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High prevalence of asthma symptoms in Warao Amerindian children in Venezuela is significantly associated with open-fire cooking: a cross-sectional observational study

Stèphan Kraai1, Lilly M Verhagen12*, Enrique Valladares3, Joaquin Goecke3, Lorena Rasquin3, Paula Colmenares3, Berenice Del Nogal34, Peter WM Hermans1 and Jacobus H de Waard23

Author Affiliations

1 Laboratory of Pediatric Infectious Diseases, Radboud University Medical Centre, PO Box 9101 (internal post 224), 6500 Nijmegen, HB, The Netherlands

2 Laboratorio de Tuberculosis, Instituto de Biomedicina, Caracas, Venezuela

3 Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela

4 Departamento de Pediatría, Hospital de Niños J.M. de los Ríos, Caracas, Venezuela

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Respiratory Research 2013, 14:76  doi:10.1186/1465-9921-14-76

Published: 20 July 2013



The International Study on Asthma and Allergies in Childhood (ISAAC) reported a prevalence of asthma symptoms in 17 centers in nine Latin American countries that was similar to prevalence rates reported in non-tropical countries. It has been proposed that the continuous exposure to infectious diseases in rural populations residing in tropical areas leads to a relatively low prevalence of asthma symptoms. As almost a quarter of Latin American people live in rural tropical areas, the encountered high prevalence of asthma symptoms is remarkable. Wood smoke exposure and environmental tobacco smoke have been identified as possible risk factors for having asthma symptoms.


We performed a cross-sectional observational study from June 1, 2012 to September 30, 2012 in which we interviewed parents and guardians of Warao Amerindian children from Venezuela. Asthma symptoms were defined according to the ISAAC definition as self-reported wheezing in the last 12 months. The associations between wood smoke exposure and environmental tobacco smoke and the prevalence of asthma symptoms were calculated by means of univariate and multivariable logistic regression analyses.


We included 630 children between two and ten years of age. Asthma symptoms were recorded in 164 of these children (26%). The prevalence of asthma symptoms was associated with the cooking method. Children exposed to the smoke produced by cooking on open wood fires were at higher risk of having asthma symptoms compared to children exposed to cooking with gas (AOR 2.12, 95% CI 1.18 - 3.84). Four percent of the children lived in a household where more than ten cigarettes were smoked per day and they had a higher risk of having asthma symptoms compared to children who were not exposed to cigarette smoke (AOR 2.69, 95% CI 1.11 - 6.48).


Our findings suggest that children living in rural settings in a household where wood is used for cooking or where more than ten cigarettes are smoked daily have a higher risk of having asthma symptoms.

Asthma[Mesh]; Wheeze; Woodsmoke; Tobacco smoke pollution[Mesh]; Smoke[Mesh]; Indigenous children