21. Mostellar RD. Simplified calculation of Body surface area. N Eng J Med1987; 22: 317.
22. World Health Organisation. WHO Growth reference chart for 5-19 years. Available at: http//:www.who.int/growthref/en. [Last accessed 5th March, 2017]
23. Mini Wright Peak Flow meter: Manufacturer’s instruction. Clement Clarke International Ltd, Airmed House, Edinburgh Way, Harlow, Essex CM20 2TT UK). Available at: https://www.haag-streit.com/clement-clarke. [Last accessed 28th April, 2017]
24. Gordon SB, Bruce NG, Grigg J, Hibberd PL, Kurmi OP, Lam K-BH, et al. Respiratory risks from household air pollution in low and middle income countries. Lancet Respir Med 2014; 2: 823–60.
25. Bruce N, Perez-Padilla R, Albalak R. Indoor Air Pollution in Developing Countries: A Major Environmental and Public Health Challenge. Bull World Health Organ 2000; 78: 1078–92.
26. Fajola A, Fakunle B, Aguwa EN, Ogbonna C, Ozioma-Amechi A. Effect of an improved cookstove on indoor particulate matter, lung function and fuel efficiency of firewood users. Am J Res Com 2014; 2(8): 189-207.
27. Primhak RA, Coates FS. Malnutrition and peak expiratory flow rate. Eur Respir J 1988; 1: 801-03.
28. Nair SP, Agarwal B, Shah M, Sawant S, Sinha N, Ratguru V, et al. Level of Physical strength capacity, respiratory muscle strength and Peak Expiratory flow rates in healthy adolescents. MGM J Med Sci 2016; 3(2): 66-71.
29. Riley DJ, Thakkervaria S. Effect of diet on lung structure, connective tissue metabolism and gene expression. J Nutr 1995; 125: S1657–60.
30. Edemeka DBU, Udoma MG, Ibrahim M. Peak expiratory flow rate in rural Nigerian children. Sahel Med J 2000; 3: 37–39.
31. Becklake MR. Gender difference in airway behaviour (physiology) on the human lifespan. Eur Respir Mon 2003; 25: 8-35.