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Improving access to asthma care for children and adolescents in Uganda

Funder: UK Research and InnovationProject code: MR/X031713/1
Funded under: MRC Funder Contribution: 635,895 GBP

Improving access to asthma care for children and adolescents in Uganda

Description

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.

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