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Symptom-based screening tool for asthma syndrome among young children in Uganda
Rebecca Nantanda1,2, Volkert Siersma3, Grace Ndeezi4
1Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda. rnantanda@gmail.com.
Insights
A new questionnaire effectively screens for asthma syndrome in young children with severe respiratory illness. This simple tool aids in early asthma diagnosis, improving care for under-fives.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Epidemiology
Background:
- Under-diagnosis of asthma in children under five years old is a significant clinical challenge.
- Accurate diagnosis in this age group is often complicated by non-specific symptoms and diagnostic difficulties.
- Improved screening tools are needed to identify children with potential asthma early.
Purpose of the Study:
- To evaluate a questionnaire-based screening tool for identifying asthma syndrome in children under five with severe respiratory illness.
- To compare questionnaire responses with expert consensus diagnoses.
Main Methods:
- A questionnaire assessing respiratory symptoms was administered to 614 children under five with severe respiratory illness in Uganda.
- Expert pediatricians made consensus diagnoses based on comprehensive clinical data, including history, physical examination, lab tests, and bronchodilator response.
- Children with asthma or bronchiolitis were classified as having "asthma syndrome".
Main Results:
- Asthma syndrome was diagnosed in 253 (41.2%) of the children.
- A combination of four questionnaire items (history of and present breathing difficulties, present cough, and wheezing) demonstrated high performance.
- This combination achieved a sensitivity of 80.8% and a specificity of 84.7% for detecting asthma syndrome.
Conclusions:
- The questionnaire-based screening tool shows potential as a simple, cost-effective, and rapid method for identifying children under five with possible asthma syndrome.
- Further validation and reliability testing of the tool in primary care settings are recommended.
Abstract:
Under-diagnosis of asthma in 'under-fives' may be alleviated by improved inquiry into disease history. We assessed a questionnaire-based screening tool for asthma among 614 'under-fives' with severe respiratory illness in Uganda. The questionnaire responses were compared to post hoc consensus diagnoses by three pediatricians who were guided by study definitions that were based on medical history, physical examination findings, laboratory and radiological tests, and response to bronchodilators. Children with asthma or bronchiolitis were categorized as "asthma syndrome". Using this approach, 253 (41.2%) had asthma syndrome. History of and present breathing difficulties and present cough and wheezing was the best performing combination of four questionnaire items [sensitivity 80.8% (95% CI 77.6-84.0); specificity 84.7% (95% CI 81.8-87.6)]. The screening tool for asthma syndrome in 'under-fives' may provide a simple, cheap and quick method of identifying children with possible asthma. The validity and reliability of this tool in primary care settings should be tested.
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