Prevalence of Asthma, Nutritional Status and Family Functionality in School Children of a Primary Care Unit in Tijuana, Mexico

Mini Review

J Fam Med. 2020; 7(2): 1195.

Prevalence of Asthma, Nutritional Status and Family Functionality in School Children of a Primary Care Unit in Tijuana, Mexico

Flores-Escutia M1*, Bermudez-Villalpando VI1, Gonzalez-Acosta JF1, Soto-Ibarra KG1, Garcia- Linares NC1 and Flores-Escutia R2

Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, Mexico

*Corresponding author: Rodriguez-Banuelos Mayra Alejandra, Department of Family Medicine, Family Medicine Unit #27 (IMSS), Baja California Delegation, Mexico

Received: December 18, 2019; Accepted: January 29, 2020; Published: February 05, 2020


Background: The prevalence of asthma in Mexico varies according to the region, in cities of the center and south it ranges between 7 and 17%.

Objective: To determine the prevalence of asthma, nutritional status and family functionality in school children of a primary care unit in Tijuana.

Methods: For the prevalence of asthma, the questionnaire "Diagnosis of Asthma for Epidemiological Studies" was applied in schoolchildren of the family medicine unit #27 in Tijuana. Nutritional status was measured with the body mass index for age according to Centers for Disease Control and Prevention (CDC) growth charts; for family functionality, family APGAR was used. In the bivariate analysis, odds ratio, Chi-square and Mann-Whitney U with a 95% confidence interval were used, a p <0.05 was considered significant.

Results: 58 cases of asthma were found with a prevalence of 28%. In nutritional status, 93 (45%) children were overweight or obese. Family dysfunctional was found in 51 (25%) families.

Conclusions: The prevalence of asthma, obesity and family dysfunction are high in this area of Tijuana compared to central and southern Mexico.

Keywords: Asthma; Pediatric Obesity; Family Functionality


Asthma is the most common chronic airway disease in pediatrics [1], has variable symptoms but the classic manifestations are wheezing, dyspnea, cough, chest tightness, bronchial hyper reactivity and variable airflow obstruction [2-4]. Pathophysiology continues under study but there is evidence of a complex interaction between genetic and environmental factors [5]; although genetics is important in the development of asthma, environmental factors such as climate change, pollution, changes in the home environment and industrialization can explain variations in prevalence of this disease [6].

The frequency of asthma worldwide varies from 235 to 300 million people [4]. In Latin America, according to The International Study of Asthma and Allergies in Childhood (ISAAC), a prevalence of 17% is estimated [7] with variations according to age and region; in children, Brazil reports 13% [8]; Argentina from 10 to 18% [9]; Bolivia 14% [9]; Chile from 11 to 21% [10]; Colombia from 9 to 17% [11]; Venezuela from 15 to 20% and Peru 20% [9]. In Mexico, the prevalence of asthma ranges between 1 and 15% [9].

The prevalence of asthma is based on the clinical diagnosis and the report of questionnaires created for the evaluation of symptoms. These instruments are auxiliary tools in the diagnosis and monitoring of patients; the most used is ISAAC, which evaluates the frequency of asthma symptoms, atopic dermatitis and allergic rhinitis in children aged 6 to 7 years and adolescents aged 13 to 14 years [12]. In Mexico, Mancilla-Hernández and collaborators created and validated the questionnaire “diagnosis of asthma for epidemiological studies” to determine the prevalence of asthma in Mexican children, which has been applied in different regions of the country [13].

According to the Mexican questionnaire, Puebla has a prevalence of 14%; Tulancingo 17%; Tlaxcala 7%; Cancun 14% [14] and Cuernavaca 11.9% [15], with an average of 12.7% in the five cities. The use of the Mexican questionnaire in different regions of the country allows a more precise evaluation of the prevalence of asthma considering the national context, also offers a more comprehensive view on the background, symptoms and evolution of patients.

Asthma requires constant attention from all family members, especially parents. Due to its evolution, multiple visits to the doctor and even hospitalizations in the emergency services may be necessary. These paranormative crises and disease events cause changes in the daily life of the family, with repercussions on normal family functioning and adjustment of roles [16]. The family influences the behavior of the children by supporting healthy lifestyle habits such as balanced eating and frequent physical activity, which are important resources in the treatment of asthma and shape the behavior of children through observation and adaptation [17]. All of the above, the general objective of the study was to determine the prevalence of asthma, nutritional status and family functionality in children aged 6 to 12 years in a primary care medical unit in Tijuana, Mexico.



Tijuana is the sixth most populous city in Mexico with 1.6 million inhabitants and is located as the sixth metropolitan area of the country. Together with the cities of Rosarito, Tecate and San Diego, they make up the largest transnational metropolitan area in Mexico with more than 2.2 million inhabitants. Tijuana's climate is dry and very dry, with temperatures ranging from 5-30°C, with an annual average of 19°C. Rains are very scarce with an annual average rainfall of 200 millimeters [18].

Study design and population

An analytical cross-sectional study was carried out in Tijuana, Baja California, Mexico, between January and April 2019. The research was carried out in the family medicine unit #27 (FMU #27) of the Instituto Mexicano del Seguro Social (IMSS); first level care unit and main center of health care in the region. Patients of school age (6-12 years) who agreed to participate in the study by informed consent and informed consent by parents were included. Children with lung diseases (except asthma), neurological or psychiatric were excluded from the study; the patients were recruited in the waiting rooms of the outpatient clinic of family medicine.


The collection of variables was done with a standardized data sheet; the variables to be studied were the following: age, which was collected directly from the patients and their medical card; sex, through phenotypic characteristics; nutritional status, the Quetelet formula (BMI= weight/height2) was used to calculate the body mass index, then the percentile patient for age was calculated according to the tables of the Center for Disease Control and Prevention (CDC), was considered overweight and obese who exceeded the 85th and 95th percentile respectively.

Family functionality was measured according to the family APGAR questionnaire, which consists of five questions that seek to demonstrate the individual perception of the functional status of the family, was created by Smilkstein [19] in 1978 and validated into Spanish in 1996 [20], is considered a functional family if the score is equal to or greater than 7 points in at least two family members older than 10 years; finally, the diagnosis of asthma was made with the Mexican questionnaire “diagnosis of asthma for epidemiological studies”, which was validated in 2014 with a cronbach alpha of 0.7 designed for children and adults, consists of nine items, taking as diagnosis a score greater than or equal to 0.75 [13].

Statistical analysis

In the qualitative variables we use frequencies and percentages; for quantitative variables, median and interquartile range. Asthma frequency was determined using the formula for punctual prevalence. The normality test was performed using the Kolmogorov-Smirnov test. Chi-square analysis was performed to test the differences in the categorical variables and the odds ratio was used to calculate the relative risk. The results were evaluated in a 95% confidence interval, a p <0.05 was considered significant. For data analysis, the IBM SPSS program, version 20 (Armonk, NY, USA) was used.