Nxwisen, ntzarrin or ntzo’lin? Mapping children's respiratory symptoms among indigenous populations in Guatemala

Abstract

Estimating the prevalence of asthma is an epidemiologic challenge, particularly in rural areas of lesser-developed countries characterized by low literacy and poor access to health care. To avoid under-or over-reporting of symptoms, questionnaires must use terminology familiar to participants and that accurately describes the triad of cough, wheeze and breathlessness characteristic of asthma. In preparation for a large longitudinal cohort study entitled Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter (CRECER) that will examine the effects of variable early lifetime woodsmoke exposure on the respiratory health of Mam-speaking children residing in communities in the western highlands of Guatemala, we conducted individual interviews (n=18) and five focus groups (n=46) with indigenous women from 17 of these communities to elicit and define local Mam and Spanish terms for common respiratory symptoms used to describe their own and their children's respiratory symptoms. Focus group participants were also shown an International Study of Asthma and Allergies in Childhood (ISAAC) video of wheezing children and adults. We developed a conceptual framework that can be used as an efficient model for future studies investigating health and/or disease terminology in isolated communities, an integral step in the development of standardized questionnaires. Among this Mam-speaking population, wheeze was best described as: nxwisen or ntzarrin, "breathing sounds that are heard in the neck but come from the chest." The variation in understanding of terms between women with and without children with a history of wheeze (such that for those without wheezing children some terms were virtually unrecognized), has important implications for large-scale populations surveys within countries and comparative surveys such as ISAAC. It is important to use linguistically and culturally appropriate

Impact of improved cookstoves on indoor air pollution and adverse health effects among Honduran women

“…Previous studies have demonstrated that women exposed to higher levels of indoor air pollution from the burning of biomass fuels are more likely to experience adverse symptoms Regalado et al 2006), although not consistently (Riojas-Rodriguez et al 2001). Inconsistent evidence of the relationship between cookstove exposures and reported symptoms may arise because of discrepancies in the understanding of terms used to describe symptoms, particularly because rural areas of developing countries are often characterized by low literacy and poor access to health care Thompson et al 2007). Another potential limitation of the symptoms analyses is the potential of reporting bias; that is, the knowledge of the adverse health effects of cookstoves could have influenced women with traditional stoves to report more symptoms because of this knowledge.…”

Biomass Smoke Exposure and Atopy among Young Children in the Western Highlands of Guatemala: A Prospective Cohort Study

“…All QRQs were conducted by field workers fluent in the participating mothers’ primary language (Mam). Details of the questionnaire development and translation processes have been published elsewhere [ 32 ]. All questions were close ended (Yes/No/Don’t know) and began with “in the last three months”.…”

Wheezing defined

“…Video questionnaires have also been used in epidemiological studies (53)(54)(55)(56)(57)(58)(59)(60)(61)(62). A common finding from these studies is that written questionnaires provide higher prevalence of wheeze compared to video questionnaires (56,62).…”