Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren.

OBJECTIVE: The extent to which urban children endure the symptoms and consequences of asthma without a physician diagnosis has not been well studied. Our objective was to obtain an estimate of the prevalence of possible undiagnosed asthma in a population of urban schoolchildren. DESIGN AND METHODS: A population-based cross-sectional study was conducted in urban schoolchildren, grades 3 to 5. Undiagnosed asthma was defined as caretaker report of symptoms and/or bronchial hyperresponsiveness, defined as a 15% or greater drop in baseline forced expiratory volume in 1 second, after exercise challenge. RESULTS: A total of 230 children (61% of those eligible) participated in the study. Forty children (17.4%; 95% Confidence interval (CI) = 12.5% to 22.3%) had reports of a physician diagnosis of asthma. Of these, 33 (14.3%; (95% CI = 9.8% to 18.9%) reported wheezing in the past 12 months. Among the remaining 189 eligible children, 11 (5.8%; 95% CI = 2.5% to 9.2%) met study criteria for undiagnosed asthma based on bronchial hyperresponsiveness (BHR). Another 16 (8.5%; 95% CI = 4.5% to 12.4%) met study criteria for undiagnosed asthma through modified American Thoracic Society symptom criteria. Overall, 27 children (27/189; 14.3%) fulfilled criteria for undiagnosed asthma. Children identified as having undiagnosed asthma were compared with children who had no BHR and no symptoms and who did not report a physician diagnosis of asthma (children without asthma). Children with BHR were more likely to have a report of allergies and eczema than children without asthma, odds ratios (OR) = 8.5 (95% CI = 2.4 to 30.7) and 6.4 (95% CI = 1.1 to 38.1), respectively. Children meeting symptom criteria were more likely to have a report of allergies, OR = 6.2 (95% CI = 2.0 to 19.1), and bronchitis, OR = 6.7 (95% CI = 2.0 to 22.4), and were also more likely to report sleep disruption, OR = 7.1 (95% CI = 2.3 to 21.8) and missed physical education classes, OR = 15.0 (95% CI = 4.8 to 46.7), compared with children without asthma. CONCLUSIONS: We estimated a prevalence of 14.3% for possible undiagnosed asthma among urban schoolchildren, grades 3 to 5, through caretaker report of symptoms or BHR postexercise challenge. Children with undiagnosed asthma reported more atopic disease than children without asthma. In addition, children meeting symptom criteria for asthma reported more bronchitis, sleep disruption, and missed physical education classes than did those without asthma. These results suggest that rates of undiagnosed asthma may be high in this predominantly black school-age population.

Encuesta domiciliaria sobre salud y enfermedad en zonas rurales de Bolivia. / Household survey of health and disease in rural areas of Bolivia

La encuesta domiciliaria que aqui se presenta proporciona informacion reciente acerca de los patrones de morbilidad y mortalidad en las zonas rurales de los llanos de Bolivia.Se pretende que los datos ayuden a los planificadores de salud y a otros interesados en mejorar los servicios rurales de salud en esta y otras situaciones comparables

Prevalence and cost of illness episodes in rural Bolivia.

As part of a demonstration project to improve the delivery of health services in rural Bolivia, a household survey of 3372 persons (98% participation) was conducted in the Montero region of eastern Bolivia during the last 3 months of 1977. The population surveyed was relatively young, 52% less than 15 years of age. Spells of illness occurring during the 14 days prior to the survey were reported by 42% of the population. Nearly half (46%) of these symptomatic illnesses, here defined as illness episodes, were respiratory or gastrointestinal problems, and medical assistance was sought for 21% of them. Physicians were consulted by 70% of the persons who sought medical assistance. Only 39% of persons disabled 3 or more days by a symptomatic illness obtained medical assistance. The average expenditure for illness episodes during the preceding 2 weeks was $2.13 per person, 76% for medication, 15% for fees, 5% for transportation, and 4% for other expenses. The results of this survey are intended to aid the Bolivian government in planning more effectively for improved rural health services.