A comparative analysis of asthma treatment guidelines and Essential Medicine Lists in sub-Saharan Africa (original) (raw)
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International Journal of Environmental Research and Public Health, 2019
Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013–2020 sets an 80% target for essential NCD medicines’ availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013–2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses—41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamo...
Background: Inhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma. However, underutilization of ICSs is common and little is known about factors contributing toward this undesirable use. Methods: A cross-sectional study was conducted through interview and chart review among persistent asthmatic patients attending chest clinic of Tikur Anbessa Specialized Hospital from 1 May to 31 September 2014. A total of 131 eligible patients who attended the clinic during study period were included in the study. A multivariate logistic regression was used to examine the association between independent and dependent variables. Results: Overall, extent of underutilization of ICSs was found to be 68%. Monthly income, comorbidity and types of ICSs products prescribed showed significant association with reported underutilization. Patients' reported reasons for underutilization includes; unaffordability (44%), using only when symptoms exacerbate (21%), fear of side effects (10%), practitioners' recommendation (10%) and unavailability of ICSs in the local market (7%). Physicians also stated unaffordability, fear of side effects and dependency, lack of local guideline for asthma management and unavailability of ICSs as the contributing factors. Conclusion: In this setting, extent of underutilization of ICSs was found to be high and seems the result of complex interaction of various factors. Financial problem combined with inconsistent availability of ICSs in the local market, patients' poor knowledge of asthma and ICSs, negative attitude toward ICSs, absence of local guidelines for asthma management are found to be essential elements dictating an extent of ICSs use.
Journal of Asthma and Allergy, 2020
Introduction: Inhaled corticosteroids (ICSs) are a cornerstone medicine for preventive therapy of persistent severe asthma. Although ICs are very effective for the treatment of severe persistent asthma, the majority of the prescribers worldwide aren't aware of ICs use for the treatment of severe persistent asthma. Objective: To evaluate factors contributing to underutilization of ICS by asthmatic patients. Methods: Patient interview was conducted among asthmatic patients using a cross-sectional study design who were attending at the Adama Hospital Medical College from March 1 to July 25, 2017. The total number of patients involved in the study was 94. Semi-structured questionnaire through patient interview was used for data collection and data from physicians who were working at the chest clinic of AHMC were collected by self-administered semistructured questionnaire focusing their perspectives and experiences on patients' ICS. Results: Generally 73.5% of underutilization of ICS was reported from the total number of patients involved in the study according to the patient's perception. Monthly income, comorbid disease, and behaviors of ICS use were the main factors contributing to underutilization of ICS. According to patient's report, some of the reasons for underutilization of ICS were unaffordability, using the drugs only when symptoms appear, inaccessibility, side effects and recommendation by physicians. There were also similar reports by the physicians working in the AHMC. Conclusion: In our study setting, prevalence of underutilization of ICS was high and the contributing factors were increased cost of ICS, inaccessibility of ICS, poor knowledge of the patients on asthma disease and ICS, bad attitude toward ICS, and lack of recently reviewed local guideline for asthma treatment. Thus, concerned experts need to take actions that guarantee accessibility of ICS at a reasonable price and increase awareness of patients about asthma disease and use of ICS.
BMJ Open, 2021
Introduction Health systems in sub-Saharan African (SSA) countries are fragile and centralised. Consequently, majority of people have restricted access to healthcare services. Given the rise in the prevalence and burden of asthma in SSA, it is imperative to scrutinise the utilisation of healthcare services by people with asthma. We aim to understand, through this review, the extent of utilisation of healthcare services by asthma patients in SSA countries. Methods and analysis Arksey and O’Malley’s scoping review methodology framework will be used to guide the conduct of this scoping review. We will conduct a search of the literature on the electronic databases: Medline, (using PubMed interface), EMBASE, EBSCOHOST, Web of Science and Google Scholar, grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Registration of the proposed scoping ...
The Lancet Global Health
Background Asthma is one of the most common non-communicable diseases globally. This study aimed to assess asthma medicine use, management plan availability, and disease control in childhood, adolescence, and adulthood across different country settings. Methods We used data from the Global Asthma Network Phase I cross-sectional epidemiological study (2015-20). A validated, written questionnaire was distributed via schools to three age groups (children, 6-7 years; adolescents, 13-14 years; and adults, ≥19 years). Eligible adults were the parents or guardians of children and adolescents included in the surveys. In individuals with asthma diagnosed by a doctor, we collated responses on past-year asthma medicines use (type of inhaled or oral medicine, and frequency of use). Questions on asthma symptoms and health visits were used to define past-year symptom severity and extent of asthma control. Income categories for countries based on gross national income per capita followed the 2020 World Bank classification. Proportions (and 95% CI clustered by centre) were used to describe results. Generalised structural equation multilevel models were used to assess factors associated with receiving medicines and having poorly controlled asthma in each age group. Findings Overall, 453 473 individuals from 63 centres in 25 countries were included, comprising 101 777 children (6445 [6•3%] with asthma diagnosed by a doctor), 157 784 adolescents (12 532 [7•9%]), and 193 912 adults (6677 [3•4%]). Use of asthma medicines varied by symptom severity and country income category. The most used medicines in the previous year were inhaled short-acting β2 agonists (SABA; range across age groups, 29•3-85•3% participants) and inhaled corticosteroids (12•6-51•9%). The proportion of individuals with severe asthma symptoms not taking inhaled corticosteroids (inhaled corticosteroids alone or with long-acting β2 agonists) was high in all age groups (934 [44•8%] of 2085 children, 2011 [60•1%] of 3345 adolescents, and 1142 [55•5%] of 2058 adults), and was significantly higher in middle-to-low-income countries. Oral SABA and theophylline were used across age groups and country income categories, contrary to current guidelines. Asthma management plans were used by 4049 (62•8%) children, 6694 (53•4%) adolescents, and 3168 (47•4%) adults; and 2840 (44•1%) children, 6942 (55•4%) adolescents, and 4081 (61•1%) adults had well controlled asthma. Independently of country income and asthma severity, having an asthma management plan was significantly associated with the use of any type of inhaled medicine (adjusted odds ratio [OR] 2•75 [95% CI 2•40-3•15] for children; 2•45 [2•25-2•67] for adolescents; and 2•75 [2•38-3•16] for adults) or any type of oral medicine (1•86 [1•63-2•12] for children; 1•53 [1•40-1•68] for adolescents; and 1•78 [1•55-2•04] for adults). Poor asthma control was associated with low country income (lower-middle-income and low-income countries vs high-income countries, adjusted OR 2•33 [95% CI 1•32-4•14] for children; 3•46 [1•83-6•54] for adolescents; and 4•86 [2•55-9•26] for adults). Interpretation Asthma management and control is frequently inadequate, particularly in low-resource settings. Strategies should be implemented to improve adherence to asthma treatment guidelines worldwide, with emphasis on access to affordable and quality-assured essential asthma medicines especially in low-income and middle-income countries.
Systematic Reviews, 2019
Background: Asthma is a major worldwide public health problem affecting an estimated 334 million people with over 300,000 deaths annually. Twenty-two million disability-adjusted life years (DALYs) are lost annually due to asthma. The condition may present many challenges if not managed well and effectively. This systematic review will provide a comprehensive synthesis of qualitative literature regarding the challenges experienced in the management of asthma and strategies adopted to counter these challenges. The review will answer the following questions: (i) what challenges have been experienced in the treatment of asthma in Sub-Saharan Africa (SSA)? and (ii) what strategies have been used to overcome asthma treatment challenges in SSA? Methods: The reviewers will search for the following databases for relevant qualitative studies: PubMed/MEDLINE, Scopus/Embase (Elsevier), EbscoHost, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar, using the Medical Subject Headings (MeSH) and controlled vocabulary. These articles must have been published in the English language between January 2008 and December 2018. The identified papers will then be assessed for meeting eligibility criteria. Two independent reviewers will screen titles and abstracts of articles and then review the full texts of the selected research articles. Standard data extraction forms will be utilised, and the quality of the included studies will be assessed using the Joanna Briggs checklist for qualitative research appraisal tool. Results from eligible articles will be qualitatively synthesised using the framework synthesis approach and reported according to the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement. Discussion: This systematic review will provide an overview of reported challenges in the treatment of asthma in Sub-Saharan Africa from 2008 to 2018. The review is expected to provide information that will help form the basis for future research, policy development and practice in treatment of asthma. Systematic review registration: PROSPERO CRD42018095802
Social Science Research Network, 2022
Background Asthma is one of the most common non-communicable diseases globally. This study aimed to assess asthma medicine use, management plan availability, and disease control in childhood, adolescence, and adulthood across different country settings. Methods We used data from the Global Asthma Network Phase I cross-sectional epidemiological study (2015-20). A validated, written questionnaire was distributed via schools to three age groups (children, 6-7 years; adolescents, 13-14 years; and adults, ≥19 years). Eligible adults were the parents or guardians of children and adolescents included in the surveys. In individuals with asthma diagnosed by a doctor, we collated responses on past-year asthma medicines use (type of inhaled or oral medicine, and frequency of use). Questions on asthma symptoms and health visits were used to define past-year symptom severity and extent of asthma control. Income categories for countries based on gross national income per capita followed the 2020 World Bank classification. Proportions (and 95% CI clustered by centre) were used to describe results. Generalised structural equation multilevel models were used to assess factors associated with receiving medicines and having poorly controlled asthma in each age group. Findings Overall, 453 473 individuals from 63 centres in 25 countries were included, comprising 101 777 children (6445 [6•3%] with asthma diagnosed by a doctor), 157 784 adolescents (12 532 [7•9%]), and 193 912 adults (6677 [3•4%]). Use of asthma medicines varied by symptom severity and country income category. The most used medicines in the previous year were inhaled short-acting β2 agonists (SABA; range across age groups, 29•3-85•3% participants) and inhaled corticosteroids (12•6-51•9%). The proportion of individuals with severe asthma symptoms not taking inhaled corticosteroids (inhaled corticosteroids alone or with long-acting β2 agonists) was high in all age groups (934 [44•8%] of 2085 children, 2011 [60•1%] of 3345 adolescents, and 1142 [55•5%] of 2058 adults), and was significantly higher in middle-to-low-income countries. Oral SABA and theophylline were used across age groups and country income categories, contrary to current guidelines. Asthma management plans were used by 4049 (62•8%) children, 6694 (53•4%) adolescents, and 3168 (47•4%) adults; and 2840 (44•1%) children, 6942 (55•4%) adolescents, and 4081 (61•1%) adults had well controlled asthma. Independently of country income and asthma severity, having an asthma management plan was significantly associated with the use of any type of inhaled medicine (adjusted odds ratio [OR] 2•75 [95% CI 2•40-3•15] for children; 2•45 [2•25-2•67] for adolescents; and 2•75 [2•38-3•16] for adults) or any type of oral medicine (1•86 [1•63-2•12] for children; 1•53 [1•40-1•68] for adolescents; and 1•78 [1•55-2•04] for adults). Poor asthma control was associated with low country income (lower-middle-income and low-income countries vs high-income countries, adjusted OR 2•33 [95% CI 1•32-4•14] for children; 3•46 [1•83-6•54] for adolescents; and 4•86 [2•55-9•26] for adults). Interpretation Asthma management and control is frequently inadequate, particularly in low-resource settings. Strategies should be implemented to improve adherence to asthma treatment guidelines worldwide, with emphasis on access to affordable and quality-assured essential asthma medicines especially in low-income and middle-income countries.
2017
Background: Bronchial asthma is a global health problem that causes significant morbidity and mortality in all age groups. Global Initiative for Asthma (GINA) seeks to standardize the care asthma patients receive. We assessed the knowledge, attitude, and practices of doctors in Umuahia, Southeast Nigeria, regarding asthma and determined the extent to which they abide by GINA guidelines in their management of asthma. Methodology: It was a descriptive cross-sectional study. A pretested self-administered questionnaire was used to obtain information from the participants regarding knowledge of asthma prevalence, asthma risk factors, and management practices. Results: Out of 142 questionnaires administered, 117 were retrieved giving a response rate of 82%. About 70% were men, and the most common age group was 30–39 years (57.3%). The median duration of medical practice was 6 (3–12) years. About 77% reported asthma prevalence to be on the increase. While 105 (89.7%) respondents had seen a...