multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.C1 Eskisehir Osmangazi Univ, Asthma & Allergy Working Grp Turkish Thorac Soc, Eskisehir, Turkey.Eskisehir Osmangazi Univ, Dept Publ Hlth, Eskisehir, Turkey.Kocaeli Univ, Dept Pulm Dis, Kocaeli, Turkey.Abant Izzet Baysal Univ, Dept Pulm Dis, Duzce, Turkey.Celal Bayar Univ, Dept Pulm Dis, Manisa, Turkey.Ondokuz Mayis Univ, Dept Publ Hlth, Samsun, Turkey.Firat Univ, Dept Pulm Dis, Elazig, Turkey.Afyon Kocatepe Univ, Dept Pulm Dis, Afyton, Turkey.Ataturk Univ, Dept Pulm Dis, Erzurum, Turkey.Uludag Univ, Dept Pulm Dis, Bursa, Turkey.Yuzuncu Yil Univ, Dept Internal Med, Van, Turkey.Pamukkale Univ, Dept Pulm Dis, Denizli, Turkey.Acibadem Hosp, Istanbul, Turkey.State Hosp, Tarsus, Turkey.Suleyman Demirel Univ, Dept Pulm Dis, Isparta, Turkey

Implications of insecticide resistance for malaria vector control with long-lasting insecticidal nets: trends in pyrethroid resistance during a WHO-coordinated multi-country prospective study

BackgroundIncreasing pyrethroid resistance has been an undesirable correlate of the rapid increase in coverage of insecticide-treated nets (ITNs) since 2000. Whilst monitoring of resistance levels has increased markedly over this period, longitudinal monitoring is still lacking, meaning the temporal and spatial dynamics of phenotypic resistance in the context of increasing ITN coverage are unclear.MethodsAs part of a large WHO-co-ordinated epidemiological study investigating the impact of resistance on malaria infection, longitudinal monitoring of phenotypic resistance to pyrethroids was undertaken in 290 clusters across Benin, Cameroon, India, Kenya and Sudan. Mortality in response to pyrethroids in the major anopheline vectors in each location was recorded during consecutive years using standard WHO test procedures. Trends in mosquito mortality were examined using generalised linear mixed-effect models.ResultsInsecticide resistance (using the WHO definition of mortality < 90%) was detected in clusters in all countries across the study period. The highest mosquito mortality (lowest resistance frequency) was consistently reported from India, in an area where ITNs had only recently been introduced. Substantial temporal and spatial variation was evident in mortality measures in all countries. Overall, a trend of decreasing mosquito mortality (increasing resistance frequency) was recorded (Odds Ratio per year: 0.79 per year (95% CI: 0.79-0.81, P < 0.001). There was also evidence that higher net usage was associated with lower mosquito mortality in some countries.DiscussionPyrethroid resistance increased over the study duration in four out of five countries. Insecticide-based vector control may be compromised as a result of ever higher resistance frequencies