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Validity of a respiratory questionnaire to identify pneumonia in children in Lima, Peru
C F Lanata1, N Quintanilla, H A Verastegui
1Instituto de Investigación Nutricional, Lima, Peru.
Insights
This study validates a survey questionnaire for identifying childhood pneumonia in surveillance programs. A combination of cough, fast breathing, and fever accurately identifies pneumonia cases within a 30-day recall period.
Area of Science:
- Pediatrics
- Epidemiology
- Public Health
Background:
- Clinical pneumonia is a significant cause of mortality in children under 3.
- Accurate diagnostic tools are crucial for monitoring and evaluating respiratory control programs.
- Community-based surveillance provides a valuable platform for validating health assessment tools.
Purpose of the Study:
- To assess the validity of a survey questionnaire for diagnosing clinical pneumonia in young children.
- To determine the optimal recall period and symptom combination for accurate pneumonia detection via survey.
- To evaluate the questionnaire's utility in community-based prospective surveillance.
Main Methods:
- A nested case-control study design was employed.
- Cases of clinical pneumonia were identified from a prospective surveillance study of children under 3 years.
- Three types of matched controls (ARI clinic, ARI community, healthy community) were selected.
Main Results:
- The combination of cough, fast breathing or shortness of breath, and fever yielded the highest positive predictive value for pneumonia.
- Questionnaire sensitivity decreased when interviews occurred more than 15 days post-diagnosis.
- A 15-day recall period did not improve the survey's positive predictive value.
Conclusions:
- The validated survey questionnaire, using a 30-day recall and specific symptom combinations, is a viable tool for monitoring respiratory control programs in trained, surveilled populations.
- Further evaluation in untrained populations and diverse regions is necessary before widespread adoption for Acute Respiratory Infection (ARI) control programs.
Abstract:
We conducted a nested case-control study utilizing cases of clinical pneumonia identified in a community-based prospective surveillance study of children under 3 years of age in order to test the validity of a survey questionnaire. Three types of sex- and age-matched concurrent controls were selected from the surveillance population: acute respiratory infection (ARI) clinic controls. ARI community controls and healthy community controls. Survey interviews were scheduled at random for any of four consecutive 7-day periods after the diagnosis of the case. The questionnaire covered a 30-day recall period. The combination of cough with fast breathing or shortness of breath, and with fever, provided the highest positive predictive value for pneumonia. The sensitivity of some questions dropped when the interview took place more than 15 days after the diagnosis of the case. However, the utilization of a 15-day recall period did not increase the positive predictive value of the survey. We conclude that in this trained population under surveillance, a survey questionnaire utilizing a 30-day recall period and using the combination of cough, fast breathing or shortness of breath and fever to define episodes with a high likelihood of pneumonia, offers an acceptable tool for the monitoring and evaluation of respiratory control programmes. This questionnaire needs further evaluation in an untrained population and in other regions before it can be adopted for use in ARI control programmes.