Ughasoro Maduka D, Eze Joy N, Oguonu Tagbo, Onwujekwe Emmanuel Obinna
Department of Paediatrics, University of Nigeria, Enugu Campus, Enugu, Nigeria.
Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria.
Paediatr Respir Rev. 2022 Mar;41:61-67. doi: 10.1016/j.prrv.2021.07.004. Epub 2021 Aug 10.
A better representation of the burden of childhood asthma should rely on both morbidity and mortality and not only mortality. This will reduce the dearth of information on burden of childhood asthma, and enhance evidence-based decision-making. In this study, burden of childhood asthma was estimated, using disability-adjusted-life-years (DALYs), factoring in the disability weights for asthma, age at mortality and life expectancy.
The study was conducted at the University of Nigeria Teaching Hospital, Enugu. An Interviewer Administered Questionnaire was used to collect information from parents of children with asthma who presented to respiratory clinics regarding level of their asthma control (controlled, partially controlled and poorly controlled asthma), their age distributions, and gender. The prevalence of asthma, prevalence of associated disability, and case-fatality were obtained from previous publications. The DALYs were estimated by adding together the years lost to disability (YLDs) and years lost to life (YLLs) to asthma (DALYs = YLD + YLL). DALYs were dis-aggregated by age group and by whether their asthma were controlled, partially controlled and poorly controlled.
A total of 66 children with asthma were studied. The proportion of the subjects with controlled, partially controlled and poorly controlled asthma were 26 (39.4%), 31 (47%), and 9 (13.6%) respectively. The subjects that had some form of asthma-related disability were 16 (24.3%). Childhood asthma caused 23.6-34.24 YLLs per 1000 population, 0.01-1.28 YLDs per 1000 population and 24.23-34.41 DALY per 1000 population. There was minimal difference in DALYs across the three clinical categories, but this was consistently higher among older children 12-17 years. The estimated national DALYs was 407820.2, reflecting about of 1.6% of the global all age (children and adults) DALYs of 24.8 million.
The DALYs due to childhood asthma were high and did not vary much across the clinical categories, but increased with age. This imperatively necessitates the de-emphasis on just clinical responses as an indicator of the efficiency of childhood asthma control interventions but rather a holistic approach should be adopted considering the limitations the child suffers as a component of both life and environmental modification in a deliberate attempt to prevent attacks. The ability of the child to function optimally while on treatment should be considered in the treatment impact review.
对儿童哮喘负担的更准确描述应同时考虑发病率和死亡率，而不仅仅是死亡率。这将减少儿童哮喘负担信息的匮乏，并加强基于证据的决策制定。在本研究中，使用伤残调整生命年（DALYs）对儿童哮喘负担进行了估计，同时考虑了哮喘的伤残权重、死亡年龄和预期寿命。
该研究在尼日利亚大学教学医院埃努古分校进行。采用访谈式问卷从前往呼吸科诊所就诊的哮喘儿童家长处收集信息，内容包括哮喘控制水平（控制良好、部分控制和控制不佳的哮喘）、年龄分布和性别。哮喘患病率、相关残疾患病率和病死率来自以往的出版物。DALYs通过将因残疾损失的年数（YLDs）和因早死损失的年数（YLLs）相加来估计（DALYs = YLD + YLL）。DALYs按年龄组以及哮喘控制良好、部分控制和控制不佳进行分类。
共研究了66名哮喘儿童。哮喘控制良好、部分控制和控制不佳的受试者比例分别为26名（39.4%）、31名（47%）和9名（13.6%）。有某种形式哮喘相关残疾的受试者为16名（24.3%）。儿童哮喘每1000人口导致23.6 - 34.24个YLLs、每1000人口0.01 - 1.28个YLDs以及每千人口24.23 - 34.41个DALYs。三个临床类别之间的DALYs差异极小，但在12 - 17岁的大龄儿童中一直较高。估计全国的DALYs为407820.2，约占全球所有年龄段（儿童和成人）2480万DALYs的1.6%。
儿童哮喘导致的DALYs很高，在临床类别之间差异不大，但随年龄增加。这迫切需要不再仅仅强调临床反应作为儿童哮喘控制干预效果的指标，而应采取整体方法，考虑到儿童作为生活和环境改变一部分所遭受的限制，以刻意预防发作。在评估治疗效果时应考虑儿童在治疗期间最佳功能的能力。
