الفهرس 
Review of literatureOnly 14 pages are availabe for public view
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Abstract
Bronchial Asthma (BA) is a global public health problem, in developed and developing countries which was underdiagnosed and undertreated and most asthma related death commonly occurs in low income and lower –middle income countries. Asthma is reported to be one of the most common chronic disease in childhood impairing the quality of life and affecting the quality of life of their families and incurring high cost to the health care system and society. In Egypt the prevalence of BA among school children ranged from 6.2% in Assuit city in upper Egypt up to 46% in Cairo . Risk Factors related to the development and expression of asthma included: host and environment factors. The host risk factors included atopy status and family history of asthma. In the susceptible host and a critical time of development, two major environment factors have emerged as the most important in the development, persistence and severity of asthma which are air borne allergens and viral respiratory infections.
Meta-analysis is an epidemiological technique for amalgamating, summarizing and reviewing previous quantitative and qualitative research, by using meta-analysis, a wide variety of questions can be investigated as long as a reasonable body of primary research studies exists. selected parts of the reported results of primary studies are entered into a database and this “meta-data” is meta-analyzed in similar ways to work with other data.
The aim of this study was conducting meta-analysis study on the prevalence and asthma determinants, risk factors of bronchial asthma in children in Egypt. This is the first study of its nature, as there is no previously published study in this topic.
In this study meta-analysis of published literature about childhood asthma prevalence and risk factors in Egypt was performed.
Three medical bibliographic databases (Medline, Scopus, and Cochrane Library) were searched from 2000 to 2018 according to study protocol. Search keywords were: “Egypt”, “Asthma”, “Child”, “Risk factors”, “Determinants”, “Prevalence”. Search Boolean was adjusted according to searched medical database. Manual search was performed in the references of retrieved papers. Among the studies retrieved in the search, duplicate studies were removed. The selection of studies that meet the inclusion/exclusion criteria based on the abstracts was done, and then making the final selection of studies based on their full text. The selection of studies that meet the inclusion criteria (Participants were asthmatic children in Egypt, In English language, reporting prevalence and/or determinants/risk factors related to asthma, and full text can be accessed was done.
This study used the random effect model meta-analysis to get the pooled estimate prevalence with 95% Confidence Interval (CI), and odd ration (OR) with 95% CI. This study conducted a relative risk (RR) meta-analysis to get the probability of happening of an event as a pooled RR with 95% CI. Heterogeneity between studies was assessed using the I2 test and Cochrane Q test. A significance threshold of p < 0.05 was applied to the heterogeneity (I2). Furthermore, Egger’s tests were used to test publication bias when there were at least 10 studies in a pooled analysis. The program (MedCalc statistical software, version 20) was used for all statistical analyses reported in this meta-analysis.
The limitations of this study included the low number of published studies which indexed in selected medical databases such as Scopus and Medline. The sample size in some identified asthma determinants or risk factors was low which affected the generalization of results. Significant heterogenicity between some studies was found.
The literature search was performed using Medline, Scopus, and Cochrane library databases and 203 articles records were obtained. After removal of duplicates, screening of titles/abstracts, and applying inclusion/exclusion criteria 35 articles were selected for full-text review. Finally, 23 articles were included in this meta-analysis. Of the included 23 studies, 10 were case control studies, and 9 were cross sectional studies, 2 were observational, 1 was longitudinal, and 1 was retrospective study. The most common location of included studies was Cairo = 12 studies. Other Egyptian regions and location were also reported by included studies such as: Sohag, Beni Suef, Assiut, Menofia, Al Qalyobia, Dakahlia, Nile Delta region, Fayoum, and Dimietta.
This meta-analysis included 23 studies, with 29854 participants from Egypt. The mean of age of included asthmatic children was (7.19±3.55).
This is the first meta-analysis to identify the pooled estimate of prevalence of asthma in Egypt from 2000 to 2018 and it is the first to conduct a meta-analysis to identify and get the pooled estimate effect of the asthma risk factors, risk factors for asthma exacerbations, and treatment.
This study identified and analyzed 12 risk factors for asthma, 3 of common asthma symptoms, 8 of risks of asthma execrations, seasonal effect on asthma, and the pooled estimate prevalence of using regular treatment for asthma.
Childhood Asthma prevalence in Egypt was estimated to be: (7.69% with 95% CI = 4.3% to 11.9%), with considerable heterogenicity (I2 inconsistency=99.15, 95% CI= 98.92 to 99.33, P=0.0001).
The pooled odd ratio of urban residency as a risk factor of childhood asthma in Egypt was 1.033 with (95% CI= 0.790 to 1.349) which was higher than rural residency (Odd ratio = 0.968 , 95% CI = 0.741 to 1.265). while male gender as a risk factor of childhood asthma in Egypt was (Odd ratio= 1.223 with 95% CI= 1.077 to 1.388) which was obviously higher than female gender (Odd ratio = 0.816, 95% CI = 0.717 to 0.927). Positive family history of asthma as a risk factor of childhood asthma in Egypt is very high which was (Odd ratio= 12.4 with 95% CI= 5.789 to 26.565) and the relative risk was (RR = 5.019, with 95% CI=2.825 to 8.918). Passive smoking as a risk factor of childhood asthma was (Odd ratio= 2.136 with 95% CI= 1.602 to 2.850) = 55.25 to 86.28). Additionally, illiterate father as a risk factor of childhood asthma in Egypt was (Odd ratio= 1.170 with 95% CI= 0.863 to 1.587) which was higher than illiterate mother (Odd ratio = 0.973, 95% CI = 0.685 to 1.382). Low social status as an asthma determinant and risk factor of childhood asthma in Egypt was (Odd ratio= 1.303 with 95% CI= 0.575 to 2.953) which was obviously higher than other social status (Middle and higher social status) (Odd ratio = 0.616, 95% CI = 0.204 to 1.858). Breast feeding as a risk factor of childhood asthma in Egypt was (Odd ratio= 0.931 with 95% CI= 0.409 to 2.115). Furthermore, presence of other allergies as a risk factor of childhood asthma in Egypt was (Odd ratio= 4.503 with 95% CI= 1.806 to 11.226) and the relative risk was (RR = 2.690, with 95% CI=1.418 to 5.104). This study estimated the total pooled prevalence of having cough as a symptom of asthma among asthmatics children in Egypt was (63.9% with 95% CI= 44.1% to 81.5%), dyspnea (40.4%with 95% CI= 35.7% to 45.2%), and wheezing (80.1% with 95% CI= 34% to 99.9%).
The total pooled prevalence of dust exposure as a risk factor for exacerbation of childhood asthma was (70.4% with 95% CI= 60.3% to 79.6%), exposure to certain foods (48.2% with 95% CI= 34.557 to 61.987), odors (32.1% with 95% CI= 24.216 to 40.544), physical activity (57.1% with 95% CI= 41.692 to 71.910), smoke (64.2% with 95% CI= 48.853 to 78.186), cockroach (51.5% with 95% CI= 16.877 to 85.305), common cold/infections (58.4%with 95% CI= 45.626 to 70.533), contact with animals (30.8% with 95% CI= 22.314 to 39.908). The total pooled prevalence of winter as a risk factor on asthma exacerbations and control in Egypt was (64.1% with 95% CI= 51.6% to 75.7%) which was obviously higher than the prevalence of summer (13.4%, 95% CI = 3.8% to 27.6%).
The total pooled prevalence of asthmatic children on regular treatment of asthma in Egypt was only (19% with 95% CI= 11.7% to 27.6%).
This study identified low prevalence of asthmatic children on regular treatment There is a need for large scale research to evaluate this result and to identify reasons.
This meta-analysis study reported the prevalence of childhood asthma in Egypt was (7.69%). This study identified many asthma determinants and risk factors which correlate with asthma morbidity such as: urban community, male gender, family history of asthma, passive smoking, illiterate father, low socioeconomic status, and presence of other allergies. Breast feeding is a protecting risk factor for asthma. The most frequent presenting symptoms of asthma among asthmatic children were: cough followed by wheezing and dyspnea. Dust, smoke, and common cold were the most three contributors for asthma exacerbations among asthmatic children in Egypt.
This study recommended identifying avoidable asthma exacerbations risk factors such as contact with animals, and certain food allergy which can protect asthmatic children from worsening asthma condition and conducting and publishing research related to childhood asthma in Egypt in high impact medical journal which were indexed in large medical databases such as Scopus and Medline is very important.