University of KwaZulu Natal, College of Health Sciences, School of Nursing and Public Health, Durban, South Africa.
Asthma, Allergy and Immunedsyfunction Clinic, 113 Kwame Nkrumah Ave, Harare, Zimbabwe.
Pan Afr Med J. 2020 Sep 24;37:85. doi: 10.11604/pamj.2020.37.85.19543. eCollection 2020.
asthma is a chronic inflammatory and a heterogeneous condition of respiratory system whose pathogenesis is linked with variable structural changes. The clinical manifestation of asthma includes attacks of breathlessness, cough, chest tightness and wheezing. Provision of basic equipment and test for asthma diagnosis and access to essential medicines by asthmatic patients reduces morbidity and mortality rates. Significant progress has been made in the diagnosis and management of asthma in other countries but not in the health care delivery system in Zimbabwe. Therefore, the aim of this study was to develop algorithm for asthma diagnosis and management for Zimbabwe.
a two stage Delphi model was used to collect data in order to develop an algorithm of asthma diagnosis and management. A baseline interview with 44 doctors was done to understand their experiences and knowledge regarding asthma diagnosis and management. We collected data using the KoBo Collect Toolbox installed on Android mobile phone and transferred the data to an Excel 2016 spreadsheet for cleaning. The data was qualitatively analysed and themes were constructed. These themes were further explored in stage two at an algorithm development workshop which was led by 4 medical expert panellists in order to develop consensus on the information to be included in the algorithms for asthma diagnosis and management. A total of 15 doctors and 30 nurses participated at the workshop.
doctors who attended the workshop described the challenges in asthma diagnosis and management that they experienced. These challenges were attributed to lack of basic equipment such as spirometers and Peak Expiratory Flow Meters and tests which included IgE tests, Skin Allergen Tests and RAST. Asthma diagnosis clinical history and management was based on the doctors' knowledge. The doctors indicated the need for refresher courses to update their knowledge on asthma diagnosis and enhance their diagnostic skills. A draft algorithm framework for asthma diagnosis was developed at the workshop and later refined by the core-research team. The final algorithm described in this paper was circulated for further contributions and endorsement by the asthma experts.
we established the need for doctors to receive constant refresher courses on asthma diagnosis for upskilling. We recommend adoption by the Zimbabwe's Ministry of Health and Child Care of the asthma diagnostic algorithm we developed.
哮喘是一种慢性炎症性疾病，也是呼吸系统的一种异质性疾病，其发病机制与可变的结构变化有关。哮喘的临床表现包括呼吸困难、咳嗽、胸闷和喘息发作。为哮喘患者提供基本设备和测试以进行哮喘诊断，并获得基本药物，可降低发病率和死亡率。其他国家在哮喘诊断和管理方面取得了重大进展，但津巴布韦的医疗保健系统并未如此。因此，本研究旨在为津巴布韦制定哮喘诊断和管理的算法。
采用两阶段德尔菲模型收集数据，以制定哮喘诊断和管理的算法。对 44 名医生进行了基线访谈，以了解他们在哮喘诊断和管理方面的经验和知识。我们使用安装在 Android 手机上的 KoBo 收集工具包收集数据，并将数据转移到 Excel 2016 电子表格中进行清理。对数据进行定性分析，并构建主题。在由 4 名医学专家组成的算法制定研讨会的第二阶段进一步探讨了这些主题，以就包含在哮喘诊断和管理算法中的信息达成共识。共有 15 名医生和 30 名护士参加了研讨会。
参加研讨会的医生描述了他们在哮喘诊断和管理方面遇到的挑战。这些挑战归因于缺乏基本设备，如肺活量计和呼气峰流速计以及包括 IgE 测试、皮肤过敏原测试和 RAST 在内的测试。哮喘诊断的临床病史和管理基于医生的知识。医生表示需要进修课程来更新他们对哮喘诊断的知识并提高他们的诊断技能。在研讨会上制定了哮喘诊断的草案算法框架，然后由核心研究团队进行了改进。本文中描述的最终算法已在业内分发，以供哮喘专家进一步提出意见和认可。
我们发现医生需要不断接受哮喘诊断的进修课程以提高技能。我们建议津巴布韦卫生部和儿童保健部采用我们开发的哮喘诊断算法。
