Improving access to asthma care for children and adolescents in Uganda

Asthma is the commonest long-term disease in children across the world, but mainly affects those in low-income countries like Uganda. They suffer from severe and frequent asthma symptoms and attacks, and this leads to very frequent emergency clinic visits and hospital admissions. A lot of scare financial resources are spent on these visits, children miss school, and their caregivers miss work, driving families deeper into poverty and contributing to the widening health gap within and between countries. Both the affected children and their caregivers experience psychosocial challenges including stigma, which contributes to the overall poor quality of life of the affected persons and their families. The uncontrolled asthma symptoms also increase the risk of developing other long-term diseases like Chronic Obstructive Pulmonary Disease. Therefore, it is extremely important that children with asthma symptoms are identified early and given appropriate care to minimize the physical, economic and psychosocial problems described above. However, evidence from research in Uganda and similar countries shows that many children with asthma symptoms are not diagnosed and/or treated appropriately even when they frequently interface with health systems. This is partly due to the inadequate knowledge and skills of healthcare providers, and lack of innovative and locally relevant ways to improve identification of children with asthma symptoms. This study aims to understand whether innovations like checking every child and adolescent visiting primary care health facilities for asthma symptoms can lead to an increase in the number of children diagnosed with asthma, and whether education about asthma directed to patients and their caregivers can lead to improvements in the understanding of asthma, use of medicines and subsequent reduction in frequency of symptoms. The study will describe how and whether the training and mentoring of healthcare workers in the health facilities can lead to improvements in identifying and managing children with asthma symptoms. The study will also describe the psychosocial challenges faced by children and adolescents with asthma, and their caregivers. The health facilities in the study site (Jinja district in South Eastern Uganda) will be randomly divided into two groups. In one group, the healthcare workers will be given a standard form to be used to check for asthma symptoms among children and adolescents who will present with symptoms of lung diseases such as cough and difficult breathing. The second group will continue their usual practices of care. Data on the number of children diagnosed with asthma before and during the study will be collected and compared to determine whether the routine checking for asthma symptoms can increase the number of children diagnosed with asthma. A similar approach will be used in another study in which community health workers will be oriented about asthma and participate in educating the patients about asthma and asthma care, and how this can lead to better health for the affected children. In addition, healthcare workers in one health facility will be trained and mentored on diagnosis and management of the children and adolescents with asthma. The process will also involve holding discussions on the best approaches to be used, and documentation of the whole process to derive lessons which can be used in future similar research aimed at finding out if training and mentorship can lead to good control of asthma symptoms. This will be a pilot study. The data on psychosocial challenges will be collected by conducting individual and group explorative interviews. It is anticipated that the findings from the study will inform efforts to integrate asthma care into routine primary care services using evidence-based interventions.

Asthma is the commonest non-communicable disease in children and adolescents but is under-diagnosed. Many children have severe and uncontrolled symptoms due to sub-optimal care, and this affects their growth and development, academic achievements, and co-curricular activities. Uncontrolled asthma increases the risk of Chronic Obstructive Pulmonary Disease, is associated with high healthcare costs, missed workdays for caregivers and poor quality of life for the affected children and their caregivers. Low- and middle-income countries (LMICs) disproportionately suffer high asthma-related morbidity and mortality. Despite the availability of comprehensive standard guidelines on asthma care like the Global Initiative for Asthma guidelines, many children with asthma symptoms remain undiagnosed and/or get sub-optimal care, leading to poor symptom control. Studies in Africa have indicated poor adherence to asthma guidelines, low knowledge and skills of healthcare workers and poor access to medicines and diagnostics for asthma, as factors that are partly responsible for the high asthma morbidity and mortality. We aim to investigate how to improve the diagnosis and management of children with asthma through interventions that are relevant to the local context, building on the NIHR-funded ACACIA (Achieving Control of Asthma in Children In Africa) study that identified a high burden of asthma in school adolescents. Specifically, we shall investigate 1) The feasibility, acceptability and effectiveness of routine screening for asthma symptoms in children and adolescents with respiratory illnesses, 2) the feasibility, acceptability and effectiveness of needs-directed training and clinical mentorship in improving the diagnosis and management of children with asthma, 3) the feasibility, acceptability and effectiveness of community health worker-led asthma education in improving asthma outcomes and 4) the psychosocial challenges experience by children and adolescents with asthma.