Volume 24, Issue 3 (August & September 2021)                   J Arak Uni Med Sci 2021, 24(3): 438-449 | Back to browse issues page


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Ghalenoei A A, Ansari H, Payandeh A, Arbabi Sarjou A, Soleimani G, Meshkinian A. Prevalence and Determinants of Eczema Among Elementary School Children, Southeast of Iran, 2019. J Arak Uni Med Sci 2021; 24 (3) :438-449
URL: http://jams.arakmu.ac.ir/article-1-6493-en.html
1- Department of Epidemiology and Biostatistics, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
2- Department of Epidemiology and Biostatistics, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. , ansarih88@gmail.com
3- Department of Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
4- Department of Pediatrics, Children and Adolescents Health Research Center, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
5- Department of Occupational Health Engineering, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
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1. Introduction
czema is a chronic inflammatory disease of the skin characterized by an itchy red rash known as “atopic eczema.” Health professionals have struggled with Eczema for a long time, but the exact cause and appropriate treatment have not yet been determined [1]. Eczema harms the quality of life of affected children and their families [2] and can disrupt the social life of these children, especially in the school environment [1]. Eczema is positively associated with urban and industrial environments, obesity, higher socioeconomic status, lower family size [1], environmental factors, and genetic factors play an essential role in disease progression [5]. This study aimed to evaluate the relationship between students’ Eczema and a range of environmental factors using the International Pediatric Asthma and Allergy Questionnaire (ISAAC) to prevent its complications to some extent by timely diagnosis and management of these factors.
2. Materials and Methods
This cross-sectional study was performed on an elementary school student in the 2019 academic year. Sampling was based on a multistage sampling of dual areas of education in proportion to the volume of each floor (8 floors). Since the prevalence of asthma and allergic symptoms, by 3.5% and considering the value of d=0.01 and alpha 0.05. and considering the effect of the design equal to 1.2, the final sample size was estimated to be about 1600 people [13]. The data collection tool was a questionnaire established by the International Asthma and Allergy Study in Children (ISAAC) in 1992 and proposed to different countries [12].
The questionnaires were revised to minimize incomplete data. Also, the intended variable that had lost data was imputation by regression method before analyzing the data. Data were described and presented using descriptive statistics, including tables, frequencies, percentages, and chi-square test. To investigate the simultaneous effect of independent variables on the incidence of Eczema using the multiple logistic regression method, variables whose significance level was less than 0.2 in univariate analysis by chi-square test method were entered into the model. Data in SPSS v. 19 were analyzed with a significance level of 05.0.
3. Results   
In terms of sex distribution, 830 boys (51.9%) and 770 girls (48.1%) were included in the study. The prevalence of skin problems based on the Isaac questionnaire is shown in Table 1 in two groups. 


The prevalence of itchy rash during life in boys and girls (95%CI =12.8-17.6) 15.2% and (95%CI=7.8-11.9) 9.7%, respectively, which is statistically significant and had a higher prevalence in males (P=0.001). Also, the prevalence of itchy rash in the last 12 months (second question) in boys and girls (95% CI=10.0-14.5) was 12.2% and (95%CI=6.5-10.5) 8.4%, respectively this difference was not statistically significant (P=0.2). The overall prevalence of Eczema diagnosed by a physician (95%CI=5.7-8.1%) was 6.9% (Table 1).
There was a strong association with other allergic diseases: 82.8% of students with current Eczema had current asthma, and 74.5% had current rhinitis (Table 1). In univariate analysis, there is a history of allergy in the family OR=2.5, father snoring OR=3.4, maternal pregnancy over the age of 35 OR=1.3, household dimension OR=0.5, keeping a pet at home OR=1.9, and smoking once a week at home OR=3.7 showed a significant relationship with students’ Eczema (P<0.05). In the final logistic regression model, the variables of family history of allergy were OR=2.35, smoking once a week at home OR=2.84, household dimension OR=0.85, keeping a pet at home OR=1.60, and history of father snoring OR=3.00 showed a significant relationship with the prevalence of Eczema in Zahedan city students (Table 2).   


4. Discussion and Conclusion
The prevalence of eczema symptoms during life and the last 12 months in Zahedan city students was 12.6% and 10.4%, respectively. The frequency of these symptoms in Ahwaz City students was 8.4 and 5.3% [12] and in the Turkish study was 7.5% and 6.5% [15]. Eczema diagnosed by a physician in our study was 6.9%. In a survey conducted by Fei Li et al. in the cities of China, the prevalence of Eczema was 4.6% [11], which is consistent with this study’s results. In contrast, in the Assaluyeh study, 13% [7] reported that these differences might be due to environmental factors, lifestyle, or racial differences [19].
A dose-response relationship effect was observed between smoking and Eczema. Smoking at least once a week increased the risk by 2.8-fold. Smoking has been shown to increase the risk of Eczema in studies by Jam in Bushehr city [10] and Edwin in the United States [19]. Our study showed that exposure to pets is associated with Eczema and increases the chances of getting it. However, it is known its effect varies depending on the type and amount of exposure [5]. The study of Mari Sasaki et al. showed keeping a pet during infancy increases the risk of Eczema. The protective effect of siblings has been well known since the 1990s and supports the so-called “health” hypothesis [5]. Our analysis confirmed these results, which suggest a link between a reduced chance of developing Eczema and an increased household size. Sasaki et al. [5] showed a negative relationship between the family dimension and Eczema, but a study in Bushehr city did not observe any significant association [21]. 
This study showed a relationship between demographic and environmental factors with Eczema and its symptoms in Zahedan city. Smoking and keeping a pet at home was one of the influential factors in the prevalence of Eczema in students, which by eliminating it, the prevalence of this disease can be reduced to some extent.

Ethical Considerations
Compliance with ethical guidelines

This study was registered with the ethics code IR.ZAUMS.REC.2018.481 in the research Ethics Committee of Zahedan University of Medical Sciences. Before the student entered this study, parents and students were informed about the goals of the project in an understandable language, and parents' consent was obtained freely and consciously. The principle of confidentiality and protection of student secrets and appropriate measures were taken to prevent its publication. In order to obtain informed consent to participate in the research, a consent form was provided to the parents or guardians of the student and their signatures were taken.

Funding
This study was sipported by Zahedan University of Medical Sciences. Also, this study was extracted from the MSc thesis of the first author at the Department of Epidemiology and Biostatistics, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan.

Authors' contributions
Research design, data collection, data refining, results in report and discussion: Ali Asghar Ghaleˈe Noeie and Hossein Ansari; Data analysis: Abolfazl Payende; Preparing the final report and writing the article: Azizaleh Arbabi Serjo; Interpretation of questionnaires and patient diagnosis: Gholamreza Soleimani; Preparing a questionnaire and collecting and reviewing the collected data: Ali Meshkinian.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We sincerely thank the Vice-Chancellor for Research of Zahedan University of Medical Sciences, who sponsored the project.


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Type of Study: Original Atricle | Subject: General
Received: 2020/11/25 | Accepted: 2021/08/8

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