Skin prick test reactivity to common allergens among women in Entebbe, Uganda

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Study Justification:
– The study aimed to estimate the prevalence of atopic sensitization and identify common aeroallergens associated with atopic sensitization among women in Entebbe, Uganda.
– Understanding the prevalence and risk factors for atopic sensitization is important for public health planning and interventions.
– The study also aimed to determine the association between atopic sensitization and a history of asthma or eczema.
Study Highlights:
– Skin prick test reactivity was assessed among 20 women with a history of asthma, 25 with a history of eczema, and 95 controls.
– The overall prevalence of skin prick test reactivity to any allergen was 30.7%.
– The most common allergens associated with atopic sensitization were Blomia tropicalis (10.9%), Dermatophagoides mix (16.8%), and cockroach (15.8%).
– The prevalence of positive skin prick tests was significantly higher among women with a history of asthma compared to those without (70% vs. 32%).
– Women with Mansonella perstans had significantly reduced odds for atopic sensitization.
Recommendations for Lay Reader and Policy Maker:
– Public health interventions should focus on reducing exposure to common allergens such as Blomia tropicalis, Dermatophagoides mix, and cockroach.
– Asthma management and prevention strategies should be implemented, as there is a strong association between a history of asthma and atopic sensitization.
– Further research is needed to explore the relationship between helminth infections (such as Mansonella perstans) and atopic sensitization.
Key Role Players:
– Researchers and scientists specializing in allergology and respiratory diseases.
– Public health officials and policymakers.
– Healthcare providers and clinicians.
– Community health workers and educators.
Cost Items for Planning Recommendations:
– Research funding for conducting further studies on atopic sensitization and allergen exposure.
– Resources for implementing public health interventions, such as educational campaigns and allergen control measures.
– Training and capacity building for healthcare providers and community health workers.
– Monitoring and evaluation of interventions to assess their effectiveness.
– Collaboration and coordination between different stakeholders involved in asthma management and prevention.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is a case-control study, which is a reliable method for investigating associations. The sample size is adequate, and the prevalence of skin prick test reactivity to common allergens is reported. However, the abstract lacks information on the representativeness of the study population and the generalizability of the findings. To improve the evidence, the abstract could include details on the recruitment process, demographics of the participants, and potential limitations of the study.

The objectives of this study were to estimate the prevalence of atopic sensitization, and to identify common aeroallergens associated with atopic sensitization among women in Entebbe, Uganda, and to determine risk factors for atopic sensitization among those with and without a history of asthma or eczema. A case-control study was conducted within a trial of deworming in pregnancy, approximately 2 years after the intervention. Skin prick test reactivity was assessed among 20 women with a history of asthma, 25 with history of eczema and 95 controls. Overall prevalence of reactivity was estimated by adjusting for the prevalence of asthma in the whole cohort. Overall skin prick test prevalence was: any allergen 30.7%, Blomia tropicalis 10.9%, Dermatophagoides mix 16.8%, cockroach 15.8%. The prevalence of a positive skin prick test was significantly associated with a history of asthma (70% to any allergen vs. 32%, P = 0.002) but not with a history of eczema (44% vs. 36%, P = 0.49). Women with Mansonella perstans had significantly reduced odds for atopic sensitization (adjusted odds ratio 0.14, 95% CI 0.03-0.69); women with a history of asthma were less likely to have hookworm (adjusted odds ratio 0.24, 95% CI 0.07-0.81) but this association was weaker for women with a history of eczema. [Clinical Trial No. ISRCTN32849447]. © 2008 Royal Society of Tropical Medicine and Hygiene.

The study participants were recruited from women in an ongoing trial, the Entebbe Mother and Baby Study (EMABS), in Entebbe and Katabi, a peri-urban area along the shores of Lake Victoria in Uganda. Details of the EMABS trial have been described (Elliott et al., 2007). In summary, pregnant women were recruited from the Entebbe hospital antenatal clinic, a free government facility, during their second or third trimester. Women who fulfilled the trial inclusion criteria and were interested in the study gave written informed consent and were requested to provide a stool sample. Blood samples were also drawn for routine tests (such as haemoglobin level and syphilis serology), for HIV serology, and for examination for malaria parasites and Mansonella perstans (the only common filarial worm in the study area). The women were then enrolled in a double-blind, placebo-controlled trial of treatment of maternal worms in pregnancy with albendazole versus placebo and praziquantel versus placebo in a 2 × 2 factorial design. As part of standard antenatal care at the clinic, all women received intermittent presumptive treatment for malaria with sulfadoxine–pyrimethamine, and HIV-positive women were enrolled in a programme for prevention of mother-to-child HIV transmission using nevirapine. Following delivery, women provided another stool and blood sample and, at 6 weeks post delivery, they all received albendazole and praziquantel. Children continued to attend the study clinic for routine follow up for immunizations in infancy and for quarterly study visits thereafter. An additional questionnaire regarding maternal and family history of allergic disease was administered to mothers attending with their children when the children were 1 year old. Women whose children had reached 1 year or more, and who had responded to the questionnaire on allergic disease, were eligible for recruitment to this study in an unmatched case–control study design. The sample included, as cases, all mothers reporting a history of asthma and or eczema and, as controls, a random sample selected from those who had no such history. The participants gave free and informed written consent. Skin prick testing of the women was conducted at least 1 year after delivery (and at least 10 months after treatment with both albendazole and praziquantel). Tests were performed using standardized extracts from organisms known to be present in the study environment (ALK Abello, Hoersholm, Denmark): Blomia tropicalis; Dermatophagoides mix (D. farinae, D. pteronyssinus); Cynodon dactylon (Bermuda grass); pollen mix (Artemisia, Chenopodium, Parietaria, Plantago); mould mix (Alternaria, Chaetomium, Cladosporium fulvum, Cladosporium herbarum, Fusarium); cat (Felix domesticus) and dog (Canis familiaris) epithelia; and American cockroach (Periplaneta americana). Histamine was used as a positive control and saline solution as the negative control. A mean wheal diameter of at least 3 mm greater than the negative control was taken as positive, with the reading taken after 15 min. Women were scheduled to visit the study clinic when their children were 1 year old. During the visit, the women were asked if they themselves had ever had asthma and or eczema. Asthma has an equivalent term in the local language but eczema does not, so it was described as a recurrent itchy rash associated with a dry or weeping skin affecting predominantly flexures (inside the elbows, behind the knees) and frictional areas such as neck, wrists and ankles, as well as below the buttocks, in the armpits, and around the eyes and ears. We estimated that a sample of 56 cases and 112 controls would have 80% power with 0.05 significance level to detect a difference of 30% versus 10% positive skin prick test among cases and controls respectively, a plausible difference in the light of results obtained elsewhere. This same sample size would also give 80% power to demonstrate skin prick test reactivity to common allergens of 10% (±3.5%) among the study women. Data were collected on pre-coded forms and questionnaires and manually checked before double data entry using Microsoft Access (Microsoft Corp., Redmond, WA, USA). Data were analysed using STATA version 8 (Stata Corp., College Station, TX, USA). Prevalence of skin prick test reactivity to each allergen was calculated separately for cases and controls. To obtain a crude estimate of the overall prevalence of skin prick test reactivity in the trial population, and for the study of the risk factors associated with atopy, six randomly selected women with asthma/eczema were added to the controls to create a reconstituted population with the same prevalence of reported frequency of asthma (6%) as that in the general trial population. Initial comparisons in the reconstituted population and between atopic and non-atopic cases and controls were made using simple tables and χ2 tests. Logistic regression was used to obtain crude and adjusted odds ratios for the associations between atopy and allergic diseases and helminth infection.

Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and resources on maternal health, including prenatal care, nutrition, and common complications. These apps can be easily accessible to women in remote areas with limited access to healthcare facilities.

2. Telemedicine: Implement telemedicine services that allow pregnant women to consult with healthcare professionals remotely. This can help address the issue of limited access to healthcare facilities, especially in rural areas.

3. Community Health Workers: Train and deploy community health workers who can provide basic prenatal care and education to pregnant women in their communities. These workers can also identify high-risk pregnancies and refer women to appropriate healthcare facilities.

4. Transportation Solutions: Develop innovative transportation solutions, such as mobile clinics or ambulances, to ensure that pregnant women can easily access healthcare facilities for prenatal care, delivery, and postnatal care.

5. Health Education Programs: Implement comprehensive health education programs that focus on maternal health, including family planning, prenatal care, nutrition, and breastfeeding. These programs can be conducted in schools, community centers, and through mass media channels.

6. Maternal Health Vouchers: Introduce voucher programs that provide pregnant women with financial assistance to access maternal healthcare services. These vouchers can cover the cost of prenatal care, delivery, and postnatal care, ensuring that women can afford the necessary healthcare services.

7. Public-Private Partnerships: Foster collaborations between public and private healthcare providers to improve access to maternal health services. This can involve leveraging private sector resources and expertise to expand healthcare infrastructure and services in underserved areas.

8. Maternal Health Monitoring Systems: Develop systems that enable the monitoring of maternal health indicators, such as blood pressure, weight, and fetal movements, remotely. This can help identify high-risk pregnancies and provide timely interventions.

9. Maternal Health Awareness Campaigns: Launch awareness campaigns to educate communities about the importance of maternal health and encourage women to seek prenatal care. These campaigns can address cultural barriers, myths, and misconceptions surrounding pregnancy and childbirth.

10. Maternal Health Financing Models: Explore innovative financing models, such as microinsurance or community-based health financing, to make maternal healthcare services more affordable and accessible to women in low-income settings.

It’s important to note that the specific context and needs of the community should be considered when implementing these innovations to ensure their effectiveness and sustainability.
AI Innovations Description
Based on the information provided, the study conducted in Entebbe, Uganda aimed to estimate the prevalence of atopic sensitization and identify common allergens associated with atopic sensitization among women. The study also aimed to determine risk factors for atopic sensitization among women with and without a history of asthma or eczema.

The study participants were recruited from the Entebbe Mother and Baby Study (EMABS), which is an ongoing trial in Entebbe and Katabi, Uganda. Pregnant women were recruited from the Entebbe hospital antenatal clinic and enrolled in a double-blind, placebo-controlled trial of treatment for maternal worms in pregnancy. Blood and stool samples were collected from the women during pregnancy and after delivery.

Skin prick testing was conducted on the women at least 1 year after delivery using standardized extracts from common allergens present in the study environment. The prevalence of skin prick test reactivity to each allergen was calculated separately for women with a history of asthma or eczema (cases) and those without (controls). Logistic regression was used to analyze the data and obtain odds ratios for the associations between atopy, allergic diseases, and helminth infection.

Based on the findings of the study, the prevalence of skin prick test reactivity to any allergen was 30.7%. The most common allergens associated with atopic sensitization were Blomia tropicalis (10.9%), Dermatophagoides mix (16.8%), and cockroach (15.8%). The prevalence of a positive skin prick test was significantly higher among women with a history of asthma compared to those without (70% vs. 32%). However, there was no significant association between a positive skin prick test and a history of eczema.

The study also found that women with Mansonella perstans had significantly reduced odds for atopic sensitization, and women with a history of asthma were less likely to have hookworm. These associations were weaker for women with a history of eczema.

Based on these findings, a recommendation to improve access to maternal health could be to incorporate routine screening for atopic sensitization during antenatal care visits. This could help identify women at risk and provide appropriate interventions and management strategies to improve maternal and fetal health outcomes. Additionally, further research could be conducted to explore the potential impact of helminth infections on atopic sensitization and allergic diseases among pregnant women in resource-limited settings.
AI Innovations Methodology
Based on the provided information, it seems that the study you mentioned is focused on identifying the prevalence of atopic sensitization and common aeroallergens associated with atopic sensitization among women in Entebbe, Uganda. The study also aims to determine the risk factors for atopic sensitization among those with and without a history of asthma or eczema.

To improve access to maternal health in this context, here are a few potential recommendations:

1. Increase awareness and education: Implement programs to raise awareness among women in Entebbe, Uganda about the importance of maternal health and the potential risks associated with atopic sensitization. This can be done through community outreach programs, workshops, and educational campaigns.

2. Strengthen healthcare infrastructure: Improve the availability and accessibility of healthcare facilities in Entebbe, Uganda, particularly those that specialize in maternal health. This can involve building new healthcare centers, equipping existing facilities with necessary resources, and training healthcare professionals to provide quality maternal healthcare services.

3. Enhance antenatal care services: Focus on improving antenatal care services by ensuring regular check-ups, providing necessary vaccinations and treatments, and offering counseling and support for pregnant women. This can help identify and address any potential health issues, including atopic sensitization, early on.

4. Promote research and innovation: Encourage further research and innovation in the field of maternal health, specifically related to atopic sensitization. This can involve supporting studies, trials, and collaborations that aim to develop new diagnostic tools, treatments, and preventive measures for atopic sensitization during pregnancy.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations on improving access to maternal health. These indicators could include the number of women receiving antenatal care, the percentage of women with access to healthcare facilities, and the prevalence of atopic sensitization among pregnant women.

2. Collect baseline data: Gather baseline data on the current state of maternal health access in Entebbe, Uganda. This can involve conducting surveys, interviews, and data analysis to understand the existing challenges and gaps in access to maternal healthcare.

3. Implement the recommendations: Implement the recommended interventions and initiatives to improve access to maternal health. This can involve collaborating with local healthcare providers, community leaders, and relevant stakeholders to ensure effective implementation.

4. Monitor and evaluate: Continuously monitor and evaluate the impact of the implemented recommendations on improving access to maternal health. This can be done through regular data collection, analysis, and reporting. Comparing the baseline data with the updated data will help assess the effectiveness of the interventions.

5. Adjust and refine: Based on the evaluation results, make necessary adjustments and refinements to the implemented recommendations. This can involve modifying strategies, reallocating resources, or introducing new interventions to further enhance access to maternal health.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health in Entebbe, Uganda. The data collected and analyzed throughout the process will provide valuable insights for future decision-making and resource allocation in the field of maternal health.

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