Risk factors for wheezing in infants born in Cuba.

BACKGROUND: Cuba is a unique country, and despite limited economic development, has an excellent health system. However, the prevalence of asthma symptoms in children in Havana, Cuba, is unusually high. AIM: As early life exposures are critical to the aetiology of asthma, we have studied environmental influences on the risk of wheezing in Cuban infants. DESIGN: Cross-sectional study. METHODS: A random sample of 2032 children aged 12-15 months living in Havana was selected for inclusion in the cohort. Data were collected using questionnaires administered by researchers. RESULTS: Of 2032 infants invited to participate, 1956 (96%) infants provided data. The prevalence of any wheeze was 45%, severe wheeze requiring use of emergency services was 30% and recurrent wheeze on three or more occasions was 20%. The largest adjusted risk factors for any wheeze were presence of eczema [odds ratio (OR) 2.09; 95% confidence interval (CI) 1.48-2.94], family history of asthma (OR 2.05; 95% CI 1.60-2.62), poor ventilation in the house (OR 1.99; 95% CI 1.48-2.67), attendance at nursery (OR 1.78; 95% CI 1.24-2.57), male sex (OR1.52; 95% CI 1.19-1.96) and the number of smokers in the house (P < 0.03 for trend), OR 1.64 (95% CI 1.17-2.31) for three or more smokers in the house compared to no smokers in the household. CONCLUSION: We have identified several risk factors for any wheeze in young infants living in modern day Cuba. As the prevalence of smoking in the house is high (51%), intervention studies are required to determine effective strategies to improve infant health.

[Tuberculosis in 0-14 year-olds in Cuba (1994-2003)]. / Tuberculosis en niños de 0-14 años: Cuba, 1994-2003.

INTRODUCTION: Tuberculosis in infants and children is a sign of continuous transmission. The present article describes the distribution and the trend in incidence rates of new tuberculosis cases in 0-15-year-olds in Cuba. METHODS: Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual average rates, and rates and percentages according to classification were determined. RESULTS: The incidence rate decreased from 0.76 x 10(5) in 1994 to 0.31 in 2003 (59.2% of the overall reduction and 6.6% of the annual average reduction). The highest rate (1.06 x 10(5)) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana, Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6%). Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6%) and 1-4 years (35.2%). CONCLUSIONS: Tuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease.

Tuberculosis en niños de 0-14 años: Cuba, 1994-2003 / Tuberculosis in 0-14 year-olds in Cuba (1994-2003)

Introducción La ocurrencia de tuberculosis en niños es un signo de transmisión continua de la infección. En este estudio describimos la distribución y tendencia de las tasas de incidencia de casos nuevos de tuberculosis de niños menores de 15 años de edad en Cuba. Métodos Se estimaron las tasas de incidencia y su tendencia, por provincias y grupos de edades del período 1994-2003. Se determinó la distribución porcentual, porcentaje de variación global y promedio anual de las tasas, así como las tasas y porcentajes de tuberculosis según su localización. Resultados La tasa de incidencia disminuyó de 0,76 × 105 en 1994 a 0,31 en 2003 (59,2 % reducción global y 6,6 % reducción anual como promedio). En 1995 se notificó la tasa más alta 1,06 × 105 (26 casos). En casi todas las provincias la tendencia de la incidencia fue descendente, excepto en Ciudad Habana, Sancti Spíritus, Santiago de Cuba e Isla de la Juventud. El 69,6 % de la tuberculosis infantil fue de localización pulmonar. Los grupos de edades de 10-14 años (35,6 %) y 1-4 (35,2 %) presentaron los porcentajes más altos dentro de la población infantil afectada. Conclusiones La tuberculosis es muy poco frecuente y más bien rara en menores de un año y en general presenta notificación muy baja en todo el país con una tendencia global descendente mantenida

Introduction Tuberculosis in infants and children is a sign of continuous transmission. The present article describes the distribution and the trend in incidence rates of new tuberculosis cases in 0-15-year-olds in Cuba. Methods Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual average rates, and rates and percentages according to classification were determined. Results The incidence rate decreased from 0.76 × 105 in 1994 to 0.31 in 2003 (59.2 % of the overall reduction and 6.6 % of the annual average reduction). The highest rate (1.06 × 105) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana, Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6 %). Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6 %) and 1-4 years (35.2 %). Conclusions Tuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease

Prescription of antibiotics for mild acute respiratory infections in children.

Acute respiratory infections (ARI), the leading class of ailments causing people to seek health care, rarely require antibiotics. Nevertheless, many physicians prescribe them needlessly. Hence, reducing the unnecessary use of antibiotics is one aim of any ARI control program. To help determine whether this aim might be achieved through a combination of refresher training for family physicians and public education campaigns, two 1991 interventions were carried out in four health areas (designated A, B, C, and D) in the city of Havana, Cuba. In each area, 10 clinics staffed by family physicians were selected through simple random sampling. In two areas (A and B), a refresher training program on ARI for health personnel was instituted at each clinic, while in areas A and C a community education program was set up. No intervention was carried out in area D. Simultaneously, from January through December 1991 trained individuals visited and administered a standard questionnaire every 15 days to 1,600 families (40 per clinic) systematically selected by random sampling. The aim of this procedure was to record the number of ARI episodes occurring among children under 5 years old, the treatment chosen in these cases, and whether antibiotics were employed. The results showed that when the two interventions were initiated, antibiotics were prescribed for 26%, 20%, 11%, and 19% of the mild ARI cases occurring in areas A, B, C, and D respectively (P > 0.05). In the period immediately following the interventions, antibiotic prescription rates declined by 26% and 63% in areas A and B, while increasing by 2% and 48% in areas C and D. Overall, prescription of antibiotics in the intervention areas A and B combined decreased by 54% (95% CI: 31-69%). These data suggest that a refresher training program for health personnel can rapidly reduce the unnecessary prescribing of antibiotics for ARI cases, but that public education alone does not appear effective.