The Prevalence and Associated Factors of Atopic Dermatitis in Children aged between Six Months and Twelve Years Attending the Pediatrics Dermatology Clinic at Kenyatta National Hospital, Kenya

Abstract

Background: Atopic dermatitis (AD), is chronic inflammatory skin disease characterized by acute flare-ups of intense pruritus and dry scaly lesions. The onset of AD is usually between 2 and 6 months of age, although it can begin at any age. AD affects up to 20% of children and 3% of adults; latest global data shows increases in its prevalence. In Africa, the prevalence of AD ranges from 4.7% to 23%. In Kenya, the prevalence and the associated factors among pediatrics is poorly defined as there is paucity of evidence around it. As such, the clinicians attending to these clients often rely on the theoretical and literature evidence sourced from other parts of the world. The study main objective is to determine the prevalence and associated factors of atopic dermatitis among pediatric patients aged between six months and twelve years seen at the dermatology clinic at Kenyatta National Hospital, Kenya.This was a cross sectional study conducted at the Dermatology Pediatrics Clinic in the period between August and November 2024. The sample for the study was recruited consecutively until the sample size of 148children was achieved. A structured questionnaire was used to collect data. The data collected include demographic, family and personal history of associated atopic conditions, atopic dermatitis diagnosis and severity of atopic dermatitis using POEM score. Ethical Approval was acquired from KNH-UON ERC. Data was analyzed using SPSS v.25 and the prevalence of atopic dermatitis was calculated as a proportion of the total sample size and expressed as percentage. Binary logistic regression was performed to investigate factors associated with AD. Significance was assessed at< 0.05. The results showed that majority of the patients, N=90(60.8%) were female, N=59 (39.9%) were aged more than 10 years, most patients had 1-5 siblings N= 62(41.9%) and N=112(75.7% had their mothers unemployed. The prevalence of atopic dermatitis was N=38(25.7%) with a CI of between 18.9% to 33.5%. After adjusting for cofounders, the adjusted odds ratio showed that factors associated with Atopic Dermatitis included age of 5 years and below (aOR = 12.11, 95% CI: 3.11, 56.37, p < 0.001), males (aOR = 2.83, 95% CI: 1.32, 6.03, p = 0.015), family history of allergic asthma (aOR = 8.33, 95% CI: 3.67 33.11, p < 0.001), family history of allergic rhinitis (aOR = 18.13, 95% CI: 7.67–70.11, p < 0.001), family history of allergic conjunctivitis (aOR = 6.11, 95% CI: 2.64–20.78, p = 0.007), family history of atopic dermatitis (aOR = 7.11, 95% CI: 1.36–23.63, p = 0.019), allergic asthma(aOR 11.18 95% CI3.14,25.11 P=<0.001), allergic rhinitis (aOR 12.88,95%CI 2.65,51.02 P=<0.001) and allergic conjunctivitis (aOR 15.53,95% CI 1.71,52.75 P=<0.001) . The severity of eczema among patients N=38 was assessed using the POEM score. The findings showed that 44.7% had minimal eczema, 34.2% had mild eczema, 13.1% had moderate eczema, and 7.4% had severe eczema. The study concluded that one in four children attending dermatology clinic were found to have atopic dermatitis. Younger children, males, and those with unemployed mothers had higher odds of developing AD. A family history of allergies and personal factors like allergic asthma, rhinitis, and conjunctivitis also increased the risk of AD. Thus, healthcare providers prioritize early screening for AD in children, especially those with a family history of allergies. Keywords: Atopic dermatitis, Eczema, pruritus, prevalence, associated factors