VALIDITY OF A RESPIRATORY QUESTIONNAIRE TO IDENTIFY PNEUMONIA IN CHILDREN IN LIMA, PERU

We conducted a nested case-control study utilizing cases of clinical p neumonia identified in a community-based prospective surveillance stud y 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 c ontrols were selected from the surveillance population: acute respirat ory infection (ARI) clinic controls, ARI community controls and health y community controls. Survey interviews were scheduled at random for a ny of four consecutive 7-day periods after the diagnosis of the case. The questionnaire covered a 30-day recall period. The combination of c ough with fast breathing or shortness of breath, and with fever, provi ded the highest positive predictive value for pneumonia. The sensitivi ty of some questions dropped when the interview took place more than 1 5 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 surveil lance, a survey questionnaire utilizing a 30-day recall period and usi ng 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 ce ntral programmes. This questionnaire needs further evaluation in an un trained population and in other regions before it can be adopted for u se in ARI control programmes.