Prevalence of asthma-like symptoms by ISAAC video questionnaire in Mozambican schoolchildren

Abstract

Background. The International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire was developed to overcome the language and cultural differences in the assessment of asthma-like symptoms. Methods. 27 schools were included in the Maputo Asthma and Allergies in childhood Study (MAPAAS) using ISAAC methods, and a video questionnaire (VQ) was administered to 1614 adolescents 13-14 years old of 20 schools located in urban, suburban and semi-rural areas of Maputo (Mozambique). Simultaneously, they also replied to the ISAAC written questionnaire (WQ). Results. According to the video questionnaire, the prevalence of current asthma was 11.9% (compared with 13.3% using the written questionnaire). Wheezing after exercise in the last year was reported by about 21%. Females reported more frequent wheezing after exercise than males (p<.001). The prevalence of nocturnal cough in the last year was 24.7%, and was more frequent in the suburban area (p<.001). “Severe attacks of asthma” was reported by 11.9% of the individuals. Teenagers instructed in the suburban schools reported more severe asthma-like symptoms than others (p<.05). There was a poor correlation between the WQ and the AVQ3.0 (kappa coefficients varied from 0.09 to 0.24). The lowest agreement was observed for the question regarding severe attacks of asthma. Agreement was better in terms of specificity than in terms of sensitivity. Conclusions. In spite of the poor agreement between the written and the video questionnaires, the prevalence of asthma symptoms estimated using the video questionnaire confirms that asthma is an important public health problem in Maputo.

Estimated Burden of Serious Fungal Infections in Mozambique

“…Surveys of adolescents in 27 schools located in urban, suburban and semi-rural areas of Maputo showed the prevalence of asthma (13.3%) to be higher than in adults ( Table 2 ) [ 48 ], so the ABPA rate may be an underestimate, although this disease has yet to be recognized in Mozambique.…”

“…The prevalence of “severe attacks of asthma” has been reported between the 11.9% and 13.3% of the adolescents of 20 schools located in urban, suburban and semi-rural areas of Maputo City. Teenagers instructed in the suburban schools reported more severe asthma-like symptoms than others ( p < 0.05) [ 8 , 48 ] ( Table 3 ). We calculated from these assumptions that SAFS affects 9072 Mozambican adolescents annually at a rate of 34 cases per 100,000 person–years ( Table 3 ).…”

Questionnaires for asthma in children: written or video?

“…Interestingly, the difference between the two questionnaires appears to be much smaller in Mozambique, where the Portuguese version of the ISAAC questionnaire was used, which has been clinically validated [23]. Despite this fact, the report of severe asthma in the written questionnaire in that study was sometimes higher than the report of any wheezing, suggesting some misunderstanding of the written questions, as is also well described by the authors [16]. Furthermore, the prevalence of wheezing on exercise, night wheeze and severe attacks in Mozambique appear to be higher with the video questionnaire.…”

“…One of the most popular hypothesis to explain the lower report of wheezing symptoms of the video questionnaire is that it would only identify the more severe cases of asthma [12,14]. The data from Mozambique [16] strongly suggests that this is not the case, as no difference has been found in the prevalence of video-reported symptoms between rural and urban areas, whereas the written questionnaire indicated more severe forms of asthma in the latter. A more likely explanation is that the sensitivity of the video questionnaire is just lower than anticipated in preliminary validation studies.…”

“…In the present issue of the Monaldi Archives, two groups; one from Iran and one from Mozambique present data on the epidemiology of childhood asthma in their countries, comparing the ISAAC video and written questionnaires [15][16]. Like most of previous reports using these instruments, they found that the video questionnaire provided lower symptom prevalence estimates than the written one (although this does not seem to occur for some questions in Mozambique), and that the agreement between the two questionnaires was poor.…”