Validation of the International Study of Asthma and Allergies in Children (ISAAC) and UK criteria for atopic eczema in Ethiopian children
Validation of the International Study of Asthma and Allergies in Children (ISAAC) and UK criteria for atopic eczema in Ethiopian children
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DOI：
10.1111/j.1365-2133.2005.06511.x
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发表时间：
2005-04-01
影响因子：
10.3
通讯作者：
Williams, HC
中科院分区：
文献类型：
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作者：
Haileamlak, A;Lewis, SA;Williams, HC
背景 特应性湿疹 (AE) 的可靠诊断标准对于进行国际比较和确定可能的疾病危险因素至关重要。对于英语不是第一语言的发展中国家特应性湿疹的患病率和 AE 诊断标准的有效性知之甚少。 目的 我们试图确定埃塞俄比亚城乡地区 AE 的患病率，并比较不同问卷和检查方法诊断该人群 AE 的预测值。 方法 我们对埃塞俄比亚西南部 Jimma 镇及其周边地区的 7915 名 1-5 岁儿童进行了横断面调查。 AE 患病率通过两种方式进行评估：(i) 使用国际儿童哮喘和过敏研究 (ISAAC) 调查问卷，以及 (ii) 使用英国改进的 Hanifin 和 Rajka 诊断标准。然后，由经验丰富的当地儿科医生对通过筛查问题和随机对照样本确定的所有可能病例进行检查，该儿科医生作为参考标准来确定用于诊断 AE 的标准的预测价值。 结果 根据 ISAAC 和英国标准，AE 的 1 年期总体患病率为 4.4%[95% 置信区间 (CI) 3.95-4.85] 和 1.8%（95% CI） 1.5-2.1），分别。 ISAAC 的相应点患病率估计值（上周的症状）为 1.8%，英国标准为 1.3%。 ISAAC 和英国标准问题对医生检查时仍报告存在的 AE 症状（上周）的阳性预测值分别为 48.8% 和 55.5%。相应的阴性预测值分别为90.5%和90.1%。单独使用可见弯曲皮炎的体征（英国标准的一个组成部分）时，其阳性和阴性预测值分别为 57% 和 91%。 结论 在本次调查中，ISAAC 和英国标准在预测 AE 病例方面均表现不佳。可能的原因包括问卷翻译问题、术语的文化观念、向父母而不是孩子询问症状、AE 症状的短暂性以及医生对典型 AE 病例的看法存在差异。结果并不排除在未来对埃塞俄比亚儿童的调查中使用标准化诊断标准和医生检查，并且了解该标准有限的预测价值应有助于解释采用此类标准的研究结果。应考虑采用可见的屈曲皮炎体征作为估计全球 AE 点患病率的标准，因为它不易受到翻译和解释问题的影响。
Background Reliable diagnostic criteria for atopic eczema (AE) are essential in order to make international comparisons and to identify possible disease risk factors. Little is known about the prevalence of atopic eczema and validity of diagnostic criteria for AE in developing countries where English is not the first language.Objectives We sought to determine the prevalence of AE in an area of urban and rural Ethiopia, and to compare the predictive values of different questionnaire and examination methods for diagnosing AE in this population.Methods We conducted a cross-sectional survey of 7915 children aged 1-5 years living in and around the town of Jimma in southwest Ethiopia. AE prevalence was assessed in two ways: (i) by using the International Study for Asthma and Allergies in Childhood (ISAAC) questionnaire, and (ii) using the U.K. refinement of Hanifin and Rajka's diagnostic criteria. All possible cases identified by screening questions and random samples of controls were then examined by an experienced local paediatrician, who acted as a reference standard to determine the predictive value of the criteria used to diagnose AE.Results The overall 1-year period prevalence of AE according to ISAAC and U.K. criteria was 4.4%[95% confidence interval (CI) 3.95-4.85] and 1.8% (95% CI 1.5-2.1), respectively. Corresponding point prevalence estimates (symptoms in the last week) were 1.8% for ISAAC and 1.3% for the U.K. criteria. The positive predictive values of the ISAAC and U.K. criteria questions for AE symptoms still reported to be present (in the last week) at the doctor's examination were 48.8% and 55.5%, respectively. Corresponding negative predictive values were 90.5% and 90.1%, respectively. The sign of visible flexural dermatitis (a component of the U.K. criteria) when used alone had positive and negative predictive values of 57% and 91%, respectively.Conclusions Neither the ISAAC nor U.K. criteria performed especially well in predicting cases of AE in this survey. Possible reasons include problems with questionnaire translation, cultural conceptions of terminology, asking parents rather than the child about symptoms, the transient nature of AE signs, and differences in what a doctor perceives to constitute a typical case of AE. The results do not preclude the use of standardized diagnostic criteria alongside a doctor's examination in future surveys of Ethiopian children, and knowledge of the criteria's limited predictive value should help to interpret study findings that have employed such criteria. Consideration should be given to adopting the sign of visible flexural dermatitis as a standard for estimating the point prevalence of AE throughout the world because it is less susceptible to problems with translation and interpretation.