Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study

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.

Anxiety disorders and asthma among adolescents in urban Uganda: the role of early life exposures

“…Asthma control test scores were generated from the Asthma Control Test 24 . Asthma control was poorer among adolescents with any of the three anxiety disorders, as depicted by the lower asthma control test scores (adjusted mean difference −2.66, 95% CI −5.01, −0.30), Table 2 .…”

Cross‐reactive carbohydrate determinant‐specific IgE obscures true atopy and exhibits ⍺‐1,3‐fucose epitope‐specific inverse associations with asthma

“…All schoolchildren were screened using the International Study on Allergy and Asthma in Children (ISAAC) questionnaire 41 . Children with a history of wheeze in the last year underwent a detailed clinical assessment by study clinicians, including a medical and treatment history, lung function tests, and were assessed for asthma control using the Asthma Control Test 38,42 . Among cases, 55.5% had well‐controlled asthma, 29.5% partly controlled and 15% poorly controlled asthma.…”

“…Only three cases had abnormal lung function tests. All cases were seen at one time point, started on the recommended treatment and were referred for additional management 42 . Children in the same class as cases, with no history of wheezing, were eligible as controls.…”

Risk factors for rhinitis, allergic conjunctivitis and eczema among schoolchildren in Uganda

“…Schoolchildren, 5-17 years, were enrolled from both primary and secondary schools in an urban area of Wakiso district in central Uganda between May 2015 and July 2017; further details of the study are described elsewhere 11 , 20 For each child with asthma (“cases”), two children without a history of asthma symptoms (“controls”) were randomly selected from the class register, using a random number generator programme in STATA (StataCorp, Texas, USA). The parents or guardians of potential participants were contacted to attend a meeting, using invitation cards delivered by the children or telephone calls by the study team.…”

“…further details of the study are described elsewhere 11,20 . For each child with asthma ("cases"), two children without a history of asthma symptoms ("controls") were randomly selected from the class register, using a random number generator programme in STATA (StataCorp, Texas, USA).…”