Asthma prevalence, associated factors and role of adverse childhood experiences among school-going adolescents: the national School Health Survey in Togo (SHeST-study)

Abstract

BACKGROUND: Limited contemporary epidemiological data exist for asthma among school-aged adolescents in Togo. This study aimed to estimate the prevalence of asthma among Togolese adolescents in Grand-Lomé (an urbanised region in the south) and Kara (a more rural area in the north). Furthermore, we explored demographics and risk factors associated with asthma diagnoses, with specific emphasis on the role of adverse childhood experiences (ACEs). METHODS: A cross-sectional study was conducted in secondary schools across southern and northern regions of Togo between February and March 2025. Adolescents aged 10-19 years were enrolled using multistage stratified random sampling. Asthma screening utilised International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires and spirometry with reversibility testing. ACEs were assessed using ACE-Q. A multilevel mixed-effects penalised binary logistic regression model identified factors associated with asthma. RESULTS: Among 2416 adolescents included in final analysis, median age was 16.0 years (IQR: 14.0-17.0), with 55.4% female. Overall asthma prevalence was 8.7% (95% CI: 7.6 to 9.9), with higher rates in the southern region (10.5%) compared with northern region (5.9%) (p<0.001). High childhood adversity (adjusted OR (aOR)=1.79; 95% CI: 1.09 to 2.94) was associated with asthma. Other factors significantly associated with asthma included: parental history of asthma (aOR=2.87; 95% CI: 2.03 to 4.05), and overweight/obesity (aOR=1.81; 95% CI: 1.22 to 2.68). Older age (aOR=0.93; 95% CI: 0.87 to 0.99) and male gender (aOR=0.67; 95% CI: 0.48 to 0.93) were associated with lower asthma likelihood. CONCLUSION: Asthma prevalence among school-going adolescents in Togo is substantial and shows marked regional variation. Beyond established risk factors, the observed association with ACEs supports the need for integrated strategies addressing both physical and psychosocial determinants and for strengthening school-based surveillance and care pathways.