A National Communications Campaign to decrease childhood stunting in Tanzania: an analysis of the factors associated with exposure.

BACKGROUND: Childhood stunting is a major problem in Tanzania, affecting an estimated 2.7 million children under 5 years of age. The purpose of this study was to examine the factors associated with exposure to mass media (radio and television) and IPC (interpersonal communication) components integrated in a national communications campaign aiming to decrease stunting in Tanzania. METHODS: A cross-sectional survey was conducted among 3082 men and 4996 women dyads after the campaign. The average age of men was 34.7 years (SD = 8.9) and 28.1 years (SD = 6.9) for women. Several factors affecting exposure to the campaign were studied. Comparisons were made between radio, TV, and IPC exposure. RESULTS: Mothers who reported i) higher wealth, ii) being the primary decision-makers in the home, iii) receiving support from their husbands, iv) frequent access to radio and TV and, v) ownership of a cell phone, were more likely to report exposure to the mass media component of the communications campaign. Contrarily, the same factors were not predictors of exposure to the IPC component. Fathers who reported: i) higher wealth and education, ii) ownership of a cell phone, iii) recently listened to the radio, iv) that the mother made the decisions in the home and v) helping at home, were more likely to be exposed to the mass media component. CONCLUSION: Significant factors affecting exposure to the communications campaign were varied but not consistent between mass media and IPC. Because of the high frequency of exposure to the campaign overall, both media and IPC components are important in a large-scale, health-related communications campaign.

Tanzanian men's engagement in household chores is associated with improved antenatal care seeking and maternal health.

BACKGROUND: Male support for partners' antenatal care (ANC) has the potential to improve women's care-seeking and maternal health outcomes. This study describes factors that are associated with men's involvement in household tasks and explores the relationship between men's help with tasks and women's ANC-seeking, diet and workload during pregnancy as well as other health behaviors. METHODS: This study was conducted in five Lake Zone regions of Tanzania. Cross-sectional surveys were carried out among approximately 10,000 households that had children under the age of 2 years. Surveys were administered to mothers of children less than 2 years and where available, their male partners. Data were collected between December 2015 and May 2020, in conjunction with a large-scale campaign aimed at reducing childhood stunting by changing the behavior of mothers, caregivers, and decision makers. Data analysis included bivariate analysis and logistic regression modeling. RESULTS: Men's engagement in household activities was significantly associated with living in an urban setting, being younger, having at least some formal schooling, early verbal interactions with their children, and male involvement in healthcare decisions. Additionally, mothers of male partners that were engaged in household activities were significantly older and more likely to have at least some secondary school education. Relative to households where men only infrequently helped out with chores or not at all, women from households where men frequently helped were significantly more likely to have taken iron tablets during pregnancy, report having eaten more than usual, lessening their household workload during their most recent pregnancy, and more likely to have played with their child in the week prior to the survey. CONCLUSION: Male's participation in household tasks is associated with a general improvement in mother's ANC behaviors. Implicit in these findings is that general primary education for both men and women has health benefits that transcend socioeconomic class and that future interventions aimed to engage males in household tasks may target older males with less education living in rural areas.

Interpersonal communication campaign promoting knowledge, attitude, intention, and consumption of iron folic acid tablets and iron rich foods among pregnant Indonesian women.

BACKGROUND AND OBJECTIVES: Indonesia's community health delivery system offers services such as prenatal care and supplementation. Despite accessibility to these services, compliance with supplementation is low, and childhood stunting rates remain high. To address undernutrition, a National Nutrition Communication Campaign (NNCC) - using interpersonal communication (IPC) strategies - was implemented to promote consumption of iron-folic acid (IFA) supplements and iron-rich foods (ATIKA). The purpose of this study was to understand how participation in IPC activities influenced knowledge, attitude/intention, and consumption of IFA supplements and ATIKA among pregnant Indonesian women. METHODS AND STUDY DESIGN: Cross-sectional data came from 766 pregnant women that participated in a survey that was based on the constructs from the Theory of Planned Behavior and Health Belief Model. Adjusted linear and logistic regression models were conducted to analyze the differences between self-reported IPC participants and non-IPC participants. Approximately 20% of women were exposed to the IFA portion of the IPC campaign, and 18% were exposed to the ATIKA portion. RESULTS: Women that were exposed to the campaign reported significantly higher knowledge of IFA tablets and ATIKA, and improved attitudes/intentions towards IFA, compared to non-exposed women. Exposure was not associated with actual consumption behaviors. CONCLUSIONS: These findings suggest that exposure to a low-intensity intervention can increase knowledge but may not be sufficient to impact behavior. As such, future efforts to reduce stunting through improved maternal nutrition should seek to increase exposure, address barriers, understand perceived susceptibility, and improve self-efficacy in order to expand intervention reach in Indonesia.

Does BCG vaccination protect against childhood asthma? Final results from the Manchester Community Asthma Study retrospective cohort study and updated systematic review and meta-analysis.

BACKGROUND: The Manchester Community Asthma Study (MANCAS) found a protective effect against the risk of wheeze at age 6 to 11 years for children given neonatal BCG vaccination. Our subsequent systematic review and meta-analysis suggested that BCG vaccination did not protect against allergic sensitization but might have exerted a protective effect against nonatopic asthma. OBJECTIVES: We sought to assess whether the protective effect of BCG vaccination on wheeze observed in the MANCAS cohort was maintained at age 13 to 17 years and to incorporate the findings from this final MANCAS analysis into an updated systematic review and meta-analysis. METHODS: BCG vaccination status was determined from health records and respiratory outcomes from questionnaire responses. We updated the systematic review and used fixed-effects and random-effects modeling to undertake meta-analyses. RESULTS: There were 1608 participants in the final MANCAS analysis. The 12-month prevalence of wheeze was 15.1%. There was no difference in prevalence between those who were and were not BCG vaccinated (15.8% vs 14.3%; relative risk, 1.05; 95% CI, 0.94-1.19). The updated meta-analysis incorporated 4 new studies: this showed that the protective effect of BCG vaccination against the development of asthma identified in our previous meta-analysis was attenuated (odds ratio, 0.95; 95% CI, 0.89-1.00). No protective effect of BCG was seen for sensitization, eczema/atopic dermatitis, rhinoconjunctivitis, or allergy in general. CONCLUSIONS: Taken together, the final results of the MANCAS cohort and the updated systematic review and meta-analysis provide clearer evidence that any protective effect of BCG vaccination on childhood asthma is likely to be transient.

Measuring treatment coverage for neglected tropical disease control programs: analysis of a survey design.

Monitoring of treatment coverage following mass drug administration is essential to ensure program success. Coverage results reported by drug administrators are often validated by using population surveys. This study evaluates the design of a multistage cluster sample survey conducted in 2007-2008 and implemented at the district level to assess drug coverage in the 4 African countries of Burkina Faso, Ghana, Niger, and Uganda. Estimates of precision of coverage were calculated, and factors contributing to the observed variance were analyzed. Precision of ±5 percentage points was obtained in 39% (n = 12) of cases, and precision of ±10 percentage points was obtained in 77% (n = 24) of cases. The factor having the largest impact on the actual precision obtained in these surveys was the high level of clustering, the impact of which is incorporated in the design effect. Key recommendations are made for the design and analysis of future surveys; guidelines are presented for thinking through the number of clusters that should be selected and how a cluster should be designed.

The Impact of a Large-Scale Social and Behavior Change Communication Intervention in the Lake Zone Region of Tanzania on Knowledge, Attitudes, and Practices Related to Stunting Prevention.

BACKGROUND: Large-scale social and behavioral change communication (SBCC) approaches can be beneficial to achieve improvements in knowledge, attitudes, and practices (KAP). Addressing Stunting in Tanzania Early (ASTUTE) included a significant SBCC component and targeted precursors to stunting including KAP related to maternal and child health, antenatal care, WASH, childhood development, and male involvement. METHODS: Baseline, midline, and endline surveys were conducted for a total of 14,996 female caregivers and 6726 male heads of household in the Lake Zone region of Tanzania. Regression analyses were used to estimate differences in KAP from baseline to midline and endline. RESULTS: Women's knowledge of handwashing and infant/child feeding practices, and attitudes related to male involvement, consistently improved from baseline to midline and baseline to endline. Women's practices related to antenatal care, breastfeeding, and early child development improved from baseline to midline and baseline to endline. Improvements in KAP among male heads of household were varied across indicators with consistent improvement in practices related to child feeding practices from baseline to midline and baseline to endline. CONCLUSION: Many changes in KAP were observed from baseline to midline and baseline to endline and corresponded with SBCC programming in the region. These results provide support for the value of large SBCC interventions. Public health efforts in settings such as Tanzania may benefit from adopting these approaches.

BCG vaccination and allergy: a systematic review and meta-analysis.

BACKGROUND: There is conflicting evidence on whether BCG vaccination might represent an effective primary preventative strategy against the development of allergic sensitization and disease. OBJECTIVES: We sought to systematically review the relationship between BCG vaccination and the risk of sensitization, eczema/atopic dermatitis, allergic rhinoconjunctivitis, asthma, and other allergic conditions, such as food allergy and anaphylaxis. METHODS: Four international databases were searched for published epidemiologic or interventional studies. Additional online study databases were searched and vaccine manufacturers and a panel of international experts were contacted in an attempt to locate unpublished or ongoing studies. Quality assessment was undertaken by using internationally established criteria. Meta-analyses were undertaken by using fixed- or random-effects modeling. Funnel plots were used to assess for the risk of publication bias. RESULTS: We identified 767 articles, of which 17 satisfied our inclusion criteria; there was only 1 randomized controlled trial, with the remaining studies being epidemiologic investigations. Meta-analyses did not show any protective effect of vaccination against the risk of sensitization, as judged by specific IgE tests (odds ratio [OR], 1.31; 95% CI, 1.07-1.60) or skin prick testing (OR, 0.87; 95% CI, 0.67-1.13); the risk of atopic eczema/dermatitis (OR, 0.84; 95% CI, 0.64-1.09); or the risk of allergic rhinoconjunctivitis (OR, 1.07; 95% CI, 0.89-1.28). BCG vaccination was associated with a protective effect against the risk of asthma (OR, 0.73; 95% CI, 0.56-0.95), although this might be explained by publication bias. CONCLUSIONS: BCG vaccination is unlikely to be associated with protection against the risk of allergic sensitization and disease. The observed possible benefit in relation to the development of asthma is unlikely to be due to allergic sensitization.

Promoting Caregiver Early Childhood Development Behaviors through Social and Behavioral Change Communication Program in Tanzania.

Objectives: Stunting remains a prevalent issue in Tanzania. The consequences of stunting include reduced height, greater susceptibility to disease, and diminished cognitive ability throughout the lifespan. Lack of psychosocial stimulation is associated with increased stunting, particularly in terms of its cognitive impact. The Addressing Stunting in Tanzania Early (ASTUTE) program was a large social and behavior change communication (SBCC) intervention that aimed to reduce childhood stunting in the region by targeting early childhood development (ECD) behaviors. The purpose of this study is to report on the extent to which exposure to ASTUTE might be related to ECD behaviors. Methods: ASTUTE disseminated program messages via a mass media campaign and interpersonal communication (IPC). Logistic regression models were used to explore the relationship between exposure to TV, radio, IPC messages, and key ECD behaviors of female primary caregivers and male heads of household. Results: Among primary caregivers, IPC was positively associated with all ECD behaviors measured. Radio was associated with all behaviors except drawing with their child. TV was associated with all behaviors except playing with their child. Among heads of household, only the radio was positively associated with the ECD behaviors measured. Conclusions for practice: Findings indicate that SBCC interventions that include mass media and IPC components may be effective at promoting parental engagement in ECD behaviors. Significance: We know that ECD is important for a child's development. We know that parents play a critical role in promoting ECD behaviors. We are still exploring ways to influence parents so that they are more involved in ECD behaviors. The results presented here provide evidence for successful mass media and IPC efforts to improve parents' ECD behaviors. We hope this study will add more evidence for large interventions such as these to the literature, and we are very hopeful that governments and large international NGOs will prioritize SBCC approaches in the future, especially in locations where face-to-face interventions may be challenging.

Association between WASH-Related Behaviors and Knowledge with Childhood Diarrhea in Tanzania.

BACKGROUND: Diarrhea remains a major cause of morbidity and mortality among children in Tanzania. The purpose of this study was to explore associations between diarrheal disease and water, sanitation, and hygiene (WASH) related behaviors and determine care-seeking predictors for diarrheal disease. METHODS: Data from 9996 female primary caregivers were collected as part of a larger integrated nutrition program. Logistic regression was used to measure associations between predictor and dependent variables and diarrheal and care-seeking outcomes. RESULTS: Knowledge of the importance of handwashing after assisting a child who has defecated (OR 0.79, CI 0.72-0.87), before preparing food (OR 0.88, CI 0.80-0.97), and before feeding a child (OR 0.89, CI 0.81-0.99) were each associated with not having a child with diarrhea in the past two weeks. Fathers or male caregivers (OR 0.65, CI 0.48-0.89) were less likely to seek medical care for a child with diarrhea. No associations were found between WASH-related knowledge or behavior and seeking medical care for a child with diarrhea. CONCLUSIONS: Findings indicate that knowledge of handwashing importance was significant in washing hands after assisting a child who has defecated, before preparing food, and prior to feeding a child. These findings demonstrate the value of parental involvement to lower morbidity and mortality among children.

National Nutrition Communication Campaign in Indonesia: a cross-sectional study of factors associated with exposure.

BACKGROUND: Reducing childhood stunting continues to be a priority in Indonesia. In 2015, the National Nutrition Communication Campaign (NNCC) implemented mass media and interpersonal communication (IPC) interventions to disseminate stunting-related information. Whereas other studies of the NNCC's impact on attitudes and behaviors are currently underway, the purpose of this study was to better understand the factors associated with exposure to the media and IPC components of the NNCC. METHODS: A cross-sectional survey was conducted following the NNCC media and IPC campaigns in rural Indonesia. The final study sample included 1734 mothers. Survey data was collected from each participant by trained interviewers using an electronic tablet. Responses relating to demographic and socioeconomic factors, use of social media and WhatsApp, and electronic device ownership were analyzed. Logistic regression analyses, using SAS version 9.4, were conducted to evaluate the relationship between technology-related items and exposure to both the media and the IPC interventions. RESULTS: Owning an internet device (OR = 1.643, CI = 1.237-2.183, p < 0.001), accessing social media (OR = 1.81, CI = 1.32-2.49, p < 0.001), using a device to access health information (OR = 2.068, CI = 1.469-2.911, p < 0.0001), and accessing WhatsApp (OR = 1.663, CI = 1.175-2.355, p < 0.05) were positively related to exposure to NNCC messages meant to change behavior to decrease stunting. In separate analyses, owning an internet device (OR = 0.609, CI = 0.459-0.81, p < 0.001) accessing social media (OR = 0.626, CI = 0.459-0.854, p < 0.05), using a device to access health information (OR = 0.528, CI = 0.377-0.740, p < 0.001), and accessing WhatsApp (OR = 0.688, CI = 0.489-0.968, p < 0.05) were negatively related to IPC exposure. Mothers with access to internet-accessible devices were more likely to be exposed to the media campaign component to decrease stunting while mothers without access to internet-accessible devices were more likely to be exposed through IPC. CONCLUSIONS: Mothers who owned devices that could access the internet were more likely to have been exposed to the media campaign component to decrease stunting by behavior change but were less likely to participate in IPC activities. The opposite was true for mothers who did not have access to internet-accessible devices. These findings may be used to inform future community health efforts in rural Indonesia and similar regions that may be considering the use of both mass media and interpersonal interventions to influence health behaviors in order to decrease stunting.

An interpersonal nutrition campaign and maternal knowledge and childhood feeding practices: a case study from mothers in rural Indonesia.

BACKGROUND: The purpose of this study was to examine the extent to which a national nutrition communication campaign (NNCC) intervention providing interpersonal communication (IPC) was associated with improved knowledge and behaviors related to feeding practices among mothers with children under two years of age in rural Indonesia. METHODS: Data came from a follow-up, cross-sectional survey of 1734 mothers. Key outcomes of interest were minimum meal frequency, minimum dietary diversity and minimum acceptable diet, as defined by the World Health Organization. Associations between exposure to the NNCC intervention and infant and young child feeding (IYCF) knowledge and behaviors were analyzed using adjusted linear and logistic regression, controlling for age, education, and income. RESULTS: A total of 525 mothers reported exposure to IPC interventions (30.3%). Participation in IPC was associated with increased knowledge of feeding practices (p < .0001). Separately, knowledge of feeding practices was related to achieving recommended behavioral practices of minimum meal frequency (p = 0.019), dietary diversity (p = 0.013), adequate diet (p < .001). CONCLUSION: These findings underscore the value of increasing maternal knowledge of IYCF practices through IPC interventions as a way to improve behavioral practices and address stunting in rural Indonesia.

Prevalence of respiratory symptoms, features of asthma, and characteristics associated with respiratory disease, in 6-11 year olds in Manchester.

AIMS: This paper describes the prevalence of respiratory symptoms, features of asthma, and characteristics associated with respiratory disease in 6-11 year old children in an historical cohort study. METHODS: The study included 5086 children, all born in the same maternity unit in the north west of England over a four-year period. The prevalence of respiratory symptoms, features of asthma, and characteristics associated with respiratory disease were determined by the use of parent-completed questionnaires. Skin prick tests were used to ascertain atopic status. RESULTS: The response was 47.5%. The prevalence of wheeze, asthma medication use and atopic sensitisation were 20.3%, 16.2% and 37.1% respectively. Wheeze and atopy were significantly more prevalent in boys (22.4% versus 17.9% and 43.0% versus 29.3%, respectively). CONCLUSIONS: This study identified a high prevalence of respiratory disease in this population and provides a baseline for monitoring trends in respiratory disease in 6-11 year old children.

Factors influencing the response to postal questionnaire surveys about respiratory symptoms.

BACKGROUND: Response rates to postal questionnaires have been falling in recent years. AIM: To examine factors affecting the response to five postal respiratory questionnaire surveys. DESIGN: Cross sectional study. SETTING: General practice. METHOD: Five surveys were conducted in all adults registered with two UK general practices using an ECRHQ-based questionnaire, with two reminders at 4-week intervals. RESULTS: Response rates declined over time (1993 - 71.2%; 1995 - 70.5%; 1999 - 65.5%; 2001 - 65.3%; 2004 - 46.9%). Age and gender of non-responders were available for 2001 and 2004: responders were older (mean 48.8 years vs 37.6, p<0.001; 50.5 vs 38.8, p<0.001) and more likely to be female (54.9% vs 44.9%, p<0.001; 55.3% vs 48.5%, p<0.001). The response rate was increased by 18% (2004) and 23% (2001) by the use of two reminders. Early responders were older and more likely to be females, but were less likely to smoke than late responders after reminders. There was no important association between respiratory symptoms and associated feature prevalence and stage of response. CONCLUSION: Declining response rates may represent reduced motivation and reluctance to share personal information. Qualitative exploration of late/non-response could help reduce bias when planning and analysing such surveys. The use of two reminders is an important factor in improving response.

Maternal Employment Status and Minimum Meal Frequency in Children 6-23 Months in Tanzania.

As women in developing world settings gain access to formal work sectors, it is important to understand how such changes might influence child nutrition. The purpose of this paper is to examine the relationship between maternal employment status and minimum meal frequency (MMF) among children in Tanzania. Interviews were conducted with 5000 mothers of children ages 0⁻23 months. The questionnaire used in these interviews was developed by adopting questions from Tanzania's latest Demographic and Health Survey (2015⁻2016) where possible and creating additional questions needed for programmatic baseline measurements. MMF was used as proxy for child nutrition. Logistic regression analyses were used to identify associations between employment status and parenting practices of Tanzanian mothers and MMF of their children. After adjusting for confounders, informal maternal employment [OR = 0.58], lack of financial autonomy [OR = 0.57] and bringing the child with them when working away from home [OR = 0.59] were negatively associated with meeting MMF. Payment in cash [OR = 1.89], carrying food for the child [OR = 1.34] and leaving food at home for the child [OR = 2.52] were positively associated with meeting MMF. Informal maternal employment was found to be negatively associated with meeting MMF among Tanzanian children. However, behaviors such as bringing or leaving prepared food, fiscal autonomy and payment in cash showed significant positive associations. These findings could help direct future programs to reduce child stunting.

Vaccine-preventable haemophilus influenza type B disease burden and cost-effectiveness of infant vaccination in Indonesia.

BACKGROUND: Most of Asia, including Indonesia, does not use Haemophilus influenzae type b (Hib) conjugate vaccines. We estimated total vaccine-preventable disease burden and the cost-effectiveness of Hib conjugate vaccine in Indonesia. METHODS: Hib pneumonia and meningitis incidences for children with access to health care were derived from a randomized vaccine probe study on Lombok Island, Indonesia during 1998-2002. Incidences were adjusted for limited access to care. Health system and patient out-of-pocket treatment cost data were collected concurrent with the probe study. For Hib vaccine in monovalent and combined (with DTP-HepB) presentations, we used 2007 UNICEF vaccine prices of US$3.30 and $3.75 per dose. RESULTS: For the 2007 Indonesian birth cohort, Hib vaccine would prevent meningitis in 1 of every 179 children, pneumonia in 1 of every 18 children, and 4.9% of mortality among those younger than 5 years. The total incremental societal costs of introducing Hib vaccine in monovalent and pentavalent presentations were, respectively, US$11.74 and $8.93 per child vaccinated. Annual discounted treatment costs averted amounted to 20% of pentavalent vaccine costs. For the pentavalent vaccine, the incremental costs per discounted death and disability adjusted life-year averted amounted to US$3102 and $74, respectively, versus $4438 and $102 for monovalent vaccine. CONCLUSIONS: Routine infant Hib vaccination would prevent a large burden of pediatric illness and death in Indonesia. Even without external funding support, Hib vaccine will be a highly cost-effective intervention in either a monovalent or pentavalent presentation based on commonly used benchmarks.

Comparison of artemether-lumefantrine with sulfadoxine-pyrimethamine for the treatment of uncomplicated falciparum malaria in eastern Nepal.

Because available data suggest that resistance of Plasmodium falciparum to sulfadoxine-pyrimethamine (SP) is increasing in Nepal, an open-label, parallel-group efficacy/safety study was conducted in 99 Nepalese patients with uncomplicated falciparum malaria randomized 2:1 to artemetherlumefantrine (AL) or SP. Efficacy was assessed from clinical and microscopic evidence of treatment failure. Four SP-treated patients (12.1%; 95% CI, 4.0-29.1%) redeveloped parasitemia during the 28-day follow-up versus 0% (95% CI, 0-6.9%) in the AL group (P = 0.011), a difference that was confirmed by polymerase chain reaction (PCR) analysis of parasite DNA. PCR detected an additional six patients (two SP and four AL) with sub-microscopic gametocytemia or breakthrough parasitemia between Days 14 and 28, suggesting that AL efficacy was lower than estimated by microscopy. Dhfr and dhps mutations were not associated with outcome. AL is more effective than SP for uncomplicated malaria in Nepal, but regular monitoring of its efficacy should be carried out if this combination therapy is introduced.

Incidences of vaccine-preventable Haemophilus influenzae type b pneumonia and meningitis in Indonesian children: hamlet-randomised vaccine-probe trial.

BACKGROUND: Most studies of Haemophilus influenzae type b (Hib) disease in Asia have found low rates, and few Asian countries use Hib vaccine in routine immunisation programmes. Whether Hib disease truly is rare or whether many cases remain undetected is unclear. METHODS: To estimate incidences of vaccine-preventable Hib pneumonia and meningitis among children younger than 2 years in Lombok, Indonesia, during 1998-2002, we undertook a hamlet-randomised, controlled, double-blind vaccine-probe study (818 hamlets). Children were immunised (WHO schedule) with diphtheria, tetanus, pertussis (DTP) or DTP-PRP-T (Hib conjugate) vaccine. Vaccine-preventable disease incidences were calculated as the difference in rates of clinical outcomes between DTP and DTP-PRP-T groups. Analyses included all children who received at least one vaccine dose. FINDINGS: We enrolled 55073 children: 28147 were assigned DTP-PRP-T and 26926 DTP. The proportion of pneumonia outcomes prevented by vaccine ranged from less than 0 to 4.8%. Calculated incidences of vaccine-preventable Hib disease (per 10(5) child-years of observation) for outcome categories were: substantial alveolar consolidation or effusion, less than zero (-43 [95% CI -185 to 98]); all severe pneumonia, 264 (95% CI less than zero to 629); all clinical pneumonia, 1561 (270 to 2853); confirmed Hib meningitis, 16 (1.4 to 31); meningitis with cerebrospinal-fluid findings consistent with a bacterial aetiology, 67 (22 to 112); and admission for suspected meningitis or presenting to a clinic with convulsions, 158 (42 to 273). INTERPRETATION: Hib vaccine did not prevent the great majority of pneumonia cases, including those with alveolar consolidation. These results do not support a major role for Hib vaccine in overall pneumonia-prevention programmes. Nevertheless, the study identified high incidences of Hib meningitis and pneumonia; inclusion of Hib vaccine in routine infant immunisation programmes in Asia deserves consideration.

Smoking, respiratory symptoms and likely asthma in young people: evidence from postal questionnaire surveys in the Wythenshawe Community Asthma Project (WYCAP).

BACKGROUND: Although it is recognised that smoking is a major risk factor for subjects with chronic obstructive pulmonary disease and is associated with respiratory symptoms, there is less agreement concerning the relationship between asthma and smoking. This study aims to examine the relationship between cigarette smoking and asthma prevalence. METHOD: Data were used from two postal questionnaire surveys (1999 and 2001) in two general practice populations, using a respiratory questionnaire based on the ECRHQ and a generic quality of life questionnaire (EQ-5D). Only subjects less than 45 years old were included in the survey. An empirical definition of likely asthma was used based on respiratory questionnaire responses. Smoking was examined according to three categories, current smoker, ex smoker and never smoker. RESULTS: Almost 3500 subjects were included in the analyses. Current smokers had a higher prevalence of likely asthma compared to never smokers, odds ratio (OR) 1.59 (95% confidence interval (CI) 1.24 to 2.04). and also compared to ex smokers OR 1.79 (CI 1.25 to 2.56), but there was no difference between ex smokers and never smokers (OR 1.00 (0.75-1.35)). Current smoking was also positively associated with all symptoms but not with a history of hayfever/eczema. CONCLUSION: Although the positive association found between current smoking and obstructive airways disease is likely to be due to the effect of cigarettes on asthma, it could reflect an association with early COPD (GOLD stages 0 or 1). Smoking cessation has a beneficial effect on the prevalence of respiratory symptoms and is therefore of paramount importance among these young adults.

Temporal change in the prevalence of respiratory symptoms and obstructive airways disease 1993-2001.

BACKGROUND: There has been little available information regarding secular changes in the prevalence of respiratory symptoms since the mid-1990s. AIM: To examine changes in the prevalence of respiratory symptoms for 1993-2001. DESIGN OF STUDY: A series of postal questionnaire surveys. SETTING: Two general practice populations, including all age groups. METHOD: Four postal respiratory questionnaire surveys were conducted between 1993 and 2001. Subjects who replied to two or more surveys (8058 adults and 2350 children) were included in the main analyses. Validated scoring systems were used to define obstructive airways disease in adults and asthma in children. RESULTS: Over the 8-year observation period there were increases among adults in the crude prevalence of wheeze, being woken by cough, receipt of current asthma medication, and of obstructive airways disease, compared with decreases in children for wheeze, night cough, asthma attacks, and asthma. For adults, adjusted odds ratios per year of secular increase were 1.03 (95% confidence interval [CI] = 1.02 to 1.03) for wheeze, 1.03 (95% CI = 1.02 to 1.03) for being woken by cough, 1.03 (95% CI = 1.02 to 1.04) for asthma medication, and 1.02 (95% CI = 1.01 to 1.03) for obstructive airways disease. These increases were greater in those aged over 44 years, in males, and in those without a family history of asthma or a history of hayfever or eczema. Corresponding decreases for children were 0.94 (95% CI = 0.92 to 0.97) for wheeze, 0.93 (95% CI = 0.91 to 0.96) for night cough, 0.93 (95% CI = 0.90 to 0.95) for asthma attacks and 0.98 (95% CI = 0.95 to 1.00) for asthma. CONCLUSION: The increases found in adults are more likely to be due to chronic obstructive pulmonary disease (COPD) than asthma. This is supported by the decreases in symptom and asthma prevalence in children.

Incidence and clinical features of hospitalization because of respiratory syncytial virus lower respiratory illness among children less than two years of age in a rural Asian setting.

BACKGROUND: Lower respiratory illness is the leading cause of child death in the developing world. Despite this few reports on respiratory syncytial virus (RSV) lower respiratory illness disease burden exist from rural areas of the developing world, and none exist for Indonesia. METHODS: We evaluated children living in any of 83 villages on Lombok Island, Indonesia who were <2 years of age when hospitalized for severe lower respiratory illness during 2000 and 2001. All hospitals on Lombok were included in the evaluation. We obtained the number of births and deaths that occurred within the study villages and time frame, allowing for incidence determination. RESULTS: Of 2677 children hospitalized for severe lower respiratory illness whose RSV status was determined, 23% had a positive test; this percentage varied from 50% at the end of the rainy season to 0% shortly before the start of the rainy season. Among children <2 years of age, the confirmed and estimated incidences of severe RSV lower respiratory illness hospitalization were 10 and 14 per 1000 child-years, respectively; values for children <1 year of age were 17 and 25 per 1000 child-years. The confirmed case-fatality percentage among RSV-positive cases was 1.9%; however, 84% of children who died were dead before RSV status could be determined, suggesting the actual case fatality percentage was higher. CONCLUSIONS: Lombok has a large burden of severe childhood RSV lower respiratory illness, and death occurs frequently. Novel RSV vaccines thus could have a substantial positive impact on lower respiratory illness morbidity and mortality.