WHEN I first moved to Ndola I noticed a fine white powder would settle like dew on the surface on my not so brand new four wheel drive vehicle.
I observed this a little and wondered about it. If you have lived in Ndola a while you probably have never noticed it. It is one of those small things, most people will easily ignore and probably think nothing of.
When you live there for the first time it is quiet striking and especially noticeable on the car windows.
It gives the impression of someone having spread aerosolised agricultural pesticide while everybody was asleep.
If you are a frequently traveller to Ndola, you may have noticed that the Kabwe Road splits Ndola into two segments, the eastern part on your right as you drive northward towards Kitwe and the western part on your left.
When I moved from Northrise, which is to the North East part of the city, to Kansenshi which is a little towards the Northwest, I saw a decline in this phenomena. I also noticed that my children sneezed and coughed a lot less than they had when we first arrived.
I discovered later that there is a large lime deposit on the eastern part of the city which attracts a significant amount of quarrying.
This raises a storm of fine lime dust that sprinkles itself like confetti across the city carried by a gust of easterly winds.
This probably all sounds innocuous, except when you realises that one of the leading causes of childhood illness in Zambia is respiratory or more simply lung disease.
If you have ever travelled to Beijing, you will have noticed that most people on the streets wear paper face masks.
It gives the eerie feeling of something untoward in the air.
When you find you are the only one without a face mask on the streets, you feel a little unsettled.
If you looked up at the sky in downtown Beijing hoping to see the sun, you would be disappointed.
The air is often, if not always covered, by a thick black cloud of particulate matter, which hugs the city like a blanket.
When you experience it, you thank your lucky stars, that it has not yet got to that in Zambia.
There has been a precipitous increase particularly in lung diseases in Zambia over the last few years, especially of Asthma.
1. What is Asthma and what causes it?
It is one of those illnesses which children tend to dread, because it means when everyone else is having fun in the playground you cannot.
You also get the feeling of having your life frequently organised around what you can and cannot do because of the “Asthma”.
When you find that your Mum, always has things packed in readiness for your hospital admission, then you feel the illness has taken over your life.
It is an illness children have heard of ,long before they know how to spell it, because so and so was taken ill from class because of it.
So what is Asthma, and what is the big deal about it? Asthma is an illness of the airway tubes in the lungs.
The disease makes the tubes narrow, suddenly and unexpectedly.
This makes it difficult for a person to breath. Imagine the feeling of being suddenly and unexpectedly deprived of air to breath, that is the feeling an Asthmatic gets. What causes Asthma?
The main cause of Asthma, is an allergic response of the air way to an environmental agent or event.
This event or agent triggers the releases of potent body chemicals that make the muscles in the airway tube constrict, release mucus secretions and clog the air passages.
The end result, is that air cannot get through to the lung and into the rest of the body.
When this happens the air attempts to force its way through the air passages, resulting in the typical wheezing sound that is heard during an Asthmatic attack.
Typically the patient will be breathless, with the chest heaving and falling in an attempt to draw in air into the lungs.
The neck muscles are taut, as they also join in, assisting the muscles of the chest to suck air in to the lungs. It is an alarming thing to experience especially when it happens to your own child or relative.
2. What are the things that put people at risk for Asthma?
Two types of Asthma are described.
These are Intrinsic Asthma and Extrinsic Asthma. Intrinsic Asthma tends to occur in younger children and runs in families.
So for many children who have this type of Asthma, someone else in the family will have had Asthma.
The attacks of wheezing start early in childhood, and are often associated with other allergies.
Typically the child will have skin rashes, sneezing, cough and watery eyes.
They may be sensitive to particular foods such as fish or sea food.
They may also react to particular drugs, such as aspirins or brufen. In simple terms they have a very sensitive immune system that releases chemical allergens into the body in the presence of many triggers.
Some of the common triggers are house dust, drugs, exercise, cold air, anger, stress and some foods.
The typical child with Asthma, tends to have staining of the eyes from frequent itchiness (chronic allergic conjunctivitis), dark shadows around the eyes, from frequent rubbing.
What is sometimes described as Raccoon eyes. The Raccoon has characteristically a black colour around its eyes, while the rest of its coat is white.
This tends to improve with age and the number of attacks reduce in frequency.
This may occur as a result of the triggers being recognized and avoided, but also as the immune system adapts better with time.
Extrinsic Asthma on the other hand occurs in older people.
There is usually a specific triggers that initiate an Asthmatic attack. Unlike Intrinsic Asthma, it tends to have no other allergies associated with it.
Common things that will trigger an attack are house dust, pollen grains, cigarette smoke and pillow fluff.
The prevalence of Asthma in Zambia is said to be between 5-7% of the adult population.
It is higher in children, and there has been a notable increase in Zambia with urbanization.
Asthma is a lot less common in rural areas than it is in urban areas.
3. What can be done to prevent this illness?
Many parents are understandably over protective of their children with Asthma.
This however makes the child less independent and more vulnerable.
Some children will also use the threat of an Asthmatic attack to manipulate parents into doing what they want. Neither of these extremes is desirable.
The child should be encouraged to accept that they have a long standing illness, but that aside from it they are perfectly healthy.
They should be encouraged to understand their illness and learn how to live with it.
The child should be allowed to live as normal a life as possible.
It is alarming for schools or teachers to receive long lists from parents of what the child should or should not do.
This has a tendency to isolate the child from other children and make for a miserable life growing up, friendless.
Many children will have less and less frequent attacks as they grow older and take charge of their own life.
Children should be weaned early from depending on their parents. Mothers are the most difficult to wean from sickly children.
They have a tendency to be overly protective, and thus encourage a reclusive and introversive childhood.
Eventually this kind of child tends to have social and sometimes relationship problems as they get older.
There are three basic approaches to prevention or reduction of Asthmatic attacks as follows
1.Avoidance of trigger
2.Adaptation to triggers
3.Allergen control
Identify early the common triggers and avoid them. It is easiest to control indoor allergens, by this is meant those allergens within the house.
The regular washing of beddings is encouraged every 1 to 2 weeks. Avoid carpets that collect dust and are difficult to clean.
Use pillows with natural and not synthetic pillow fillings.
Ensure adequate ventilation in the house and avoid dampness in the house. Make sure the windows are openned during the day and there is good exposure to the sun and ultra violet radiation during the day.
This prevents dampness and development of wall fungus or mold.
Regular good cleaning and removal of corner cob webs will keep the house well aerated and free of pollutants.
Prefer leather seats over fabric that can keep and hold house dust.
Make sure that your roof is solid and has no seepage into the walls during the rainy season.
This makes the house damp and grows house mold which is a common allergen.
Avoid household pets, especially from getting into the house and sleeping on the beds.
They carry a lot of allergens, including animal fluff, which may predispose to an asthmatic attack. Ensure regular pest control of the home.
Do not allow smoking in the house. Out door allergens are more difficult to control. Encourage out door activities.
Reduce these during seasons of peak pollen load. Spend as much time as you can in the country side, avoid living in highly urbanized cities with large levels of motor vehicle and industrial pollution if you can.
Boarding schools, which are in more rural setting can be good places to send children, in order to make them more independent and avoid common outdoor triggers.
Over the years, as children get older their body adapts to the triggers and they no longer have attacks due to them.
This is called desensitization.
The body’s defense system begins to recognize the allergen as harmless.
Therefore controlled exposure to increasing loads of allergen will progressively allow the body to adapt to it.
In practice it amounts to a practice of letting the child live as normal a life as possible. Using an inhaler will pre-empt impending attacks.
This is useful for children. An inhaler, contains an aerosolized drug that can be inhaled any time the child feels stuffy in the chest.
This will often abort an impending Asthmatic attack.
Over time some drugs and tablets can be used that prepares the body for any trigger.
This tends to keep the Asthmatic attacks to a minimum and also to abort them early.
Regular maintenance doses of anti asthmatic tablets like salbutamol, ipratropium bromide and steroids when necessary are helpful.
The cells stabilizing drug Sodium chromoglycate can also be used for this purpose. Studies have shown that regular use of Vitamin D reduces some of the chemicals in the body that mediate allergic reaction and has been shown, to be useful.
It is suggested that mothers who breast feed for longer and avoid cigarette smoke tend to have children with lower incidence of Asthma.