Pneumonia case-finding in the RESPIRE Guatemala indoor air pollution trial: standardizing methods for resource-poor settings.
OBJECTIVE: Trials of environmental risk factors and acute lower respiratory infections (ALRI) face a double challenge: implementing sufficiently sensitive and specific outcome assessments, and blinding. We evaluate methods used in the first randomized exposure study of pollution indoors and respirat...
| Published in: | Bulletin of the World Health Organization Vol. 85; no. 7; pp. 535 - 545 |
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| Main Authors: | , , , , , , , , , , , |
| Format: | clinical trial research tables/charts Journal Article |
| Published: |
World Health Organization
Jul2007
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106157091&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106157091 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00429686 BUW jtl: Bulletin of the World Health Organization issn: 00429686 maglogo: N pubinfo: dt: Jul2007 vid: 85 iid: 7 pid: 437 pub: World Health Organization artinfo: ui: 106157091 106157091 2009644875 10.2471/blt.06.035832 NLM17768502 106157091 ppf: 535 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Pneumonia case-finding in the RESPIRE Guatemala indoor air pollution trial: standardizing methods for resource-poor settings. aug: au: Bruce N Weber M Arana B Diaz A Jenny A Thompson L McCracken J Dherani M Juarez D Ordonez S Klein R Smith KR affil: Division of Public Health, Whelan Building, University of Liverpool, Liverpool L69 3GB, England; ngb@liv.ac.uk sug: subj: Air Pollution, Indoor Adverse Effects Pneumonia Epidemiology Child, Preschool Clinical Trials Confidence Intervals Data Analysis Software Data Analysis, Statistical Descriptive Statistics Guatemala Infant kappa Statistic P-Value Pneumonia Mortality Pulse Oximetry Referral and Consultation Sensitivity and Specificity Human Child, Preschool: 2-5 years Infant: 1-23 months ab: OBJECTIVE: Trials of environmental risk factors and acute lower respiratory infections (ALRI) face a double challenge: implementing sufficiently sensitive and specific outcome assessments, and blinding. We evaluate methods used in the first randomized exposure study of pollution indoors and respiratory effects (RESPIRE): a controlled trial testing the impact of reduced indoor air pollution on ALRI, conducted among children <or= 18 months in rural Guatemala. METHODS: Case-finding used weekly home visits by fieldworkers trained in integrated management of childhood illness methods to detect ALRI signs such as fast breathing. Blindness was maintained by referring cases to study physicians working from community centres. Investigations included oxygen saturation (SaO2), respiratory syncytial virus (RSV) antigen test and chest X-ray (CXR). FINDINGS: Fieldworkers referred > 90% of children meeting ALRI criteria, of whom about 70% attended a physician. Referrals for cough without respiratory signs and self-referrals contributed 19.0% and 17.9% of physician-diagnosed ALRI cases respectively. Intervention group attendance following ALRI referral was 7% higher than controls, a trend also seen in compliance with RSV tests and CXR. There was no evidence of bias by intervention status in fieldworker classification or physician diagnosis. Incidence of fieldworker ALRI (1.12 episodes/child/year) is consistent with high sensitivity and low specificity; incidence of physician-diagnosed ALRI (0.44 episodes/child/year) is consistent with comparable studies. CONCLUSION: The combination of case-finding methods achieved good sensitivity and specificity, but intervention cases had greater likelihood of reaching the physician and being investigated. There was no evidence of bias in fieldworkers classifications despite lack of concealment at home visits. Pulse oximetry offers practical, objective severity assessment for field studies of ALRI. Copyright © 2007 World Health Organization pubtype: Academic Journal doctype: clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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