Community health worker case‐detection of asthma or reactive airways disease in a resource‐poor community in Nicaragua

Introduction Asthma is a major cause of morbidity and mortality in children worldwide, but many cases may remain undiagnosed. Community health worker (CHW) programs have improved detection of other diseases such as childhood pneumonia, but none have been validated for detection of asthma in resource‐poor settings. We hypothesized that a CHW administered questionnaire would be effective in case‐detection of asthma in a poor Nicaraguan community. Methods We enrolled children aged 2–17 from a small semiurban Nicaraguan community. A trained CHW administered a questionnaire based on a previously validated school‐based screening questionnaire, which was compared to pediatric pulmonologist evaluation as a reference standard. We determined the questionnaire's sensitivity, specificity, and positive and negative likelihood ratios at different score cut‐points. Results A total of 199 out of 218 eligible children were enrolled. Total asthma prevalence based on physician diagnosis was 33%. Mean scores on the CHW questionnaire were 3.6 points out of 22 (SD = 4.3) for nonasthmatics and 11.0 points (SD = 5.3) for children with asthma (p