Abstract
Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications.
Highlights
Children from low- and middle-income countries have poor asthma control, mainly because of poor management
Based on the ISAAC questionnaire, 28.7% children reported four or more wheezing attacks in the last 12 months; 71.9% reported that their chest sounded wheezy during or after exercise in the last 12 months; 74.0% reported a dry cough at night in the last 12 months that was not associated with a common cold or chest infection; only 55.9% had ever had an asthma diagnosis (Table 1)
We found that older children were more likely to have lower asthma control scores; children who reported regular vigorous physical activity three or more times a week (WHO recommendation15) had higher scores (0.84 [0.01, 1.67], p=0.05); children with concurrent allergic rhinitis had lower scores (-1.33 [-2.28, -0.38], p=0.006); children who reported receiving antimalarial medication twice or more in the last 12 months had lower scores (-1.38 [-2.31, -0.45], p=0.007); and children who spent most of their first five years in the city had lower scores (-1.99 [-3.69, -0.29], p=0.06) (Table 2)
Summary
Children from low- and middle-income countries have poor asthma control, mainly because of poor management The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. The level of asthma control and management among children from the general population has not been investigated in Uganda, and there have been few investigations in other low income countries. This information is important in informing policy on the extent of the problem, and in identifying areas where improvements could be made cost-effectively. We conducted a cross-sectional study among schoolchildren in urban Uganda with asthma, to assess their levels of asthma control and previous management. I suggest that you support the first statement in the section of background with a reference
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