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Improving paediatric asthma care in Zambia
Somwe Wa Somwe1, Emilia Jumbe-Marsden2, Kondwelani Mateyo3
1Department of Paediatrics and Child Health, University Teaching Hospital, P/Bag RW 1X, Lusaka, Zambia .
Insights
A study in Zambia found 7% of children have asthma. Interventions improved treatment guidelines and public awareness, addressing misconceptions about asthma inhalers and control.
Area of Science:
- Global Health
- Paediatric Respiratory Medicine
- Public Health Policy
Background:
- Paediatric asthma prevalence was unknown in Zambia in 2008, with outdated national treatment guidelines.
- Zambia's healthcare system prioritizes infectious diseases, lacking comprehensive noncommunicable disease services, including asthma management focused on acute exacerbations rather than control.
Purpose of the Study:
- To estimate paediatric asthma prevalence in Lusaka, Zambia.
- To assess Zambian patients' attitudes and practices regarding asthma management.
- To inform and modernize national paediatric asthma treatment guidelines and public health policy.
Main Methods:
- An international partnership was formed involving Zambian clinicians, the government, and a pharmaceutical company.
- Two studies were conducted: one estimating prevalence and another assessing patient attitudes and practices.
- Educational programs for health workers and the public were implemented, and the national treatment guideline was revised.
Main Results:
- Asthma prevalence was found to be 7% among surveyed children in Lusaka (255/3911).
- Patient interviews revealed misconceptions, such as 49% believing symptoms were not preventable and 43% viewing inhalers as addictive.
- Educational campaigns and revised guidelines led to increased inhaler access and the inclusion of steroid inhalers for asthma control.
Conclusions:
- Collaborative efforts are essential for improving paediatric asthma care in Zambia.
- Sustainability of interventions and resource allocation aligned with disease burden are crucial for long-term success.
Problem:
In 2008, the prevalence of paediatric asthma in Zambia was unknown and the national treatment guideline was outdated.
Approach:
We created an international partnership between Zambian clinicians, the Zambian Government and a pharmaceutical company to address shortcomings in asthma treatment. We did two studies, one to estimate prevalence in the capital of Lusaka and one to assess attitudes and practices of patients. Based on the information obtained, we educated health workers and the public. The information from the studies was also used to modernize government policy for paediatric asthma management.
Local Setting:
The health-care system in Zambia is primarily focused on acute care delivery with a focus on infectious diseases. Comprehensive services for noncommunicable diseases are lacking. Asthma management relies on treatment of acute exacerbations instead of disease control.
Relevant Changes:
Seven percent of children surveyed had asthma (255/3911). Of the 120 patients interviewed, most (82/120, 68%) used oral short-acting β2-agonists for symptom control; almost half (59/120, 49%) did not think the symptoms were preventable and 43% (52/120) thought inhalers were addictive. These misconceptions informed broad-based educational programmes. We used a train-the-trainer model to educate health-care workers and ran public awareness campaigns. Access to inhalers was increased and the Zambian standard treatment guideline for paediatric asthma was revised to include steroid inhalers as a control treatment.
Lessons Learnt:
Joint activities were required to change paediatric asthma care in Zambia. Success will depend on local sustainability, and it may be necessary to shift resources to mirror the disease burden.
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