Comparative Management of Childhood Asthma in Urban and Rural Settings in Sub-Saharan Africa

Asthma is a common chronic respiratory condition affecting children all over the world. Challenges are encountered to access and implement standard asthma management in different countries and geo-locations.

To assess and compare the management of childhood asthma in urban and rural settings in Enugu State, Nigeria."

This study was conducted in Enugu State. The minimum sample size was calculated to be 480 with an attrition rate of 10%. The multistage sampling method was used to select two local government areas - Enugu-North (urban) and Awgwu (rural) and further selected two schools each from each of the geo-locations. Ethical approval was obtained for the study. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 23 with mainly Chi-square statistics and P < 0.05.

Urban participation rate was 65.1%, while rural was 93.9%. Equal sex distribution was noted in the urban setting, while a male preponderance of 2.4:1 was noted in rural. The mean age in urban was 8.53 ± 1.5 years, while in rural, it was 10.04 ± 2.0 years. Doctor or Nurse's diagnosis of asthma was low (urban - 35.7%; rural - 10.7%). Counseling on patients' asthma condition-urban (60.7%) compared to rural (11.1%). The written asthma management plan was 17.9% urban and 0% rural. Use of inhalation short-acting beta-agonist was 21.4% urban and 3.7% rural. Inhalation corticosteroid was 0% in both settings. Oral corticosteroid, spacer device, nebulizer, and controller medications were only in urban 21.4%, 17.9%, 28.6%, and 14.3%, respectively. Regular follow-up visits were 14.3% in urban and 7.4% in rural.

Standard asthma management adherence was poor, especially in the rural setting. A scale-up intervention training and awareness are needed for healthcare providers and the public. Materials and medications should be made available, accessible, and affordable for both geo-locations.