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Navigating childhood asthma care in Kenya: barriers identified by children and their caregivers
Joan Ahimbisibwe1, Roselyter Monchari Riang'a2, Angela Migowa3
1Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya. joan.ahimbisibwe@scholar.aku.edu.
Insights
Pediatric asthma management in Africa faces significant hurdles. Barriers include poor medication adherence, environmental triggers, and inadequate school support, necessitating a system-wide approach beyond expert care.
Area of Science:
- Pediatric pulmonology
- Public health
- Qualitative research
Background:
- Asthma is a leading chronic childhood illness in Africa, with high morbidity and mortality.
- Gaps persist between recommended asthma management and actual clinical practice.
- This study investigates challenges in pediatric asthma care within Kenya.
Purpose of the Study:
- To explore barriers to asthma management from the perspective of children and caregivers.
- To identify factors hindering effective asthma control in a tertiary care setting.
Main Methods:
- An exploratory phenomenological qualitative study design.
- In-depth interviews with 14 child-caregiver pairs receiving asthma treatment for over a year.
- Data analysis using NVivo software.
Main Results:
- Key themes identified: medication use barriers, modifiable risk factor barriers, nonpharmacological intervention barriers, and loss of trust in healthcare.
- Medication adherence challenges included administration difficulties, forgetfulness, and lack of support.
- Barriers to risk factor management and nonpharmacological interventions involved clinic access, cost, and environmental control.
Conclusions:
- Effective pediatric asthma management requires addressing medication adherence, environmental triggers, drug access, and school support.
- Specialist care alone is insufficient; a comprehensive, system-level strategy is crucial for improving asthma outcomes in Africa.
Background:
Asthma is one of the most common chronic conditions in children, with significant morbidity and mortality, especially in Africa. Achieving adequate asthma control in children remains challenging because of gaps between standard recommended management strategies and actual treatment practices. This study explored barriers to asthma management as perceived by children and their caregivers in a private tertiary care setting in Kenya.
Methods:
An exploratory phenomenological qualitative study was conducted at Aga Khan University Hospital (AKUH), Nairobi. Children aged 6-18 years with a confirmed diagnosis of asthma and their caregivers were recruited. The participants had been receiving treatment for at least one year but had partly controlled or uncontrolled asthma. Purposive sampling was used, and in-depth interviews were conducted with 14 child-caregiver pairs until data saturation. The data were analysed via NVivo software version 12.
Results:
Three predetermined themes were highlighted and explored in this study. These were barriers to medication use, barriers to treating modifiable risk factors, and barriers to nonpharmacological interventions. One emerging theme was identified: loss of trust in the health care system. Barriers to medication use were most frequently reported and included challenges with drug administration, forgetfulness, lack of support from schools and extended families, stigma, and monotony in treatment regimens. Modifiable risk factor barriers focused on difficulties attending clinic appointments, whereas nonpharmacological intervention barriers included the high costs of implementing recommended adjustments and ineffective environmental control.
Conclusions:
Despite access to specialist-led care and good caregiver knowledge, children with asthma faced barriers such as poor medication adherence, environmental triggers, limited drug access, and inadequate school support. This suggests that expert care alone is insufficient, and a broader, system-wide approach is needed to improve asthma outcomes in Africa.
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