4% (3746/4288) in 1993, 78.1% (1964/2514) in 1998 and 30.3% (1074/3540) in 2006. The trend to lower compliance in later surveys was consistent across all surveyed schools.

Townsend score estimations of socio-economic status did not differ between schools with high or low questionnaire compliance and were comparable across the four surveys with only small differences between responders check details and non-responders to specific core questions. Respiratory symptom questions were mostly well answered with fewer than 15% of non-responders across all surveys. There were significant differences between mean child age, maternal and paternal smoking prevalence, and maternal employment between the four surveys (all p < 0.01). Out-migration did not differ between surveys (p = 0.256) with three quarters of parents resident for at least 3 years in the survey areas.

Conclusion: Methodological differences or changes in socio-economic status of respondents find more between surveys were unlikely to explain compliance differences. Changes in maternal employment patterns may have been contributory. This analysis demonstrates

a major shift in community parental questionnaire compliance over a 15 year period to 2006. Parental questionnaire compliance must be factored into survey designs and methodologies.”
“The Styblo model is the result of international collaboration aimed at the expansion of national tuberculosis (TB) programs in partner countries. This model is the foundation of the DOTS strategy launched in the 1990s and which was subsequently expanded as a global strategy. This paper discusses the impact and relevance of this body of work.

The basic principles supporting the model still hold. There

is a tendency to be all-inclusive when global strategies are devised, which increases the complexity of such strategies. Whereas it is relatively easy to standardize diagnosis and surveillance, this is not the case with patient care and treatment where, as recent experiences in TB programs show, universal recommendations can be controversial. It may be unwise to put forward global strategies EPZ015666 when the terrain is as variable as It is in different parts of the world.

Since the conception of the model, the human immunodeficiency virus (HIV) pandemic has been gaining force in Africa. As a result, TB control efforts on the continent have been severely undermined. The relevance of the model in this setting is questioned. Although HIV infection has contributed to outbreaks of drug-resistant TB, it has also facilitated the control of outbreaks of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. Where MDR-TB has reached critical proportions in the absence of HIV, it has proven difficult to control. Technological development has not kept up with the need for new tools. Whereas many policy analysts agree that a revised strategy is required, a convincing breakthrough has yet to appear.