Uncontrolled asthma in Ethiopia: a systematic review and meta-analysis

Despite significant improvement in the diagnosis and management of this disorder, asthma in the majority of Ethiopians remains poorly controlled. Although the prevalence of uncontrolled asthma is a public health problem in Ethiopia, its reported prevalence varies from study to study. Hence, this review aims to determine the true prevalence of uncontrolled asthma among asthmatic patients in Ethiopia.

Different database searching engines were used including PubMed, Scopus, Google Scholar, Africa journal online, World Health Organization (WHO) afro library, and Cochrane review. They were systematically searched for published studies on uncontrolled asthma in Ethiopia from 2014 to 2019. Primary search terms were "asthma", "uncontrolled asthma", "uncontrolled wheezing", and "Ethiopia". The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. Publication bias was examined by the funnel plot. The random-effect model was fitted to estimate the pooled prevalence of uncontrolled asthma among asthmatic patients. All statistical analysis was done using R version 3.5.3 and the RStudio version 1.2.5033 software for Windows.

The overall pooled prevalence of uncontrolled asthma was found to be 71.67% [95% CI (0.6772; 0.7562)]. Potential associated factors were: unscheduled visits, frequency of short-acting beta2-agonist (SABA) use, type of treatment and perceived rate of asthma control, low monthly income, age group, presence of comorbidity, moderate persistent asthma, severe persistent asthma and use of SABA alone as anti-asthmatic medication, use of biomass fuel for cooking, longer duration of asthma (> 30 years), incorrect inhalation technique, and asthma exacerbation in the last 12 months. Self-perceived poor asthma control was associated with any activity limitation due to asthma, inconsistent inhaled corticosteroid use, and lack of health education on metered-dose inhaler technique [AOR =4.96; 95% CI (1.08-22.89)].

Nearly two-thirds of patients were determined to have uncontrolled asthma. Thus, this evidence suggests that attention should be given to asthma patients and health care providers.