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An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial
Sarah Rylance1,2, Beatrice Chinoko2, Bright Mnesa2
1Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK sarah.rylance@lstmed.ac.uk.
Insights
A novel outpatient asthma care package improved children's asthma control in Malawi by shifting tasks to non-physicians. This intervention reduced asthma exacerbations and school absences, showing promise for resource-limited settings.
Area of Science:
- Pediatric Pulmonology
- Global Health
- Healthcare Management
Background:
- Chronic asthma care is challenging in low-income countries due to clinical staff shortages.
- An outpatient asthma care package was evaluated, incorporating task-shifting for asthma management.
- This study addresses the need for effective pediatric asthma management strategies in resource-limited settings.
Purpose of the Study:
- To evaluate an outpatient asthma care package for children in Malawi.
- To assess the impact of task-shifting asthma management roles to non-physicians.
- To improve asthma control and reduce exacerbations in pediatric patients.
Main Methods:
- A non-blinded, individually randomized controlled trial was conducted in Blantyre, Malawi.
- Children aged 6-15 years with asthma were recruited and allocated to either the intervention or standard care group.
- The intervention involved non-physicians delivering clinical assessment, optimizing inhaled treatments, and providing asthma education.
Main Results:
- Intervention group children showed a significantly greater improvement in Childhood Asthma Control Test (cACT) scores at 3 months (2.7 points) compared to the standard care group (0.6 points).
- Fewer children in the intervention group experienced asthma exacerbations requiring emergency care (7.3% vs. 25.4%).
- School absence was significantly lower in the intervention group (20.0% vs. 62.7%) compared to the standard care group.
Conclusions:
- The outpatient asthma care package, utilizing task-shifting, effectively decreased asthma symptoms and exacerbations in children.
- Wider implementation of this intervention could significantly benefit asthmatic patients in resource-limited settings.
- Task-shifting asthma management presents a viable strategy to enhance pediatric chronic disease care globally.
Background:
Shortages of clinical staff make chronic asthma care challenging in low-income countries. We evaluated an outpatient asthma care package for children, including task-shifting of asthma management roles.
Methods:
We conducted a non-blinded individually randomised controlled trial at a tertiary-level government hospital in Blantyre, Malawi. Children aged 6-15 years diagnosed with asthma were recruited from outpatient clinic, stratified by Childhood Asthma Control Test (cACT) score and allocated 1:1 from a concealed file, accessed during electronic questionnaire completion. The intervention, delivered by non-physicians, comprised clinical assessment, optimisation of inhaled treatment, individualised asthma education. The control group received standard care from outpatient physicians. Primary outcome for intention-to-treat analysis was change in cACT score at 3 months. Secondary outcomes included asthma exacerbations requiring emergency healthcare and school absence.
Findings:
Between September 2018 and December 2019, 120 children (59 intervention; 61 control) were recruited; 65.8% males, with mean (SD) age 9.8 (2.8) years, mean (SD) baseline cACT 20.3 (2.6). At 3 months, intervention children (n=56) had a greater mean (SD) change in cACT score from baseline (2.7 (2.8) vs 0.6 (2.8)) compared with standard care participants (n=59); a difference of 2.1 points (95% CI: 1.1 to 3.1, p<0.001). Fewer intervention children attended emergency healthcare (7.3% vs 25.4%, p=0.02) and missed school (20.0% vs 62.7%, p<0.001) compared with standard care children.
Interpretation:
The intervention resulted in decreased asthma symptoms and exacerbations. Wider scale-up could present substantial benefits for asthmatic patients in resource-limited settings.
Trial Registration Number:
PACTR201807211617031.
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