Paediatric asthma in North Africa: the Asthma Insights and Reality in the Maghreb (AIRMAG) study

Abstract

Asthma has a major impact on the lives of children with asthma in the Maghreb. This could be improved by offering more appropriate care as recommended in the GINA guidelines.

Secular trends in consultations for asthma in early childhood, the 16 administrative regions of Morocco, 2004–2012

“…Considering the under-5 age group, rates found in the current study can not be compared to those of the International Survey of Asthma and Allergy in Children (ISAAC) [14] which considered participants of different age groups (6–7 years old and 13–14 years old) and were restricted only to urban areas as to Morocco. However, the recent AIRMAG study, carried out in 2008, allowed comparison as it considered a random population sample (aged under sixteen) and rate related to under-5 children was provided [4]. There is a major difference between prevalence rate of consultations for asthma, in under-5 children (0.32 %, all regions confounded) reported in the current study in 2008 (it reached 0.53 % in 2012) and asthma prevalence rates (about 4.5 %) reported in AIRMAG study in the under-five children [4].…”

“…However, the recent AIRMAG study, carried out in 2008, allowed comparison as it considered a random population sample (aged under sixteen) and rate related to under-5 children was provided [4]. There is a major difference between prevalence rate of consultations for asthma, in under-5 children (0.32 %, all regions confounded) reported in the current study in 2008 (it reached 0.53 % in 2012) and asthma prevalence rates (about 4.5 %) reported in AIRMAG study in the under-five children [4]. This may be explained by many factors.…”

“…This may be explained by many factors. AIRMAG survey [4] showed that most participants consulted a private community practice for their asthma and were followed by a specialist, and that in Morocco, more children attended private health care providers (76.7 % in private community practice; 5.5 % in private hospital clinic) and consulted specialists than in the other two countries (Algeria and Tunisia). In contrast, the current study concerned only the public sector (primary health care centers : see Methods) where general pratictionars are available; a specialist may or may not be available (disparities regarding specialists availability still exist between the Moroccan administrative regions), which is challenging as to the delivery of asthma related medicines in children of this special group of age (under-5 children) [21]; the current study concerned participants whose parents often have no health insurance, can not afford to consult a private specialist, to regularly buy asthma related medicines, or to own a peak flow meter for use at home.…”

“…Besides, although in Morocco medications at primary health care centers are free of charge, the available heath center's share often does not meet the needs of the population, which may reduce frequency of physician consultations for asthma : the outpatient may consult only to get free medicines or a free prescription from the health care center's physicians. The AIRMAG survey [4] showed that the frequency of physician consultations for asthma was higher in Algeria, with 42.9 % of children consulting a physician at least once a month (as public community care providers are most used and access to them is free in Algeria), and that in Morocco over a third of children only consulted once or twice a year or less. Prevalence rate of consultations for ashma in primary health care in Morocco may vary over time and place due to health care policy factors (availability, at region-level, of primary health care centers, of health practionners, and of medicines).…”

“…Outpatients may consult only if asthma causes problems in an attempt to get free medicines: chances of outpatients' follow-up by the primary health care center's physicians are therefore reduced and optimal asthma control is not achieved. The AIRMAG survey [3, 4] showed that asthma control was best in Tunisia and worst in Morocco (p inter-country difference value = 0.03). The low frequency of consultations for asthma, in early childhood, in both the public sector (the current study) and the private one (AIRMAG survey), should the outpatient regularly have to buy medecines, may reveal that dealing with a chronic disease such as asthma still overtakes the financial capacities of the Moroccan outpatient.…”