Targeting housing conditions of high-risk groups

Public Health Significance of Urban Pests 33

1.8. Conclusions

Asthma is a major disease of the urban environment and a substantial burden from the standpoint of both the quality of life for the many suffering from the disease and the eco- nomics of health care. The global increase in the prevalence of asthma in the last half of the 20th century has disproportionately affected urban communities in many countries. The evidence that relates asthma and domestic exposure to cockroaches, mice, and dust mites is clear. These pests are common in urban environments and play a significant role in the pathogenesis of urban asthma. Removing these pests and their allergens is a logi- cal tactic for preventing disease and reducing symptoms, but this tactic needs improved efficacy. Results from studies on avoiding allergens suggest cautious expectations about the ease with which long-term clinically relevant allergen reductions can be accomplis- hed. However, the burden of asthma in urban communities may be effectively reduced through more broadly defined asthma interventions that include allergen reduction tai- lored to an individual’s specific allergy, education about effective methods for sustained integrated pest management and general education about asthma. Allergic asthma 32 sure to pet allergens, avoidance of exposure to ET S, encouragement of extended 4 months breastfeeding and the introduction of partially hydrolysed formula as a breast- milk substitute. While there was no difference in atopy by age 2 years, those children in the active group were significantly less likely to have possible or probable asthma Becker et al., 2004. At age 7 years, the children in the active group were significantly less likely than children in the placebo group to have asthma diagnosed by a study physician Chan-Yeung et al., 2005. While lung function testing did not reveal a difference in the prevalence of bronchial hyperreactivity between the active and control groups, the active children were significantly less likely to have bronchial hyperreactivity with symptoms of wheezing. Another study, a controlled trial from the Isle of Wight, used allergen avoi- dance and either the mother maintained a diet with a low level of allergens while breast- feeding or fed the child hydrolysed formula Arshad, Bateman Matthews, 2003. This relatively small study reported that at the age of 8 years the children in the active group were significantly less likely than the children in the control group to wheeze, have noc- turnal cough or be atopic skin test positive to several food and inhaled allergens. In summary, to date the studies on primary prevention of asthma, by avoiding allergens, do not allow for a conclusion on the efficacy of this approach. As with tertiary preven- tion, dust mite covers alone do not appear to be sufficient Koopman et al., 2002; Horak et al., 2004. In one study, stringent dust mite control in the domestic environment resul- ted in better lung function, but increased atopy at age 3 years, a finding that must be exa- mined in greater detail when the children reach an age at which a reliable diagnosis of asthma can be made Woodcock et al., 2004. Multifaceted interventions, which include extended breastfeeding, delayed introduction of allergic foods and reduced exposure to ETS, appear to offer some protection Arshad, Bateman Matthews, 2003; Chan-Yeung et al., 2005. While exclusive breastfeeding and reduced exposure to ETS also can be recommended for health reasons other than asthma Arshad, 2005, the relative contri- bution of allergen avoidance in these types of studies is difficult to determine. Continued follow-up of the children in these studies at a later age and more comprehensive studies are needed to better understand the potential long-term efficacy of allergen avoidance as a component of primary prevention of asthma.

1.7.3. Targeting housing conditions of high-risk groups

In light of the high prevalence of asthma, it seems reasonable to focus public health efforts on urban communities, especially impoverished communities. The ramifications of gen- trification of these neighbourhoods are myriad and include displacement of low-income communities to fringe areas that could have equally poor or worse housing conditions Kennedy Leonard, 2001; Higgins, Wakefield Cloutier, 2005. Certainly, a holistic approach is necessary to improve housing conditions without marginalizing those at risk of developing asthma. Public Health Significance of Urban Pests References 2 Aberg N 1989. Asthma and allergic rhinitis in Swedish conscripts. Clinical and Experimental Allergy , 19:59–63. Abramson MJ, Puy RM, Weiner JM 2003. Allergen immunotherapy for asthma. Cochrane Database Systematic Reviews , 4:CD001186 DOI:10.100214651858.CD001186; http:www.mrw.interscience.wiley.comcochraneclsysrevarticlesCD001186frame.html, accessed 21 January 2007. Almqvist C et al. 2003. 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2. Cockroaches

Michael K. Rust Summary Cockroaches are one of the most significant pests found in apartments, homes, food- handling establishments, hospitals and health care facilities worldwide. Indoor species, especially the German cockroach, exploit conditions associated with high-density human populations and impoverished living conditions. In some areas of the United Kingdom and Europe, the oriental and brownbanded cockroach may also be present. Poor sanita- tion, disrepair of a structure and clutter contribute to large populations of cockroaches. In these situations, their medical importance requires the implementation of aggressive integrated pest management IPM programmes. To minimize the likelihood of insecti- cide resistance in cockroach populations and human exposure to insecticides, strategies that include baiting and built-in pest control should be adopted. Cockroach species that are found outdoors, such as the American, smokybrown and oriental cockroach, require IPM programmes that focus on altering and removing sui- table habitats and that use baits and possibly even biological control options. The primary focus is directed outdoors to prevent them from gaining access to structures.