Abstract
BackgroundRespiratory diseases are among the leading causes of morbidity and mortality in Uganda, but there is little attention and capacity for management of chronic respiratory diseases in the health programmes. This survey assessed gaps in knowledge and skills among healthcare workers in managing respiratory illnesses.MethodsA cross sectional study was conducted among primary care health workers, specialist physicians and healthcare planners to assess gaps in knowledge and skills and, training needs in managing respiratory illnesses. The perspectives of patients with respiratory diseases were also sought. Data were collected using questionnaires, patient panel discussions and review of pre-service training curricula for clinicians and nurses. Survey Monkey was used to collect data and descriptive statistical analysis was undertaken for quantitative data, while thematic content analysis techniques were utilized to analyze qualitative data.ResultsA total of 104 respondents participated in the survey and of these, 76.9% (80/104) were primary care health workers, 16.3% (17/104) specialist clinicians and 6.7% (7/104) healthcare planners. Over 90% of the respondents indicated that more than half of the patients in their clinics presented with respiratory symptoms. More than half (52%) of the primary care health workers were not comfortable in managing chronic respiratory diseases like asthma and COPD. Only 4% of them were comfortable performing procedures like pulse oximetry, nebulization, and interpreting x-rays. Majority (75%) of the primary care health workers had received in-service training but only 4% of the sessions focused on respiratory diseases. The pre-service training curricula included a wide scope of respiratory diseases, but the actual training had not sufficiently prepared health workers to manage respiratory diseases. The patients were unsatisfied with the care in primary care and reported that they were often treated for the wrong illnesses.ConclusionsRespiratory illnesses contribute significantly to the burden of diseases in primary care facilities in Uganda. Management of patients with respiratory diseases remains a challenge partially because of inadequate knowledge and skills of the primary care health workers. A training programme to improve the competences of health workers in respiratory medicine is highly recommended.
Highlights
Respiratory diseases are among the leading causes of morbidity and mortality in Uganda, but there is little attention and capacity for management of chronic respiratory diseases in the health programmes
We looked at the training curricula for doctors, clinical officers, midwives and nurses, to check for the topics related to lung health and the amount of time allocated to them, to get an idea on the scope and intensity of training that is provided to pre-service training with respect to respiratory health
Referral practices for patients with respiratory diseases The findings showed that the patients that primary care health workers commonly refer to specialists are quite diverse, with both communicable and non-communicable diseases such as TB (15.3%), pneumonia (10.5%), Chronic Obstructive Pulmonary Disease (COPD) (46%), asthma (14.4%) and bronchiectasis (32.8%)
Summary
Respiratory diseases are among the leading causes of morbidity and mortality in Uganda, but there is little attention and capacity for management of chronic respiratory diseases in the health programmes. This survey assessed gaps in knowledge and skills among healthcare workers in managing respiratory illnesses. About 90% of the deaths from respiratory diseases occur in low and middle-income countries (LMICs) [1] The World Health Organization (WHO) estimates that by 2030, lung diseases will account for about one in five deaths worldwide [2]. More than 80% of the asthma deaths occur in LMICs like Uganda, usually related to lack of proper treatment [4, 5]. The mortality and morbidity due to asthma and COPD may be underestimated as many are underdiagnosed and treated for respiratory infections [6,7,8,9,10,11]
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