Paediatrics and Child health, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
Department of Paediatrics, King Edward VIII Hospital, Congella, South Africa.
BMJ Open. 2023 Sep 1;13(9):e070784. doi: 10.1136/bmjopen-2022-070784.
This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates.
One of the aims of our National Institute for Health Research global health research group 'Achieving Control of Asthma in Children in Africa' was to use qualitative thematic analysis of transcribed audio recordings from focus group discussions (FGDs) to describe barriers to achieving good asthma control.
Schools in Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda) and Harare (Zimbabwe).
Children (n=136), 12-14 years with either asthma symptoms or a diagnosis and their caregivers participated in 39 FGDs. All were recruited using asthma control questions from the Global Asthma Network survey.
There were four key themes identified: (1) Poor understanding, (2) difficulties experienced with being diagnosed, (3) challenges with caring for children experiencing an acute asthma episode and (4) suboptimal uptake and use of prescribed medicines. An inadequate understanding of environmental triggers, a hesitancy in using metred dose inhalers and a preference for oral and alternate medications were identified as barriers. In addition, limited access to healthcare with delays in diagnosis and an inability to cope with expected lifestyle changes was reported. Based on these findings, we recommend tailored education to promote access to and acceptance of metred dose inhalers, including advocating for access to a single therapeutic, preventative and treatment option. Furthermore, healthcare systems should have simpler diagnostic pathways and easier emergency access for asthma.
In a continent with rapidly increasing levels of poorly controlled asthma, we identified multiple barriers to achieving good asthma control along the trajectory of care. Exploration of these barriers reveals several generalisable recommendations that should modify asthma care plans and potentially transform asthma care in Africa.
本研究旨在确定撒哈拉以南非洲地区改善儿童哮喘护理的障碍，并提供相关建议。尽管该地区哮喘发病率高，但目前缺乏相关的定性数据。
我们的英国国家健康研究所全球健康研究小组的目标之一是使用焦点小组讨论（FGD）的转录音频记录的定性主题分析来描述实现良好哮喘控制的障碍。
研究地点在马拉维布兰太尔、尼日利亚拉各斯、南非德班、乌干达坎帕拉和津巴布韦哈拉雷的学校。
12-14 岁有哮喘症状或诊断的儿童（n=136）及其照顾者参加了 39 次 FGD。所有参与者均根据全球哮喘网络调查的哮喘控制问题进行招募。
确定了四个关键主题：（1）理解不足，（2）诊断过程中遇到的困难，（3）照顾急性哮喘发作儿童的挑战，以及（4）处方药物的吸收和使用不理想。研究发现，对环境触发因素的认识不足、对使用计量吸入器犹豫不决以及偏爱口服和替代药物是主要障碍。此外，还报告了有限的医疗保健获取机会，导致诊断延迟以及无法应对预期的生活方式改变。基于这些发现，我们建议进行针对性的教育，以促进对计量吸入器的获取和接受，包括倡导获得单一的治疗、预防和治疗选择。此外，医疗保健系统应简化诊断途径，并为哮喘患者提供更便捷的紧急就诊渠道。
在这个哮喘控制水平迅速上升的大陆上，我们在整个护理过程中确定了实现良好哮喘控制的多个障碍。对这些障碍的探索揭示了一些可推广的建议，这些建议应该可以修改哮喘护理计划，并有可能改变非洲的哮喘护理模式。
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