Chest
Volume 115, Issue 2, February 1999, Pages 434-439
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Clinical Investigations
EPIDEMIOLOGY AND DIAGNOSIS
Measuring Persistent Cough in Children in Epidemiological Studies: Development of a Questionnaire and Assessment of Prevalence in Two Countries

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Study objective

Cough is a common symptom in children that is frequently encountered in general practice. However, most of the information on the prevalence of persistent cough has come from studies that use different, often ambiguous, definitions for persistent cough. It is therefore important that a validated questionnaire to accurately measure persistent cough is developed and is appropriate for use in different age groups of children and in different cultures. Such a questionnaire is essential for accurately measuring the prevalence of persistent cough and the factors associated with its occurrence.

Design

A parent-administered respiratory questionnaire was developed and administered twice during a 3-week interval pilot study to test repeatability. The questionnaire was then administered to a randomly selected cross-section of Australian children aged 5 to 7 years old and 8 to 11 years old (N = 511 and N = 654, respectively), and to 566 Nigerian children aged 8 to 11 years old.

Results

The new questionnaire was reliable, with most of the questions having a κ value of above 0.6. The prevalence of persistent cough was similar in younger and older Australian children, but significantly less in Nigerian children (p < 0.001). Also, persistent cough was more prevalent in children of high rather than low socioeconomic status among older Australian children (p = 0.04).

Conclusions

The newly developed questionnaire will be an important tool in epidemiological studies for measuring the prevalence, morbidity, and risk factors of persistent cough in childhood. Although our findings showed that persistent cough does not occur more frequently in younger than in older Australian children, it is more frequent in Australian than in Nigerian children.

Section snippets

Development of Questionnaire

The new questionnaire was a modification of one developed by the Institute of Respiratory Medicine at the University of Sydney that has been used widely in studies of children.13 New questions to measure the morbidity of cough were added using clinicians’ description of cough variant asthma. A focus group was formed consisting of clinicians (pediatricians and respiratory physicians), epidemiologists, and parents with children in the age group to be studied. Questions to best describe persistent

Results

To test the repeatability of the questionnaire, it was distributed to 199 children aged 9 to 12 years and returned completely filled by 165 children (response rate, 83%) at the first administration, and 109 children at the second administration 3 weeks later. Repeatability measures estimated from the duplicate 109 questionnaires as suggested by Chinn and Burney15 are shown in Table 1. A κ value above 0.4 indicates moderate agreement, above 0.6 indicates good agreement, and above 0.8 indicates

Repeatability and Validity

Using rigorous methods, a reliable questionnaire was developed and was used to measure the prevalence and morbidity of persistent cough in children in two communities. We used a previously validated questionnaire13,17 and added questions about the frequency of cough, sleep disturbance due to cough, triggers for cough, and use of medical services for cough. Although questionnaires are subject to bias in replies,14,18 they are the most practical method available for measuring the respiratory

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