Household and Environmental Determinants That Influence the Prevalence Atopic Dermatitis Among Young Rural Children, in Mpumalanga Province, South Africa

Household and Environmental Determinants That Influence the Prevalence Atopic Dermatitis Among Young Rural Children, in Mpumalanga Province, South Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Household and Environmental Determinants That Influence the Prevalence Atopic Dermatitis Among Young Rural Children, in Mpumalanga Province, South Africa Thokozani P Mbonane This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4633129/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim : This study aimed to evaluate and determine the prevalence of atopic dermatitis, as well as the factors that contribute to its development, particularly household and environmental determinants, in young children residing in a rural area in South Africa. Subject and Methods : A cross-sectional analytical study was conducted, wherein caregivers and children were purposefully recruited as participants. Data collection involved the utilization of an adapted version of the International Study of Asthma and Allergies in Childhood questionnaire, which was then analyzed using Stata MP version 18. The study included a total of 881 caregivers, with a majority of the child participants being boys (n=477, 54.14%). Results : The prevalence rates of historical and current atopic dermatitis were found to be 13.96% and 18.62%, respectively. Natural birth was found to be a protective factor in the study for both historical (Adjusted Odds Ratio [AOR]: 0.094, 95% Confidence Interval [CI]: 0.039-0.224) and current atopic dermatitis (AOR: 0.098, 95% CI: 0.042-0.231). The use of a traditional grass broom for sweeping the floor, exposure to household environmental tobacco smoking, and undergoing renovations were associated with both historical and current atopic dermatitis. Moreover, having an indoor domestic cat (AOR: 2.166, 95% CI: 0.931-5.036) was found to be associated with current atopic dermatitis. Conclusion : These findings demonstrate that the prevalence of atopic dermatitis in rural areas is similar to that in urban areas among children. Consequently, there is a need to provide primary health care services, particularly for skin diseases, which are currently limited in rural areas. Additionally, environmental health services could play a crucial role in the management and control of atopic dermatitis and similar conditions in rural areas. Atopic dermatitis household and environmental determinants children rural areas prevalence Figures Figure 1 Introduction Atopic dermatitis is a common chronic disease that is influenced by environmental factors. It affects a significant number of young children worldwide [ 1 , 2 ]. Studies estimate that 15–20% of children globally experience atopic dermatitis each year [ 3 ]. In sub-Saharan children, the prevalence of atopic dermatitis ranges from 4.7–23% [ 4 ]. Scientific evidence suggests that children in urban areas have a higher risk of developing atopic dermatitis compared to those in rural areas [ 5 ]. However, studies conducted in sub-Saharan regions have shown no difference in the prevalence of atopic dermatitis between urban and rural children, despite the perception that urban children are more affected [ 6 ]. It is important to note that children in rural areas may have limited access to healthcare services, including those for skin conditions, due to the shortage or absence of primary healthcare facilities [ 7 , 8 ]. While genetic predisposition plays a role in atopic dermatitis, household and environmental factors also contribute significantly to the development of this condition (9–11). Current evidence shows that atopic dermatitis can be triggered by numerous individual, genetic and household (home environment) risk factors [ 12 ]. Family history of atopic dermatitis, personal hygiene products gender (male children were at high risk) child diet, food allergies, and history of eczema, allergies, hay fever or asthma have been linked to atopic dermatitis in different environments [ 13 , 14 ]. Furthermore, atopic has been associated with birth season, birth method, breastfeeding duration, number of siblings, and ordinal position [ 15 – 18 ]. A few studies have shown that home/ residential risk factors such as indoor pet ownership, and household income play a role in triggering atopic dermatitis. Numerous environmental factors contribute to and are linked to the development of atopic dermatitis among children [ 10 ]. These factors included climatological risk factors, air pollution and related activities, house dampness, mold in the walls, and residing near bushes or green areas [ 19 ]. A recent analytical cross-sectional study in an urban area conducted among schoolchildren 7 years or younger linked current atopic dermatitis to household environmental tobacco smoke (ETS) exposure (OR = 1.61; 95% CI: 1.07–2.43), cooking and heating fuel use (OR = 1.94; 95% CI: 1.00–3.74), use of building materials (renovation), indoor dust, and frequent of trucks passing [ 20 ]. In recent years, several studies have indicated that atopic dermatitis is more common among urban children compared to those living in rural areas [ 6 , 21 , 22 ]A community-based study conducted in China discovered that the prevalence of atopic dermatitis was higher in urban areas (10.2%) as opposed to rural areas (4.6%) [ 22 ]. However, many of the residential and environmental risk factors associated with atopic dermatitis are linked to poor socioeconomic conditions, which are often prevalent in rural communities. Therefore, the researcher hypothesized that children living in rural areas, where agricultural and mining activities are common, may be more vulnerable to developing atopic dermatitis than children in urban areas, due to household and environmental risk factors. The objectives of the study were: i) to describe the prevalence of atopic dermatitis; ii) to identify household and environmental risk factors; and iii) to assess the determinants that influence the prevalence of atopic dermatitis among young rural children from Louiville, Mpumalanga Province, South Africa. Materials and Methods Study Design and Area A cross-sectional analytical study was conducted between August 2021 and September 2023. The study was conducted in a rural residential of Barberton town in Mpumalanga Province, South Africa. The residential area is situated near the Lily gold mine and is surrounded by agricultural activities. This residential area has a main gravel road to access agrarian farms and the closed Lily gold mine. Population and Sampling The study sample consisted of caregivers/mothers and their children residing in a rural residential area. The children were between the ages of 5 and 13, and it was required that the mother had resided in the area with her parents when the child was 12 months old or younger. Children who were born in different towns were excluded from the study, and questionnaires with missing information were not considered. Participants were recruited using convenience sampling, and households with children were identified beforehand with the support of the local Ward-Based Outreach Teams. Data Collection The data was collected using an adapted ISAAC questionnaire. The questionnaire has been used in South African studies and populations. Trained research assistants (environmental health 4th year students) administered the questionnaire. During data collection, the research assistants were paired (one research assistant must have been conversant with either isiSwati or siTsonga). The questionnaire was translated into isiSwati and xiTsonga, the two most common languages in Louiville before data collection and the responses were translated back to English by two professional linguistics. The questionnaire was divided into socio-demographics (participants' characteristics), study health outcome (atopic dermatitis), and household and dietary and environmental determinants. The socio-demographic included the mother/caregiver’s educational levels (no schooling/primary school/high school), income sources (government social grants/self-employed/salary) income (equal or less than R2500/R2501-R7500/Above R7500), child gender (male/female), age (7 years old or younger/8-10 years old/11-13 years old), childbirth method (caesarian/natural birth), the ordinal position of the child (firstborn/middle/lastborn) pre-school (remote/local), food allergy (no/yes) and history of AD in the family (no/yes) Study Health Outcomes The study health outcomes were prevalence of current and history of atopic dermatitis. History of Atopic Dermatitis was determined by the positive (yes) to the following question by the mother/caregiver: 1) Has your child previously had atopic dermatitis? The current atopic dermatitis was estimated through the parents/guardian’s response with a “yes” to all three questions: Has your child experienced a persistent dry and itchy rash in the past 6 months, Has your child experienced a rash with inflamed skin in the past 6 months, Has your child experienced a persistent dry and itchy rash and inflamed skin in the past 6 months, Household and Dietary Determinants Household and Dietary Determinants included having an indoor domestic cat (yes/no), having an outdoor dog (yes/no), using chemicals for cleaning (occasional/every day), using a grass broom for sweeping the floor (yes/no), having an old mat or rag at home (yes/no), consumable housed milked dairy products, household hatched eggs and homegrown vegetables and fruits (yes/no), how often do you eat eggs/homegrown vegetables and fruits, peanuts (seldom/sometimes/regularly) and renovation during the mother’s pregnant period or child was younger than 12 months (yes/no). Environmental Determinants The study's environmental determinants were exposure to environmental tobacco smoking at home (yes/no), location of the household street (back street-(away from the busy main road)/main street), house surrounding (bushes/no bushes), cooking and heating fuel (electricity/paraffin/coal), dampness in the inside of the house (yes/no), stagnant water within walking distance of the home (yes/no), any house renovations during mother’s pregnancy or 12 months after child was born (yes/no). Data Analysis The data was analyzed using Stata MP software (version 18). Tables and figures were used to present the findings regarding frequency and percentages. Fischer's exact test was employed to determine statistically significant differences between variables. The association between the prevalence of atopic dermatitis and socio-demographic variables and household and environmental factors was examined. Initially, a bivariate regression analysis was conducted, and the variables that demonstrated a statistically significant association with the prevalence of atopic dermatitis were included in the final model. The final model consisted of a multivariate regression analysis, utilizing statistical variables where a p-value of 0.05 or lower was considered statistically significant. Ethical Approval The study obtained ethical clearance from the University of Johannesburg, Faculty of Health Sciences Research Ethics Committee (REC-01-11-2019). Informed consent was obtained from the study participants before data collection. Results Characteristics of the study participants All the participants were females and were referred to as mothers/caregivers of the children. Most of the mothers/caregivers had high school educational levels (n=360, 41.32%), were dependent on government social grants for survival as the source of income (n=314, 35.64%) and had R2500 or less to live on per month (n=443, 50.28%). There were more boys children (n=477, 54.14%) than girls (n=404, 45.86%) in this study. The majority of the study participants were between the age of 6-8 years old (n=332; 37.68%) and natural born (n=709; 80.48%). Furthermore, most were either a middle child (n=318; 36.10%) or lastborn (n=300; 34.05%) in their family structure (position). There were 275 (31.21%) study participants who lived with a mother/guardian dependent on a government social grant for the source of income. Lastly, 452 (51.31%) lived with a mother who is a smoker. Table 1 below shows a details description of the characteristics of the study participants. Table 1. Study participants characteristics Characteristics Frequency (n) Percent (%) Mother/Caregiver’s educational levels No schooling 144 16.35% Primary School 201 22.81% High School 360 41.32% College/University 176 19.52% Mother/Caregiver’s Income sources Government Social grants 314 35.64% Self-employed 292 33.14% Salary 275 31.21% Mother/Caregiver’s income Equal/less than R2500 443 50.28% R2501-R7500 233 26.45% Above R7500 205 23.27% Gender Female 404 45.86% Male 477 54.14% Age 5-7 years old 332 37.68% 8-10 years old 290 32.92% 11-13 years old 259 29.40% Childbirth Method Caesarian 172 19.52 Natural Birth 709 80.48 Ordinal position Firstborn 263 29.85% Middle 318 36.10% Lastborn 300 34.05% Pre-school Remote 716 81.27% Local 165 18.73 Food Allergy No 201 22.81% Yes 680 77.19% History of AD in the family No 129 14.64% Yes 752 85.36% 3.2. Prevalence of current and history atopic dermatitis There were 123 (13.96%) children who had experienced AD previously. While 164 (18.62%) children have experienced AD in the past six months. As shown in Figure 1. Household determinants of Atopic Dermatitis in the study In children with a history of AD, 523 (59.36%) households did not have a pet cat that stayed indoors. More households used cleaning chemicals occasionally (n=632, 71.74%), did not use the local grass broom (n=700, 79.46%) and more than half (n=459, 52.10%) of households had either an old mat or rug. More households (n=451, 51.19% vs n=430, 48.81%) milked their cows and consumed that milk yet there were few children (n=56, 12.42% vs n=67, 15.58%) with a history of AD from these households. The majority of households preferred to grow and consume their fruit and vegetables (n=702, 79.68%) which are consumed regularly (n=460, 52.21%) such as peanuts, a common commodity (n=467, 53.01%). However, when comparing children with a history of AD and no history of AD, the analysis showed a statistical difference for the following categorical variables: cat (p=0.001), cleaning chemicals (p<0.001), broom (p<0.001), household eggs (p=0.001), eggs (p=0.001) and furniture (p<0.001). Table 2, below gives full details of descriptive and statistical differences in household determinants when comparing children with either a history or no history of AD. Households with an indoor pet cat (n=358, 40.64%) and an outdoor dog (n=632, 71.74%) had children with current AD with 18 (5.03%) and 72 (17.87 %) respectively. Children with AD resided in households that used the grass broom (n=117, 64.64%). There were more children with current AD (n=459, 52.10%) in households with old mats or rugs, yet there was no statistical difference between AD and no AD children (p=0.083). Households that consumed household eggs and stayed in a renovated house had children with current AD, with 131(15.10%) and 176 (19.98%) respectively. Fewer children ate eggs regularly with current AD (n=77, 17.34%) compared to those without current AD (n=384, 83.48%). The study findings showed that most children consume homegrown vegetables and fruits (n=702, 79.68%), and eat vegetables (n=460, 52.21%) and peanuts (n=467, 53.01%)regularly. Table 2, below shows a detailed comparative of current AD and no AD among household and dietary determinants. Table 2. Household and Dietary Determinants and Atopic Dermatitis. Determinant Total N (%) History P-value* Total N (%) Current P-value AD No AD AD No AD Cat No 523 (59.36%) 123 (23.52%) 400 (%) 0.001 523 (59.36%) 146 (27.92%) 377 (72.08%) 0.001 Yes 358 (40.64%) 0 (-) 358 (%) 358 (40.64%) 18 (5.03%) 340 (94.97%) Dog No 478 (54.26%) 68 (14.23%) 410 (85.77%) 0.846 478 (54.26%) 92 (19.25%) 386 (80.75%) 0.664 Yes 403 (45.91%) 55 (13.65%) 348 (86.35%) 403 )45.74%) 72 (17.87 %) 331 (82.13%) Cleaning Chemicals Occasional 632 (71.74%) 63 (9.97%) 569 (90.03%) <0.001 632 (71.74%) 82 (12.97%) 550 (87.03%) <0.001 Everyday 249 (28.26%) 60 (24.10%) 189 (75.90%) 249 (28.26%) 82 (32.93%) 167 (67.07%) Broom No 700 (79.46%) 9 (1.29%) 691 (98.71%) <0.001 700 (79.46%) 47 (6.71%) 653 (93.29%) <0.001 Yes 181 (20.54) 114 (62.98%) 67 (37.02%) 181 (20.54%) 117 (64.64%) 64 (35.36%) Old mats or rugs No 422 (47.90%) 60 (14.22%) 362 (85.78%) 0.846 422 (47.90%) 89 (21.09%) 333 (78.91%) 0.083 Yes 459 (52.10%) 63 (13.73%) 396 (86.27%) 459 (52.10%) 75 (16.34%) 384 (83.66%) Diary Milk No 430 (48.81%) 67 (15.58%) 363 (84.42%) 0.206 430 (48.81%) 86 (20.00%) 344 (80.00 %) 0.341 Yes 451 (51.19%) 56 (12.42%) 395 (87.58%) 451 (51.19%) 78 (17.29%) 373 (82.71%) Household Eggs No 748 (84.90%) 25 (3.34%) 723 (96.66%) <0.001 748 (84.90%) 32 4.28 716 (95.72%) <0.001 Yes 133 (15.10%) 98 (73.68%) 35 (26.32%) 131 (15.10%) 132 99.25 1 (0.75%) Eggs Seldom 195 (22.13%) 18 (9.23%) 177 (90.77%) 0.001 195 (22.13%) 19 (9.74%) 176 (90.26%) <0.001 Sometimes 242 (27.47%) 47 (19.42%) 195 (80.58%) 242 (27.47%) 68 (28.10%) 174 (71.90%) Regular 444 (50.40%) 58 (13.06%) 386 (86.94%) 444 (50.40%) 77 (17.34%) 367 (82.66%) Home Grown Vegetable/Fruits No 179 (2032%) 25 (13.97%) 154 (86.03%) 1.000 179 (20.32%) 32 (17.88%) 147 (82.12%) 0.830 Yes 702 (79.68%) 98 (13.96%) 604 (86.04%) 702 (79.68%) 132 (18.80%) 570 (81.20%) Vegetables Seldom 158 (17.93%) 22 (13.92%) 136 (86.08%) 0.633 158 (17.93%) 23 (14.56%) 135 (85.44%) 0.010 Sometimes 263 (29.85%) 41 (15.59%) 222 (84.41%) 263 (29.85%) 65 (24.71%) 198 (75.29%) Regular 460 (52.21%) 60 (13.04%) 400 (86.96%) 460 (52.21%) 76 (16.52%) 384 (83.48%) Peanuts Seldom 181 (2054%) 22 (12.15%) 159 (87.85%) 0.243 181 (20.54%) 30 (16.57%) 151 (83.43%) 0.025 Sometimes 233 (26.45%) 27 (11.59%) 206 (88.41%) 233 (26.45%) 32 (13.73%) 201 (86.27%) Regular 467 (53.01%) 74 (15.85%) 393 (84.15%) 467 (53.01%) 102 (21.84% 365 (78.16%) Furniture No 705 (80.02%) 69 (9.79%) 636 (90.21%) <0.001 705 (80.02%) 109 (15.46%) 596 (84.54%) <0.001 Yes 176 (19.98%) 54 (30.96%) 122 (69.32%) 176 (19.98%) 55 (18.62%) 121 (68.75%) * P-value Fischer’s Exact Test and Bold shows statistical significance at 0.050 Environmental Risk factors of Atopic Dermatitis in the study Table 3 shows the descriptive analysis of environmental risk factors according to history and current cases of atopic dermatitis. There were children with AD in both history (n=97, 75.78%) and current (n=124, 96.88%) cases in households with environmental tobacco smoking exposure. There were more children with current AD (n=77, 18.51%) that stayed in households surrounded by bushes when compared to history of AD children (n=59, 14.18%). Most children with AD come from households that use coal for cooking and heating. In children with a history of AD, 14.86% (n=70) and 13.80% (n=93) used coal for cooking and heating respectively. Of children with current AD, 86 (18.26%) and 121 (17.95%) were from households that use coal for cooking and heating respectively. The analysis shows a statistical difference in both children with history and current AD for the following environmental determinants; environmental tobacco smoking exposure, house street location, heating fuel and residing in a house with renovations The was no statistical difference. Determinants of Atopic Dermatitis in the study The bivariate analysis showed that history of AD in the family old (UOR:26.167, 95%CI: 16.527-41.429), using chemicals for cleaning every day (UOR 1.349, 95%CI: 0.069-0.001), using a grass broom for sweeping the floor (UOR 1.008, 95%CI: 0.004-0.016), consuming household eggs (UOR 1.349, 95%CI: 0.007-0.022), having new furniture (UOR 3.245, 95%CI: 0.163-0.368), household environmental tobacco smoking exposure (UOR: 1.011, 95%CI: 0.007-0.020) and house renovation (UOR:6.543, 95%CI: 4.117-10.396) were associated with the prevalence of history of AD. While the following determinants were associated with current AD in the bivariate analysis, history of AD in the family (UOR: 66.958, 95%CI:3.136-11.559), having an indoor domestic cat (UOR:7.315, 95%CI: 4.388-12.195), using chemical to clean the house every day (UOR: 3.304, 0.214-0.432), using a grass broom (UOR2.039, 95%CI:0.026-0.060), having an old mat or rug (UOR: 1.368, 95%CI: 0.974-1.923), having new furniture (UOR: 1.402, 95%CI: 0.276-0.058), household environmental tobacco smoking exposure (UOR: 1.011, 95%CI: 0.007-0.020) and house renovation (UOR: 6.543, 4.117-10.396). In the final multivariate analysis model, being born through caesarian was a protective factor for both children with history (AOR: 0.094,95%CI: 0.039-0.224) and current AD (AOR: 0.098,95%CI: 0.042-0.231). While residing in a household that used a grass broom for cleaning the floor (AOR:1.106,95%CI: 0.044-0.255), ETS exposure (AOR:1.001,95%CI: 0.044-0.255) and renovated house (AOR 4: 0.020, 95%CI: 1.778-9.9.088) were risk factors for history of AD. Similar in children with current AD residing in a household that used a grass broom for cleaning the floor (AOR: 1.113,95%CI: 0.048-0.265), having an indoor domestic cat (AOR: 2.166, 95%CI: 0.931-5.036), ETS exposure (AOR: 2.701, 95%CI: 2.122-2.921), renovated house (AOR: 3.998,95%CI: 1.769-9.036 ) and were risk factors that influence the prevalence of AD Table 4: Multi-logistic regression analysis of determinants associated with the prevalence history of AD Determinant Reference UOR Std Error p-value 95%CI AOR Std Error p-value 95%CI Childbirth Method Natural Birth Caesarian 0.024 0.006 0.001 0.015-0.039 0.094 0.042 <0.001 0.039-0.224 Broom Yes No 1.008 0.003 0.001 0.004-0.016 1.106 0.048 <0.001 0.044-0.255 ETS Yes No 0.011 0.003 0.001 0.007-0.020 1.001 0.001 <0.001 1.000-1.005 Renovation Yes No 6.543 1.546 0.001 4.117-10.396 4.020 1.673 0.001 1.778-9.088 Bold shows statistical significance at 0.050 Table 4: Multi-logistic regression analysis of determinants associated with the prevalence history of AD Determinant Reference UOR Std Error p-value 95%CI AOR Std Error p-value 95%CI Childbirth Method Natural Birth Caesarian 0.024 0.006 0.001 0.015-0.039 0.098 0.043 <0.001 0.042-0.231 Broom Yes No 2.039 0.009 0.001 0.026-0.060 1.113 0.049 <0.001 0.048-0.265 Cat Yes No 7.315 1.908 0.001 4.388-12.195 2.166 0.933 0.052 0.931-5.036 ETS Yes No 1.011 0.003 0.001 0.007-0.020 2.701 0.001 <0.001 2.122-2.921 Renovation Yes No 6.543 1.546 0.001 4.117-10.396 3.998 1.663 0.001 1.769-9.036 Bold shows statistical significance at 0.050 Discussion The prevalence of a history of and current atopic dermatitis among children aged 7 to 13 years in rural areas was found to be 13.96% and 18.62%, respectively. This study's findings fall within the range of prevalence reported in studies conducted in urban areas of South Africa. This similarity may be attributed to the presence of industrial activities, such as agricultural practices and the now-defunct Lily gold mine, close to these rural communities. Previous research has suggested that industrial activities in urban settings may contribute to the onset and progression of atopic dermatitis[6]. Previous studies have reported the role of ETS and house renovation on the development of atopic dermatitis [20, 23–26]. Recently a South African study in an urban area has shown that there is an ETS (AOR=1.66; 95% CI: 1.08-2.55) and atopic dermatitis among preschool children aged 7 years [20]. This is similar to other South African studies and elsewhere among young children and adolescents [27–32]. The study was in line with previous studies, ETS was associated with history (AOR:1.001, p<0.001, 95%CI:1.000-1.005) and current (2.701, p<0.001, 95%CI:2.122-2.921) atopic dermatitis. The study also shows an association between house renovation during pregnancy or infancy with history and current atopic dermatitis. This finding is consistent with previous studies[19, 23]. A cross-sectional study conducted among Chinese children aged 3-6 found home renovation was a risk factor for atopic dermatitis. Both findings are important for parental educational awareness for preventing environmental risk factors for atopic dermatitis and similar conditions, especially during pregnancy and infancy. The utilization of a grass broom to sweep the floor has been identified as a risk factor for both historical (AOR: 1.106, p<0.001, 95%CI: 0.044-0.255) and current atopic dermatitis (AOR: 1.113, p<0.001, 95%CI: 0.048-0.265). One potential explanation for this association may be the presence of grass allergens originating from the broom itself, as previous research has indicated that grass pollen can trigger the development of atopic dermatitis [33, 34]. Additionally, the broom may serve as a device that captures dust mites and other mites commonly found on the floor daily [35, 36]. Nevertheless, further investigation is warranted to determine the underlying cause for the correlation between the use of a grass broom and atopic dermatitis. In addition, there was an association between current atopic dermatitis and owning an indoor domestic cat as a pet (AOR=2.166, p=0.052, 95%CI: 0.931-5.036). This could be because indoor household pets produce allergens that can be harmful to people with atopic dermatitis [37–41]. However, most studies have focused on the association between keeping a dog as an indoor pet [38]. The findings of this study are particularly relevant for rural areas, where cats can be a significant source of endotoxin and allergens due to their frequent movement between indoors and outdoors [40]. The relationship between the childbirth method and the development of atopic dermatitis and other allergic conditions has been a subject of investigation. Although there is no conclusive worldwide evidence, several studies have suggested a potential link between cesarean birth and allergic conditions. For instance, a Swedish National Cohort study involving children aged 5 or younger found that those born by c-section were at a higher risk of developing atopic dermatitis in early childhood (adj-HR 1.12, 95% CI: 1.10-1.14). These findings align with a Scandinavian cohort study by Hoel et al. in 2023. Conversely, a cohort study conducted in the United States did not find an association between c-section and atopic dermatitis [aRR (95% CI): 1.02 (0.99, 1.05)] [42]. Similarly, a prospective birth cohort study conducted in Greece also found no association between atopic dermatitis and c-section birth (OR 1.35; 95% CI 0.74-2.47) [43]. Notably, the Greek study found that natural birth was a protective factor against atopic dermatitis, which supports the hypothesis that c-sections may influence its development. These findings could be valuable for maternal education and encourage expecting mothers to consider natural birth when it is safe, as part of primary prevention for childhood atopic dermatitis. One of the study's strengths was using the ISAAC questionnaire which has been validated globally and in local settings. There were two study limitations. The study determined the association using a cross-sectional study and does not show the cause-effect relationship between atopic dermatitis and determinants. Hence, the study recommends a longitudinal study in the same or similar setting. Lastly, the study did not conduct a clinical diagnosis of atopic dermatitis among participants. Conclusion The study demonstrates that the prevalence of atopic dermatitis is comparable to previous findings in urban areas. Further investigation is warranted in rural areas regarding the occurrence of atopic dermatitis among children, as these areas often suffer from limited access to healthcare services. In addition, the study highlights the influence of residential and environmental factors in the development of atopic dermatitis. Consequently, there is a pressing need to implement environmental prevention programs aimed at safeguarding children residing in rural areas from the triggers of atopic dermatitis. Declarations Funding : This research received no external funding. Conflicts of Interest : The authors declare no conflicts of interest. Ethical Approval : The study was conducted following the Declaration of Helsinki and approved by the Research Ethics Committee of the University of Johannesburg Health Sciences (REC-01-11-2019 and 06 May 2019). Consent to participate : Informed consent was obtained from all subjects involved in the study. Availability of data and material : The data can be accessed by the author upon a reasonable request and must adhere to the South African Protection of Personal Information Act (POPI Act). Author’s contribution : Conceptualization, T.PM.; methodology, T.P.M.; validation, T.P.M.; formal analysis, T.PM.; investigation, T.PM.; resources, T.PM.; data curation, T.P.M.; writing—original draft preparation, T.PM.; writing—review and editing, T.PM.; visualization, T.PM and project administration, T.PM. Acknowledgements : The researcher acknowledges the support from the Department of Environmental Health for financial support for logistics. 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Shin J, Kim K, Kim H, Ko H, Kim B, Kim M, et al. Geographic differences in atopic dermatitis risk between urban and rural area: A systematic review and meta-analysis. JDDG: J der Deutschen Dermatologischen Gesellschaft. 2023;21:973–82. Nielsen M, D’Agostino D, Gregory P. Addressing Rural Health Challenges Head On. Mo Med. 2017;114:363–6. Morris-Paxton AA, Reid S, Ewing R-MG. Primary healthcare services in the rural Eastern Cape, South Africa: Evaluating a service-support project. Afr J Prim Health Care Fam Med. 2020;12. Kapszewicz K, Podlecka D, Polańska K, Stelmach I, Majak P, Majkowska-Wojciechowska B, et al. Home Environment in Early-Life and Lifestyle Factors Associated with Asthma and Allergic Diseases among Inner-City Children from the REPRO_PL Birth Cohort. Int J Environ Res Public Health. 2022;19:11884. Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev Clin Immunol. 2017;13:15–26. Løset M, Brown SJ, Saunes M, Hveem K. Genetics of Atopic Dermatitis: From DNA Sequence to Clinical Relevance. Dermatology. 2019;235:355–64. Pyun BY. Natural History and Risk Factors of Atopic Dermatitis in Children. Allergy Asthma Immunol Res. 2015;7:101. Mehta Y, Fulmali DG. Relationship Between Atopic Dermatitis and Food Allergy in Children. Cureus. 2022. https://doi.org/10.7759/cureus.33160 . Ho C-L, Chang L-I, Wu W-F. The prevalence and risk factors of atopic dermatitis in 6–8 year-old first graders in Taipei. Pediatr Neonatol. 2019;60:166–71. Calov M, Alinaghi F, Hamann CR, Silverberg J, Egeberg A, Thyssen JP. The Association Between Season of Birth and Atopic Dermatitis in the Northern Hemisphere: A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2020;8:674–e6805. Mubanga M, Lundholm C, Rohlin ES, Rejnö G, Brew BK, Almqvist C. Mode of delivery and offspring atopic dermatitis in a Swedish nationwide study. Pediatr Allergy Immunol. 2023;34. Bergmann RL, Diepgen TL, Kuss O, Bergmann KE, Kujat J, Dudenhausen JW, et al. Breastfeeding duration is a risk factor for atopic eczema. Clin Experimental Allergy. 2002;32:205–9. Lisik D, Ermis SSÖ, Ioannidou A, Milani GP, Nyassi S, Spolidoro GCI et al. Birth order, sibship size, and risk of atopic dermatitis, food allergy, and atopy: A systematic review and meta-analysis. Clin Transl Allergy. 2023;13. Takaoka M, Suzuki K, Norbäck D. The home environment and current dermatitis in Japanese junior high school children in Kansai area. Indoor Built Environ. 2022;31:1557–63. Bhuda M, Wichmann J, Shirinde J. Association between Outdoor and Indoor Air Pollution Sources and Atopic Eczema among Preschool Children in South Africa. Int J Environ Res Public Health. 2024;21:326. Haileamlak A, Dagoye D, Williams H, Venn AJ, Hubbard R, Britton J, et al. Early life risk factors for atopic dermatitis in Ethiopian children. J Allergy Clin Immunol. 2005;115:370–6. Xu F, Yan S, Li F, Cai M, Chai W, Wu M et al. Prevalence of childhood atopic dermatitis: An urban and rural community-based study in shanghai, China. PLoS ONE. 2012;7. Xu F, Yan S, Zheng Q, Li F, Chai W, Wu M, et al. Residential Risk Factors for Atopic Dermatitis in 3- to 6-Year Old Children: A Cross-Sectional Study in Shanghai, China. Int J Environ Res Public Health. 2016;13:537. Zhang R, Weschler LB, Ye J, Wang Z, Deng Q, Li B, et al. Associations between home environmental factors and childhood eczema and related symptoms in different cities in China. Heliyon. 2023;9:e21718. Herbarth O, Fritz GJ, Rehwagen M, Richter M, Röder S, Schlink U. Association between indoor renovation activities and eczema in early childhood. Int J Hyg Environ Health. 2006;209:241–7. Ahn K. The role of air pollutants in atopic dermatitis. J Allergy Clin Immunol. 2014;134:993–9. Wichmann J, Wolvaardt JE, Maritz C, Voyi KVV. Association between children’s household living conditions and eczema in the Polokwane area, South Africa. Health Place. 2008;14:323–35. Shirinde J, Wichmann J, Voyi K. Environmental tobacco smoke and the risk of eczema symptoms among school children in South Africa: a cross-sectional study. BMJ Open. 2015;5:e008234. Yi O, Kwon H-J, Kim H, Ha M, Hong S-J, Hong Y-C, et al. Effect of environmental tobacco smoke on atopic dermatitis among children in Korea. Environ Res. 2012;113:40–5. Kim SY, Sim S, Choi HG. Atopic dermatitis is associated with active and passive cigarette smoking in adolescents. PLoS ONE. 2017;12:e0187453. Choi K-Y, Yang S-I, Lee E, Jung YH, Yu H-S, Hong K-M, et al. Environment Tobacco Smoke Exposure Affect Childhood Atopic Dermatitis Modified By TNF-α and TLR4 Polymorphisms. J Allergy Clin Immunol. 2015;135:AB109. Akhtar S, Al-Shanfari S, Booalayan H, Abdulrasool M, Boujarwa A, Al-Mukaimi A, et al. Exposure to household secondhand tobacco smoke and the odds of developing atopic dermatitis among adolescents: A causal mediation analysis. Tob Induc Dis. 2024;22:1–9. Werfel T, Heratizadeh A, Niebuhr M, Kapp A, Roesner LM, Karch A, et al. Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber. J Allergy Clin Immunol. 2015;136:96–e1039. Idrose NS, Lodge CJ, Peters RL, Douglass JA, Koplin JJ, Lowe AJ et al. The role of short-term grass pollen exposure in food skin‐prick test reactivity, food allergy, and eczema flares in children. Pediatr Allergy Immunol. 2022;33. Mehmood K, Desfontis J-C, Kang B, Kim H-J. J-h L, H-j K. Effect of indoor house dust mite concentration on canine atopic dermatitis. Emran H, Chieng CSE, Taib S, Cunningham AC. House dust mite sensitisation and association with atopic dermatitis in Brunei. Clin Transl Allergy. 2019;9:65. Cid BJ, Perez-Mateluna G, Iturriaga C, Zambrano MJ, Vives MI, Valenzuela PM, et al. Is there an association between indoor allergens and the severity of atopic dermatitis? Int J Dermatol. 2019;58:433–9. Sebõk B, Schneider I, Harangi F. Familiar and environmental factors influencing atopic dermatitis in the childhood. J Eur Acad Dermatol Venereol. 2006;20:418–22. Pelucchi C, Galeone C, Bach J-F, La Vecchia C, Chatenoud L. Pet exposure and risk of atopic dermatitis at the pediatric age: A meta-analysis of birth cohort studies. J Allergy Clin Immunol. 2013;132:616–e6227. Ownby DR, Peterson EL, Wegienka G, Woodcroft KJ, Nicholas C, Zoratti E, et al. Are cats and dogs the major source of endotoxin in homes? Indoor Air. 2013;23:219–26. Fujimura KE, Johnson CC, Ownby DR, Cox MJ, Brodie EL, Havstad SL, et al. Man’s best friend? The effect of pet ownership on house dust microbial communities. J Allergy Clin Immunol. 2010;126:410–e4123. Richards M, Ferber J, Chen H, Swor E, Quesenberry CP, Li D, et al. Caesarean delivery and the risk of atopic dermatitis in children. Clin Experimental Allergy. 2020;50:805–14. Papathoma E, Triga M, Fouzas S, Dimitriou G. Cesarean section delivery and development of food allergy and atopic dermatitis in early childhood. Pediatr Allergy Immunol. 2016;27:419–24. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4633129","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319752582,"identity":"86b3d5a4-dfff-439b-a8ab-f4cbb2898f3c","order_by":0,"name":"Thokozani P Mbonane","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYFACHgjFz8CQQKwGqBbJBpK1GBwg1ln2YmcPPi6ouSNnfCPhAcOPGgZ7/gZCtkjnJRvPOPbM2OxGQgJjzzEGZglC1vFI55hJ87AdTtwG1MLA28DAxkCcln+H6zfPANryt4GBR54oLbxthxMMJBISmIG2SBAMB57bQL/w9h02nHHmQcJhmWMSBoaEtLDPzj34mOfbYXn+9pzEh29qbOzlCGlBtjABqFiCePUgC0kwfhSMglEwCkYUAACr0Tqo5IkDqgAAAABJRU5ErkJggg==","orcid":"","institution":"University of Johannesburg","correspondingAuthor":true,"prefix":"","firstName":"Thokozani","middleName":"P","lastName":"Mbonane","suffix":""}],"badges":[],"createdAt":"2024-06-25 03:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4633129/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4633129/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60631950,"identity":"a0cf0022-aa3c-46c8-b210-2ab34bf3c522","added_by":"auto","created_at":"2024-07-19 01:24:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":13401,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of history and current atopic dermatitis\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4633129/v1/2f781ab0cfa84d9f2d4f82c6.png"},{"id":99314520,"identity":"24cccfeb-5f12-44c6-8bcd-34e330d5f9db","added_by":"auto","created_at":"2025-12-31 16:21:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":966907,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4633129/v1/0ddc8c9c-5e1b-423a-b228-d038658879e4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHousehold and Environmental Determinants That Influence the Prevalence Atopic Dermatitis Among Young Rural Children, in Mpumalanga Province, South Africa\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAtopic dermatitis is a common chronic disease that is influenced by environmental factors. It affects a significant number of young children worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Studies estimate that 15\u0026ndash;20% of children globally experience atopic dermatitis each year [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In sub-Saharan children, the prevalence of atopic dermatitis ranges from 4.7\u0026ndash;23% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Scientific evidence suggests that children in urban areas have a higher risk of developing atopic dermatitis compared to those in rural areas [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, studies conducted in sub-Saharan regions have shown no difference in the prevalence of atopic dermatitis between urban and rural children, despite the perception that urban children are more affected [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is important to note that children in rural areas may have limited access to healthcare services, including those for skin conditions, due to the shortage or absence of primary healthcare facilities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. While genetic predisposition plays a role in atopic dermatitis, household and environmental factors also contribute significantly to the development of this condition (9\u0026ndash;11).\u003c/p\u003e \u003cp\u003eCurrent evidence shows that atopic dermatitis can be triggered by numerous individual, genetic and household (home environment) risk factors [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Family history of atopic dermatitis, personal hygiene products gender (male children were at high risk) child diet, food allergies, and history of eczema, allergies, hay fever or asthma have been linked to atopic dermatitis in different environments [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Furthermore, atopic has been associated with birth season, birth method, breastfeeding duration, number of siblings, and ordinal position [\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A few studies have shown that home/ residential risk factors such as indoor pet ownership, and household income play a role in triggering atopic dermatitis.\u003c/p\u003e \u003cp\u003eNumerous environmental factors contribute to and are linked to the development of atopic dermatitis among children [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These factors included climatological risk factors, air pollution and related activities, house dampness, mold in the walls, and residing near bushes or green areas [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A recent analytical cross-sectional study in an urban area conducted among schoolchildren 7 years or younger linked current atopic dermatitis to household environmental tobacco smoke (ETS) exposure (OR\u0026thinsp;=\u0026thinsp;1.61; 95% CI: 1.07\u0026ndash;2.43), cooking and heating fuel use (OR\u0026thinsp;=\u0026thinsp;1.94; 95% CI: 1.00\u0026ndash;3.74), use of building materials (renovation), indoor dust, and frequent of trucks passing [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, several studies have indicated that atopic dermatitis is more common among urban children compared to those living in rural areas [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]A community-based study conducted in China discovered that the prevalence of atopic dermatitis was higher in urban areas (10.2%) as opposed to rural areas (4.6%) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, many of the residential and environmental risk factors associated with atopic dermatitis are linked to poor socioeconomic conditions, which are often prevalent in rural communities. Therefore, the researcher hypothesized that children living in rural areas, where agricultural and mining activities are common, may be more vulnerable to developing atopic dermatitis than children in urban areas, due to household and environmental risk factors. The objectives of the study were: i) to describe the prevalence of atopic dermatitis; ii) to identify household and environmental risk factors; and iii) to assess the determinants that influence the prevalence of atopic dermatitis among young rural children from Louiville, Mpumalanga Province, South Africa.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional analytical study was conducted between August 2021 and September 2023. The study was conducted in a rural residential of Barberton town in Mpumalanga Province, South Africa. The residential area is situated near the Lily gold mine and is surrounded by agricultural activities. This residential area has a main gravel road to access agrarian farms and the closed Lily gold mine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study sample consisted of caregivers/mothers and their children residing in a rural residential area. The children were between the ages of 5 and 13, and it was required that the mother had resided in the area with her parents when the child was 12 months old or younger. Children who were born in different towns were excluded from the study, and questionnaires with missing information were not considered. Participants were recruited using convenience sampling, and households with children were identified beforehand with the support of the local Ward-Based Outreach Teams.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data was collected using an adapted ISAAC questionnaire. The questionnaire has been used in South African studies and populations. Trained research assistants (environmental health 4th year students) administered the questionnaire. During data collection, the research assistants were paired (one research assistant must have been conversant with either isiSwati or siTsonga). The questionnaire was translated into isiSwati and xiTsonga, the two most common languages in Louiville before data collection and the responses were translated back to English by two professional linguistics. The questionnaire was divided into socio-demographics (participants\u0026apos; characteristics), study health outcome (atopic dermatitis), and household and dietary and environmental determinants.\u003c/p\u003e\n\u003cp\u003eThe socio-demographic included the mother/caregiver\u0026rsquo;s educational levels (no schooling/primary school/high school), income sources (government social grants/self-employed/salary) income (equal or less than R2500/R2501-R7500/Above R7500), child gender (male/female), age (7 years old or younger/8-10 years old/11-13 years old), childbirth method (caesarian/natural birth), the ordinal position of the child (firstborn/middle/lastborn) pre-school (remote/local), food allergy (no/yes) and history of AD in the family (no/yes)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Health Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study health outcomes were prevalence of current and history of atopic dermatitis. History of Atopic Dermatitis was determined by the positive (yes) to the following question by the mother/caregiver: 1) Has your child previously had atopic dermatitis? The current atopic dermatitis was estimated through the parents/guardian\u0026rsquo;s response with a \u0026ldquo;yes\u0026rdquo; to all three questions:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eHas your child experienced a persistent dry and itchy rash in the past 6 months,\u003c/li\u003e\n \u003cli\u003eHas your child experienced a rash with inflamed skin in the past 6 months,\u003c/li\u003e\n \u003cli\u003eHas your child experienced a persistent dry and itchy rash and inflamed skin in the past 6 months,\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eHousehold and Dietary Determinants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHousehold and Dietary Determinants included having an indoor domestic cat (yes/no), having an outdoor dog (yes/no), using chemicals for cleaning (occasional/every day), using a grass broom for sweeping the floor (yes/no), having an old mat or rag at home (yes/no), consumable housed milked dairy products, household hatched eggs and homegrown vegetables and fruits (yes/no), how often do you eat eggs/homegrown vegetables and fruits, peanuts (seldom/sometimes/regularly) and renovation during the mother\u0026rsquo;s pregnant period or child was younger than 12 months (yes/no).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEnvironmental Determinants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study\u0026apos;s environmental determinants were exposure to environmental tobacco smoking at home (yes/no), location of the household street (back street-(away from the busy main road)/main street), house surrounding (bushes/no bushes), cooking and heating fuel (electricity/paraffin/coal), dampness in the inside of the house (yes/no), stagnant water within walking distance of the home (yes/no), any house renovations during mother\u0026rsquo;s pregnancy or 12 months after child was born (yes/no).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data was analyzed using Stata MP software (version 18). Tables and figures were used to present the findings regarding frequency and percentages. Fischer\u0026apos;s exact test was employed to determine statistically significant differences between variables. The association between the prevalence of atopic dermatitis and socio-demographic variables and household and environmental factors was examined. Initially, a bivariate regression analysis was conducted, and the variables that demonstrated a statistically significant association with the prevalence of atopic dermatitis were included in the final model. The final model consisted of a multivariate regression analysis, utilizing statistical variables where a p-value of 0.05 or lower was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study obtained ethical clearance from the University of Johannesburg, Faculty of Health Sciences Research Ethics Committee (REC-01-11-2019). Informed consent was obtained from the study participants before data collection.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of the study participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the participants were females and were referred to as mothers/caregivers of the children. Most of the mothers/caregivers had high school educational levels (n=360, 41.32%), were dependent on government social grants for survival as the source of income (n=314, 35.64%) and had R2500 or less to live on per month (n=443, 50.28%). There were more boys children (n=477, 54.14%) than girls (n=404, 45.86%) in this study. The majority of the study participants were between the age of 6-8 years old (n=332; 37.68%) and natural born (n=709; 80.48%). Furthermore, most were either a middle child (n=318; 36.10%) or lastborn (n=300; 34.05%) in their family structure (position). There were 275 (31.21%) study participants who lived with a mother/guardian dependent on a government social grant for the source of income. Lastly, 452 (51.31%) lived with a mother who is a smoker. Table 1 below shows a details description of the characteristics of the study participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Study participants characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"426\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eMother/Caregiver\u0026rsquo;s educational levels\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eNo schooling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e16.35%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e22.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e41.32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eCollege/University\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e19.52%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eMother/Caregiver\u0026rsquo;s Income sources\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eGovernment Social grants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e35.64%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e33.14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eSalary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e31.21%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eMother/Caregiver\u0026rsquo;s income\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eEqual/less than R2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e50.28%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eR2501-R7500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e26.45%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eAbove R7500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e23.27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e45.86%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e54.14%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003e5-7 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e37.68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003e8-10 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e32.92%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003e11-13 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e29.40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eChildbirth Method\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eCaesarian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e19.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eNatural Birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e80.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eOrdinal position\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eFirstborn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e29.85%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e36.10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eLastborn\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e34.05%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003ePre-school\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eRemote\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e81.27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eLocal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e18.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eFood Allergy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e22.81%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e680\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e77.19%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"3\"\u003e\n \u003cp\u003eHistory of AD in the family\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e14.64%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.98360655737705%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.508196721311474%\"\u003e\n \u003cp\u003e85.36%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.2. Prevalence of current and history atopic dermatitis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThere were 123 (13.96%) children who had experienced AD previously. While 164 (18.62%) children have experienced AD in the past six months. As shown in Figure 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHousehold determinants of Atopic Dermatitis in the study\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn children with a history of AD, 523 (59.36%) households did not have a pet cat that stayed indoors. More households used cleaning chemicals occasionally (n=632, 71.74%), did not use the local grass broom (n=700, 79.46%) and more than half (n=459, 52.10%) of households had either an old mat or rug. More households (n=451, 51.19% vs n=430, 48.81%) milked their cows and consumed that milk yet there were few children (n=56, 12.42% vs n=67, 15.58%) with a history of AD from these households. The majority of households preferred to grow and consume their fruit and vegetables (n=702, 79.68%) which are consumed regularly (n=460, 52.21%) such as peanuts, a common commodity (n=467, 53.01%). However, when comparing children with a history of AD and no history of AD, the analysis showed a statistical difference for the following categorical variables: cat (p=0.001), cleaning chemicals (p\u0026lt;0.001), broom (p\u0026lt;0.001), household eggs (p=0.001), eggs (p=0.001) and furniture (p\u0026lt;0.001). Table 2, below gives full details of descriptive and statistical differences in household determinants when comparing children with either a history or no history of AD.\u003c/p\u003e\n\u003cp\u003eHouseholds with an indoor pet cat (n=358, 40.64%) and an outdoor dog (n=632, 71.74%) had children with current AD with 18 (5.03%) and 72 (17.87 %) respectively. Children with AD resided in households that used the grass broom (n=117, 64.64%). There were more children with current AD (n=459, 52.10%) in households with old mats or rugs, yet there was no statistical difference between AD and no AD children (p=0.083). Households that consumed household eggs and stayed in a renovated house had children with current AD, with 131(15.10%) and 176 (19.98%) respectively. Fewer children ate eggs regularly with current AD (n=77, 17.34%) compared to those without current AD (n=384, 83.48%). The study findings showed that most children consume homegrown vegetables and fruits (n=702, 79.68%), and eat vegetables (n=460, 52.21%) and peanuts (n=467, 53.01%)regularly. Table 2, below shows a detailed comparative of current AD and no AD among household and dietary determinants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eHousehold and Dietary Determinants and Atopic Dermatitis.\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"978\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.404907975460123%\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeterminant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.153374233128833%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.245398773006134%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.37837837837838%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.027027027027028%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo AD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.62162162162162%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.972972972972972%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo AD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eCat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e523 (59.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\" valign=\"top\"\u003e\n \u003cp\u003e123 (23.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\" valign=\"top\"\u003e\n \u003cp\u003e400 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e523 (59.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e146 (27.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e377 (72.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e358 (40.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e0 (-)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\" valign=\"top\"\u003e\n \u003cp\u003e358 (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e358 (40.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e18 (5.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e340 (94.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eDog\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e478 (54.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\" valign=\"top\"\u003e\n \u003cp\u003e68 (14.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\" valign=\"top\"\u003e\n \u003cp\u003e410 (85.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.846\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e478 (54.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e92 (19.25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e386 (80.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.664\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e403 (45.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e55 (13.65%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\" valign=\"top\"\u003e\n \u003cp\u003e348 (86.35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e403 )45.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e72 (17.87 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e331 (82.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eCleaning Chemicals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eOccasional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e632 (71.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\"\u003e\n \u003cp\u003e63 (9.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\"\u003e\n \u003cp\u003e569 (90.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e632 (71.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e82 (12.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e550 (87.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eEveryday\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e249 (28.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e60 (24.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e189 (75.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e249 (28.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e82 (32.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e167 (67.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eBroom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e700 (79.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\" valign=\"top\"\u003e\n \u003cp\u003e9 (1.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\" valign=\"top\"\u003e\n \u003cp\u003e691 (98.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e700 (79.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e47 (6.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e653 (93.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e181 (20.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e114 (62.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\" valign=\"top\"\u003e\n \u003cp\u003e67 (37.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e181 (20.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e117 (64.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e64 (35.36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eOld mats or rugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e422 (47.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\" valign=\"top\"\u003e\n \u003cp\u003e60 (14.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\" valign=\"top\"\u003e\n \u003cp\u003e362 (85.78%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e422 (47.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e89 (21.09%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e333 (78.91%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e459 (52.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e63 (13.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\" valign=\"top\"\u003e\n \u003cp\u003e396 (86.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e459 (52.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e75 (16.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e384 (83.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eDiary Milk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e430 (48.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\" valign=\"top\"\u003e\n \u003cp\u003e67 (15.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\" valign=\"top\"\u003e\n \u003cp\u003e363 (84.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e430 (48.81%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e86 (20.00%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e344 (80.00 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.341\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e451 (51.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\" valign=\"top\"\u003e\n \u003cp\u003e56 (12.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\" valign=\"top\"\u003e\n \u003cp\u003e395 (87.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e451 (51.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e78 (17.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e373 (82.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eHousehold Eggs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e748 (84.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\"\u003e\n \u003cp\u003e25 (3.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\"\u003e\n \u003cp\u003e723 (96.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e748 (84.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e32 4.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e716 (95.72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e133 (15.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e98 (73.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e35 (26.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e131 (15.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e132 99.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e1 (0.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"3\"\u003e\n \u003cp\u003eEggs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eSeldom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e195 (22.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\"\u003e\n \u003cp\u003e18 (9.23%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\"\u003e\n \u003cp\u003e177 (90.77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e195 (22.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\"\u003e\n \u003cp\u003e19 (9.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\"\u003e\n \u003cp\u003e176 (90.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e242 (27.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e47 (19.42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e195 (80.58%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e242 (27.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\"\u003e\n \u003cp\u003e68 (28.10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\"\u003e\n \u003cp\u003e174 (71.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e444 (50.40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e58 (13.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e386 (86.94%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e444 (50.40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\"\u003e\n \u003cp\u003e77 (17.34%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\"\u003e\n \u003cp\u003e367 (82.66%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eHome Grown Vegetable/Fruits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e179 (2032%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\"\u003e\n \u003cp\u003e25 (13.97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\"\u003e\n \u003cp\u003e154 (86.03%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e179 (20.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e32 (17.88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e147 (82.12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e702 (79.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e98 (13.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e604 (86.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e702 (79.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e132 (18.80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e570 (81.20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"3\"\u003e\n \u003cp\u003eVegetables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eSeldom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e158 (17.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\"\u003e\n \u003cp\u003e22 (13.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\"\u003e\n \u003cp\u003e136 (86.08%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"3\"\u003e\n \u003cp\u003e0.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e158 (17.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\"\u003e\n \u003cp\u003e23 (14.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\"\u003e\n \u003cp\u003e135 (85.44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e263 (29.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e41 (15.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e222 (84.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e263 (29.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\"\u003e\n \u003cp\u003e65 (24.71%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\"\u003e\n \u003cp\u003e198 (75.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e460 (52.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e60 (13.04%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e400 (86.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e460 (52.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\"\u003e\n \u003cp\u003e76 (16.52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\"\u003e\n \u003cp\u003e384 (83.48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"3\"\u003e\n \u003cp\u003ePeanuts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eSeldom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e181 (2054%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\"\u003e\n \u003cp\u003e22 (12.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\"\u003e\n \u003cp\u003e159 (87.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"3\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e181 (20.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e30 (16.57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e151 (83.43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eSometimes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e233 (26.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e27 (11.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e206 (88.41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e233 (26.45%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e32 (13.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e201 (86.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eRegular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e467 (53.01%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e74 (15.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e393 (84.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e467 (53.01%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e102 (21.84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e365 (78.16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.656441717791411%\" rowspan=\"2\"\u003e\n \u003cp\u003eFurniture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.748466257668712%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e705 (80.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.883435582822086%\"\u003e\n \u003cp\u003e69 (9.79%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.269938650306749%\"\u003e\n \u003cp\u003e636 (90.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.202453987730062%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.975460122699387%\" valign=\"top\"\u003e\n \u003cp\u003e705 (80.02%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.815950920245399%\" valign=\"top\"\u003e\n \u003cp\u003e109 (15.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.429447852760736%\" valign=\"top\"\u003e\n \u003cp\u003e596 (84.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.042944785276074%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.90990990990991%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e176 (19.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.91891891891892%\"\u003e\n \u003cp\u003e54 (30.96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.01801801801802%\"\u003e\n \u003cp\u003e122 (69.32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.711711711711711%\" valign=\"top\"\u003e\n \u003cp\u003e176 (19.98%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.414414414414415%\" valign=\"top\"\u003e\n \u003cp\u003e55 (18.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.315315315315315%\" valign=\"top\"\u003e\n \u003cp\u003e121 (68.75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e* P-value Fischer\u0026rsquo;s Exact Test and \u003cstrong\u003eBold\u0026nbsp;\u003c/strong\u003eshows statistical significance at 0.050\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEnvironmental Risk factors of Atopic Dermatitis in the study\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 shows the descriptive analysis of environmental risk factors according to history and current cases of atopic dermatitis. There were children with AD in both history (n=97, 75.78%) and current (n=124, 96.88%) cases in households with environmental tobacco smoking exposure. There were more children with current AD (n=77, 18.51%) \u0026nbsp;that stayed in households surrounded by bushes when compared to history of AD children (n=59, 14.18%). Most children with AD come from households that use coal for cooking and heating. In children with a history of AD, 14.86% (n=70) and 13.80% (n=93) used coal for cooking and heating respectively. Of children with current AD, 86 (18.26%) and 121 (17.95%) were from households that use coal for cooking and heating respectively. The analysis shows a statistical difference in both children with history and current AD for the following environmental determinants; environmental tobacco smoking exposure, house street location, heating fuel and residing in a house with renovations The was no statistical difference.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDeterminants of Atopic Dermatitis in the study\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe bivariate analysis showed that history of AD in the family old (UOR:26.167, 95%CI: 16.527-41.429), using chemicals for cleaning every day (UOR 1.349, 95%CI: 0.069-0.001), using a grass broom for sweeping the floor (UOR 1.008, 95%CI: 0.004-0.016), consuming household eggs (UOR 1.349, 95%CI: 0.007-0.022), having new furniture (UOR 3.245, 95%CI: 0.163-0.368), household environmental tobacco smoking exposure (UOR: 1.011, 95%CI: 0.007-0.020) and house renovation (UOR:6.543, 95%CI: 4.117-10.396) were associated with the prevalence of history of AD. While the following determinants were associated with current AD in the bivariate analysis, history of AD in the family (UOR: 66.958, 95%CI:3.136-11.559), having an indoor domestic cat (UOR:7.315, 95%CI: 4.388-12.195), using chemical to clean the house every day (UOR: 3.304, 0.214-0.432), using a grass broom (UOR2.039, 95%CI:0.026-0.060), having an old mat or rug (UOR: 1.368, \u0026nbsp;95%CI: 0.974-1.923), having new furniture (UOR: 1.402, 95%CI: 0.276-0.058), household environmental tobacco smoking exposure (UOR: 1.011, 95%CI: 0.007-0.020) and house renovation (UOR: 6.543, 4.117-10.396).\u003c/p\u003e\n\u003cp\u003eIn the final multivariate analysis model, being born through caesarian was a protective factor for both children with history (AOR: 0.094,95%CI: 0.039-0.224) and current AD (AOR: 0.098,95%CI: 0.042-0.231). While residing in a household that used a grass broom for cleaning the floor (AOR:1.106,95%CI: 0.044-0.255), ETS exposure (AOR:1.001,95%CI: 0.044-0.255) and renovated house (AOR 4: 0.020, 95%CI: 1.778-9.9.088) were risk factors for history of AD. Similar in children with current AD residing in a household that used a grass broom for cleaning the floor (AOR: 1.113,95%CI: 0.048-0.265), having an indoor domestic cat (AOR: 2.166, 95%CI: 0.931-5.036), ETS exposure (AOR: 2.701, 95%CI: 2.122-2.921), renovated house (AOR: 3.998,95%CI: 1.769-9.036 ) and were risk factors that influence the prevalence of AD\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: Multi-logistic regression analysis of determinants associated with the prevalence history of AD\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"912\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.79582875960483%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeterminant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.45225027442371%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.45225027442371%\"\u003e\n \u003cp\u003e\u003cstrong\u003eUOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.67178924259056%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.244785949506038%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.440175631174533%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.574094401756311%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.122941822173436%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.025246981339188%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.220636663007683%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.570175438596491%\"\u003e\n \u003cp\u003eChildbirth Method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.307017543859649%\"\u003e\n \u003cp\u003eNatural Birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.442982456140351%\"\u003e\n \u003cp\u003eCaesarian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.442982456140351%\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.662280701754385%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2368421052631575%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.429824561403509%\"\u003e\n \u003cp\u003e0.015-0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.565789473684211%\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.114035087719298%\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.210526315789474%\"\u003e\n \u003cp\u003e0.039-0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.570175438596491%\"\u003e\n \u003cp\u003eBroom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.307017543859649%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.442982456140351%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.442982456140351%\"\u003e\n \u003cp\u003e1.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.662280701754385%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2368421052631575%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.429824561403509%\"\u003e\n \u003cp\u003e0.004-0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.565789473684211%\"\u003e\n \u003cp\u003e1.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.114035087719298%\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.210526315789474%\"\u003e\n \u003cp\u003e0.044-0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.570175438596491%\"\u003e\n \u003cp\u003eETS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.307017543859649%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.442982456140351%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.442982456140351%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.662280701754385%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2368421052631575%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.429824561403509%\"\u003e\n \u003cp\u003e0.007-0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.565789473684211%\"\u003e\n \u003cp\u003e1.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.114035087719298%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.210526315789474%\"\u003e\n \u003cp\u003e1.000-1.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.570175438596491%\"\u003e\n \u003cp\u003eRenovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.307017543859649%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.442982456140351%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.442982456140351%\"\u003e\n \u003cp\u003e6.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.662280701754385%\"\u003e\n \u003cp\u003e1.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2368421052631575%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.429824561403509%\"\u003e\n \u003cp\u003e4.117-10.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.565789473684211%\"\u003e\n \u003cp\u003e4.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.114035087719298%\"\u003e\n \u003cp\u003e1.673\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.017543859649122%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.210526315789474%\"\u003e\n \u003cp\u003e1.778-9.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBold shows statistical significance at 0.050\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: Multi-logistic regression analysis of determinants associated with the prevalence history of AD\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"902\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.277161862527716%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeterminant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.647450110864744%\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e\u003cstrong\u003eUOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.982261640798226%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.977827050997783%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.645232815964523%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.314855875831485%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.534368070953438%\"\u003e\n \u003cp\u003e\u003cstrong\u003e95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.643015521064301%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.647450110864744%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.982261640798226%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.977827050997783%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.645232815964523%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.314855875831485%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.534368070953438%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003eChildbirth Method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.643015521064301%\"\u003e\n \u003cp\u003eNatural Birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.647450110864744%\"\u003e\n \u003cp\u003eCaesarian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.982261640798226%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.977827050997783%\"\u003e\n \u003cp\u003e0.015-0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.645232815964523%\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.314855875831485%\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.534368070953438%\"\u003e\n \u003cp\u003e0.042-0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003eBroom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.643015521064301%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.647450110864744%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e2.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.982261640798226%\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.977827050997783%\" valign=\"top\"\u003e\n \u003cp\u003e0.026-0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.645232815964523%\"\u003e\n \u003cp\u003e1.113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.314855875831485%\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.534368070953438%\"\u003e\n \u003cp\u003e0.048-0.265\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003eCat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.643015521064301%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.647450110864744%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e7.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.982261640798226%\"\u003e\n \u003cp\u003e1.908\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.977827050997783%\" valign=\"top\"\u003e\n \u003cp\u003e4.388-12.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.645232815964523%\"\u003e\n \u003cp\u003e2.166\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.314855875831485%\"\u003e\n \u003cp\u003e0.933\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.052\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.534368070953438%\"\u003e\n \u003cp\u003e0.931-5.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003eETS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.643015521064301%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.647450110864744%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e1.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.982261640798226%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.977827050997783%\" valign=\"top\"\u003e\n \u003cp\u003e0.007-0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.645232815964523%\"\u003e\n \u003cp\u003e2.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.314855875831485%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.534368070953438%\"\u003e\n \u003cp\u003e2.122-2.921\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003eRenovation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.643015521064301%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.647450110864744%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e6.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.982261640798226%\"\u003e\n \u003cp\u003e1.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.651884700665189%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.977827050997783%\"\u003e\n \u003cp\u003e4.117-10.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.645232815964523%\"\u003e\n \u003cp\u003e3.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.314855875831485%\"\u003e\n \u003cp\u003e1.663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.534368070953438%\"\u003e\n \u003cp\u003e1.769-9.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eBold\u003c/strong\u003e shows statistical significance at 0.050\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence of a history of and current atopic dermatitis among children aged 7 to 13 years in rural areas was found to be 13.96% and 18.62%, respectively. This study\u0026apos;s findings fall within the range of prevalence reported in studies conducted in urban areas of South Africa. This similarity may be attributed to the presence of industrial activities, such as agricultural practices and the now-defunct Lily gold mine, close to these rural communities. Previous research has suggested that industrial activities in urban settings may contribute to the onset and progression of atopic dermatitis[6].\u003c/p\u003e\n\u003cp\u003ePrevious studies have reported the role of ETS and house renovation on the development of atopic dermatitis [20, 23\u0026ndash;26]. Recently a South African study in an urban area has shown that there is an ETS (AOR=1.66; 95% CI: 1.08-2.55) and atopic dermatitis among preschool children aged 7 years [20]. This is similar to other South African studies and elsewhere among young children and adolescents [27\u0026ndash;32]. The study was in line with previous studies, ETS was associated with history (AOR:1.001, p\u0026lt;0.001, 95%CI:1.000-1.005) and current (2.701, p\u0026lt;0.001, 95%CI:2.122-2.921) atopic dermatitis. The study also shows an association between house renovation during pregnancy or infancy with history and current atopic dermatitis. This finding is consistent with previous studies[19, 23]. A cross-sectional study conducted among Chinese children aged 3-6 found home renovation was a risk factor for atopic dermatitis. Both findings are important for parental educational awareness for preventing environmental risk factors for atopic dermatitis and similar conditions, especially during pregnancy and infancy.\u003c/p\u003e\n\u003cp\u003eThe utilization of a grass broom to sweep the floor has been identified as a risk factor for both historical (AOR: 1.106, p\u0026lt;0.001, 95%CI: 0.044-0.255) and current atopic dermatitis (AOR: 1.113, p\u0026lt;0.001, 95%CI: 0.048-0.265). One potential explanation for this association may be the presence of grass allergens originating from the broom itself, as previous research has indicated that grass pollen can trigger the development of atopic dermatitis [33, 34]. Additionally, the broom may serve as a device that captures dust mites and other mites commonly found on the floor daily [35, 36]. Nevertheless, further investigation is warranted to determine the underlying cause for the correlation between the use of a grass broom and atopic dermatitis.\u003c/p\u003e\n\u003cp\u003eIn addition, there was an association between current atopic dermatitis and owning an indoor domestic cat as a pet (AOR=2.166, p=0.052, 95%CI: 0.931-5.036). This could be because indoor household pets produce allergens that can be harmful to people with atopic dermatitis [37\u0026ndash;41]. However, most studies have focused on the association between keeping a dog as an indoor pet [38]. The findings of this study are particularly relevant for rural areas, where cats can be a significant source of endotoxin and allergens due to their frequent movement between indoors and outdoors [40].\u003c/p\u003e\n\u003cp\u003eThe relationship between the childbirth method and the development of atopic dermatitis and other allergic conditions has been a subject of investigation. Although there is no conclusive worldwide evidence, several studies have suggested a potential link between cesarean birth and allergic conditions. For instance, a Swedish National Cohort study involving children aged 5 or younger found that those born by c-section were at a higher risk of developing atopic dermatitis in early childhood (adj-HR 1.12, 95% CI: 1.10-1.14). These findings align with a Scandinavian cohort study by Hoel et al. in 2023. Conversely, a cohort study conducted in the United States did not find an association between c-section and atopic dermatitis [aRR (95% CI): 1.02 (0.99, 1.05)] [42]. Similarly, a prospective birth cohort study conducted in Greece also found no association between atopic dermatitis and c-section birth (OR 1.35; 95% CI 0.74-2.47) [43]. Notably, the Greek study found that natural birth was a protective factor against atopic dermatitis, which supports the hypothesis that c-sections may influence its development. These findings could be valuable for maternal education and encourage expecting mothers to consider natural birth when it is safe, as part of primary prevention for childhood atopic dermatitis.\u003c/p\u003e\n\u003cp\u003eOne of the study\u0026apos;s strengths was using the ISAAC questionnaire which has been validated globally and in local settings. There were two study limitations. The study determined the association using a cross-sectional study and does not show the cause-effect relationship between atopic dermatitis and determinants. Hence, the study recommends a longitudinal study in the same or similar setting. Lastly, the study did not conduct a clinical diagnosis of atopic dermatitis among participants.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study demonstrates that the prevalence of atopic dermatitis is comparable to previous findings in urban areas. Further investigation is warranted in rural areas regarding the occurrence of atopic dermatitis among children, as these areas often suffer from limited access to healthcare services. In addition, the study highlights the influence of residential and environmental factors in the development of atopic dermatitis. Consequently, there is a pressing need to implement environmental prevention programs aimed at safeguarding children residing in rural areas from the triggers of atopic dermatitis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e: The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e: The study was conducted following the Declaration of Helsinki and approved by the Research Ethics Committee of the University of Johannesburg Health Sciences (REC-01-11-2019 and 06 May 2019).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: Informed consent was obtained from all subjects involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e: The data can be accessed by the author upon a reasonable request and must adhere to the South African Protection of Personal Information Act (POPI Act).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contribution\u003c/strong\u003e: Conceptualization, T.PM.; methodology, T.P.M.; validation, T.P.M.; formal analysis, T.PM.; investigation, T.PM.; resources, T.PM.; data curation, T.P.M.; writing\u0026mdash;original draft preparation, T.PM.; writing\u0026mdash;review and editing, T.PM.; visualization, T.PM and project administration, T.PM.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: The researcher acknowledges the support from the Department of Environmental Health for financial support for logistics. An appreciation to the research assistants who assisted with data collection and study participants for their willingness to participate.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNutten S. Atopic Dermatitis: Global Epidemiology and Risk Factors. Ann Nutr Metab. 2015;66:1:8\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSasaki M, Yoshida K, Adachi Y, Furukawa M, Itazawa T, Odajima H, et al. Environmental factors associated with childhood eczema: Findings from a national web-based survey. Allergology Int. 2016;65:420\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuschkova D, Zeiser K, Ludwig A, Traidl-Hoffmann C. Atopic eczema is an environmental disease. Allergol Select. 2021;5:244\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSendrasoa FA, Razafimaharo TI, Ramarozatovo LS, Rapelanoro Rabenja F. 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J Allergy Clin Immunol. 2015;135:AB109.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkhtar S, Al-Shanfari S, Booalayan H, Abdulrasool M, Boujarwa A, Al-Mukaimi A, et al. Exposure to household secondhand tobacco smoke and the odds of developing atopic dermatitis among adolescents: A causal mediation analysis. Tob Induc Dis. 2024;22:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWerfel T, Heratizadeh A, Niebuhr M, Kapp A, Roesner LM, Karch A, et al. Exacerbation of atopic dermatitis on grass pollen exposure in an environmental challenge chamber. J Allergy Clin Immunol. 2015;136:96\u0026ndash;e1039.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIdrose NS, Lodge CJ, Peters RL, Douglass JA, Koplin JJ, Lowe AJ et al. The role of short-term grass pollen exposure in food skin‐prick test reactivity, food allergy, and eczema flares in children. 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J Eur Acad Dermatol Venereol. 2006;20:418\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePelucchi C, Galeone C, Bach J-F, La Vecchia C, Chatenoud L. Pet exposure and risk of atopic dermatitis at the pediatric age: A meta-analysis of birth cohort studies. J Allergy Clin Immunol. 2013;132:616\u0026ndash;e6227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOwnby DR, Peterson EL, Wegienka G, Woodcroft KJ, Nicholas C, Zoratti E, et al. Are cats and dogs the major source of endotoxin in homes? Indoor Air. 2013;23:219\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujimura KE, Johnson CC, Ownby DR, Cox MJ, Brodie EL, Havstad SL, et al. Man\u0026rsquo;s best friend? The effect of pet ownership on house dust microbial communities. J Allergy Clin Immunol. 2010;126:410\u0026ndash;e4123.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichards M, Ferber J, Chen H, Swor E, Quesenberry CP, Li D, et al. Caesarean delivery and the risk of atopic dermatitis in children. Clin Experimental Allergy. 2020;50:805\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapathoma E, Triga M, Fouzas S, Dimitriou G. Cesarean section delivery and development of food allergy and atopic dermatitis in early childhood. Pediatr Allergy Immunol. 2016;27:419\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Atopic dermatitis, household and environmental determinants, children, rural areas, prevalence","lastPublishedDoi":"10.21203/rs.3.rs-4633129/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4633129/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e: This study aimed to evaluate and determine the prevalence of atopic dermatitis, as well as the factors that contribute to its development, particularly household and environmental determinants, in young children residing in a rural area in South Africa.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubject and Methods\u003c/strong\u003e: A cross-sectional analytical study was conducted, wherein caregivers and children were purposefully recruited as participants. Data collection involved the utilization of an adapted version of the International Study of Asthma and Allergies in Childhood questionnaire, which was then analyzed using Stata MP version 18. The study included a total of 881 caregivers, with a majority of the child participants being boys (n=477, 54.14%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The prevalence rates of historical and current atopic dermatitis were found to be 13.96% and 18.62%, respectively. Natural birth was found to be a protective factor in the study for both historical (Adjusted Odds Ratio [AOR]: 0.094, 95% Confidence Interval [CI]: 0.039-0.224) and current atopic dermatitis (AOR: 0.098, 95% CI: 0.042-0.231). The use of a traditional grass broom for sweeping the floor, exposure to household environmental tobacco smoking, and undergoing renovations were associated with both historical and current atopic dermatitis. Moreover, having an indoor domestic cat (AOR: 2.166, 95% CI: 0.931-5.036) was found to be associated with current atopic dermatitis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: These findings demonstrate that the prevalence of atopic dermatitis in rural areas is similar to that in urban areas among children. Consequently, there is a need to provide primary health care services, particularly for skin diseases, which are currently limited in rural areas. Additionally, environmental health services could play a crucial role in the management and control of atopic dermatitis and similar conditions in rural areas.\u003c/p\u003e","manuscriptTitle":"Household and Environmental Determinants That Influence the Prevalence Atopic Dermatitis Among Young Rural Children, in Mpumalanga Province, South Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 01:24:08","doi":"10.21203/rs.3.rs-4633129/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"15fed2d7-f2a5-40f2-9012-34cb6ec1dfd0","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-28T21:53:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-19 01:24:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4633129","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4633129","identity":"rs-4633129","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}