Knowledge of asthma and its management in newly qualified doctors in Accra, Ghana

Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review

Background

Respiratory diseases are the leading cause of death and disability worldwide. Oxygen is an essential medicine used to treat hypoxemia from respiratory diseases. However, the availability and utilization of oxygen delivery systems for adults in sub-Saharan Africa is not well-described. We aim to identify and describe existing data around oxygen availability and provision for adults in sub-Saharan Africa, determine knowledge or research gaps, and make recommendations for future research and capacity building.

Methods

We systematically searched four databases for articles on April 22, 2020, for variations of keywords related to oxygen with a focus on countries in sub-Saharan Africa. Inclusion criteria were studies that included adults and addressed hypoxemia assessment or outcome, oxygen delivery mechanisms, oxygen availability, oxygen provision infrastructure, and oxygen therapy and outcomes.

Results

35 studies representing 22 countries met inclusion criteria. Availability of oxygen delivery systems ranged from 42%-94% between facilities, with wide variability in the consistency of availability. There was also wide reported prevalence of hypoxemia, with most studies focusing on specific populations. In facilities where oxygen is available, health care workers are ill-equipped to identify adult patients with hypoxemia, provide oxygen to those who need it, and titrate or discontinue oxygen appropriately. Oxygen concentrators were shown to be the most cost-effective delivery system in areas where power is readily available.

Conclusions

There is a substantial need for building capacity for oxygen delivery throughout sub-Saharan Africa. Addressing this critical issue will require innovation and a multi-faceted approach of developing infrastructure, better equipping facilities, and health care worker training.

Implementation of GINA guidelines in asthma management by primary care physicians in Vietnam

Background

Asthma control is suboptimal in Vietnam. Lack of knowledge of primary care physicians (PCPs) for asthma management may potentially be one of the causes.

Purpose

The aim of this study was to assess the knowledge and practice of PCPs’ asthma management based on the Global Initiative for Asthma (GINA) guidelines (2015 update).

Methods

A cross-sectional study with convenience sampling was conducted among PCPs in an urban and rural area of Vietnam using questionnaires related to asthma patients daily practice: use of spirometry and the asthma control test (ACT), prescription of asthma medications, and frequency of consultations. Five asthma case scenarios were also used to ask participants to classify GINA-defined levels of asthma control and to choose the initial or adjusted treatment options based on the current situation. All scenarios are common in Vietnam, ie, three cases for adults, one case for children, and one case for pregnant women.

Results

Of the 327 completed questionnaires, 201 questionnaires could be analyzed. Most PCPs consulted their asthma patients on a weekly to monthly basis. Approximately 50% used spirometry for asthma care and only 25% used ACT. For asthma treatment, oral short-acting beta agonists and oral steroids were still commonly used and long-acting beta agonists alone were prescribed by 70%. Regarding GINA-defined levels of asthma control, 24% of the responders had ≥50% of correct answers, 21% had no correct answers, 2% had all five correct answers, and 20–42% had a correct answer for each of the five questions. Regarding treatment choice, 22% had ≥50% of correct answers, 14% had a wrong answer for all nine questions, and no respondent had a correct answer for ≥8 questions.

Conclusion

The percentage of PCPs in Vietnam who had implemented GINA 2015 was low. Some drugs with a high risk of side effects were still being prescribed. There is a need to improve both knowledge and daily practice. Additional studies should determine why these guidelines are not largely adopted by PCPs in Vietnam.

Knowledge of Asthma among Doctors Practicing in Three South Eastern States of Nigeria

Background:

Asthma is a chronic airway disease that has a significant impact on patients with substantial global socioeconomic burden. Appropriate knowledge by health care practitioners is important in the management of asthma.

Aim:

The aim was to assess the knowledge of asthma among doctors practicing in health care facilities in three South-Eastern states of Nigeria.

Subjects and Methods:

This was a descriptive cross-sectional study. The participants were selected using multi-staged sampling method and interviewed with structured, self-administered questionnaires. Comparison of the different outcome variables using the Chi-square (categorical) and Student's t-test (noncategorical) with the characteristics of the participants were done.

Result:

A total of 283 doctors were interviewed. Eighty-eight percent of them identified asthma as a common disease in our environment, (P = 0.04) but unrelated to socioeconomic status. Knowledge of epidemiology was poor among medical officers and registrars (P = 0.04). Most of the doctors (80%)(226/283) recognized the pathogenic significance of bronchospasm in exacerbation, while 58.6% (166/283) of them considered chronic inflammation as a significant factor in asthma pathogenesis P < 0.001. Majority of the doctors (84.1%) (238/283) were aware of the use of steroids in acute exacerbation, while 59.4% (168/283) considered aminophylline as the first line medication in exacerbation (P = 0.02). Knowledge about the use of steroids as controller medication was noted in 1.7% (5/283) of the respondents. Only 47.3% (134/283) of the participants were aware of the Global Initiative on Asthma guideline, (P = 0.03).

Conclusion:

There was good knowledge of epidemiology and clinical features of asthma, but a small number of the doctors had knowledge of pathophysiology and treatment of the disease. For best practices in asthma management, there is a need for further education.

Developing effective chronic disease interventions in Africa: insights from Ghana and Cameroon

Background

Africa faces an urgent but 'neglected epidemic' of chronic disease. In some countries stroke, hypertension, diabetes and cancers cause a greater number of adult medical admissions and deaths compared to communicable diseases such as HIV/AIDS or tuberculosis. Experts propose a three-pronged solution consisting of epidemiological surveillance, primary prevention and secondary prevention. In addition, interventions must be implemented through 'multifaceted multi-institutional' strategies that make efficient use of limited economic and human resources. Epidemiological surveillance has been prioritised over primary and secondary prevention. We discuss the challenge of developing effective primary and secondary prevention to tackle Africa's chronic disease epidemic through in-depth case studies of Ghanaian and Cameroonian responses.

Methods

A review of chronic disease research, interventions and policy in Ghana and Cameroon instructed by an applied psychology conceptual framework. Data included published research and grey literature, health policy initiatives and reports, and available information on lay community responses to chronic diseases.

Results

There are fundamental differences between Ghana and Cameroon in terms of 'multi-institutional and multi-faceted responses' to chronic diseases. Ghana does not have a chronic disease policy but has a national health insurance policy that covers drug treatment of some chronic diseases, a culture of patient advocacy for a broad range of chronic conditions and mass media involvement in chronic disease education. Cameroon has a policy on diabetes and hypertension, has established diabetes clinics across the country and provided training to health workers to improve treatment and education, but lacks community and media engagement. In both countries churches provide public education on major chronic diseases. Neither country has conducted systematic evaluation of the impact of interventions on health outcomes and cost-effectiveness.

Conclusions

Both Ghana and Cameroon require a comprehensive and integrative approach to chronic disease intervention that combines structural, community and individual strategies. We outline research and practice gaps and best practice models within and outside Africa that can instruct the development of future interventions.

Nurse-led care for asthma at primary level in rural sub-Saharan Africa: the experience of Bafut in Cameroon

BACKGROUND AND PURPOSE

Asthma is an important health condition in sub-Saharan Africa, with major gaps in clinical care. The aim of this project was to implement nurse-led care for asthma in rural Cameroon.

METHODS

We set-up a nurse-led structured management program for asthma in Bafut rural health district in Cameroon from 1998 to 2000. After an initial phase of intensive medical supervision, nurses were offered to run the clinics independently. Patients were monitored for all-cause mortality, hospitalizations, and control of asthma attacks.

RESULTS

At the final evaluation, 87 (73.4% women) were registered in the two pilot clinics. They were 4 to 92 years of age (median 51) and had been diagnosed with asthma for 0 to 40 years. The median duration of follow-up was 5 months (range 1-20) and patients attended on average 3 visits (range 1 to 14). During follow-up, a 66-year-old participant died and 170 emergency hospital admissions/consultations were recorded in 34 participants, 82.3% of them being women. Overall there was a significant downward trend in the number of days/month with attacks with the duration of follow-up, and at the last visit most patients had improved compared with the initial visit. This trend was apparent in most subgroups of participants. Hospital admission before baseline visit was a predictor of hospital admission during follow-up, hazard ratio (95% confidence interval) 3.20 (1.30-7.91), p = 0.012.

CONCLUSIONS

The program was well received by the community at large. A marked improvement was observed for most patients as substantiated by the reduction in the number of asthma attacks. Trained nurses are a good alternative for the management of asthma in a resource-limited context.

Prevalence of asthma symptoms among university students 15 to 35 years of age in Obafemi Awolowo University, Ile-Ife, Osun State

INTRODUCTION

Asthma continues to cause increasing morbidity and mortality among young adults in the developing world. There is scarcity of data on the prevalence of asthma among young Nigerian adults.

METHODS

We studied the prevalence of asthma among students (15-35 years of age) of the Obafemi Awolowo University using a standardized questionnaire. One thousand self-administered questionnaires were distributed; 903 were retrieved and analyzed (469 males, 434 females). Symptoms indicative of asthma were cough, chest tightness at rest and on exposure to irritants, and the presence of nocturnal symptoms. Students with three or more symptoms or who had a diagnosis of asthma were considered probable asthmatics and those with one or two symptoms as suspected asthmatics. Students in any of these two categories were defined as symptomatic respondents.

RESULTS

The 12-month prevalence of wheeze, night waking with cough, and chest tightness in the morning was 9.0% (n = 81) 9.4% (n = 85) and 8.0% (n = 72), respectively. One hundred and twenty-seven respondents (14.1%) comprising 49 males (10.4%) and 78 females (17.9%) had probable asthma. The remaining symptomatic respondents consisting of 20 males (4.3%) and 16 females (3.9%) had suspected asthma. Of these, only 32.5% (53/163) had been previously diagnosed and 22.1% were on occasional inhaled bronchodilator treatment.

CONCLUSION

These results indicate a relatively high prevalence of asthma among the students. A greater proportion of them had not been diagnosed and were not receiving proper treatment.

Selective suppression of cytochrome P450 gene expression by the medicinal herb, Thonningia sanguinea in rat liver

The effect of the administration of Thonningia sanguinea (T. S.) on the abundance of individual components of the cytochrome P450 monooxygenase enzyme was examined using Western blotting and competitive reverse-transcriptase-polymerase chain reaction (RT-PCR). We also investigated the time-course of inhibition of T. S. on drug metabolizing enzymes. A single intraperitoneal dose of T. S. extract (5 ml/kg) suppressed CYP, cytochrome b5 and NADPH-CYP reductase activity by 45%, 34% and 22% respectively 24 h after T. S. administration. While T. S. did not have any significant effect on microsomal glutathione S-transferase activity, it inhibited p-nitrophenol hydroxylase (PNPH, CYP2E1) and 7-methoxyresorufin O-demethylase (MROD, CYP 1A2) activities by 37% and 32% respectively at 12 h post-T. S. administration. PNPH, erythromycin N-demethylase (ERDM, CYP 3A1/2) and MROD activities were inhibited by 28-36% 24 h after T. S. injection. Consistent with these observations, the levels of CYP2E1, CYP1A2 and CYP3A2 proteins were also suppressed 24 h post-T. S. administration. While CYP2E1 mRNA was unaffected by T. S. administration, CYP1A2 and CYP3A2 mRNAs were decreased by T. S. Cytosolic glutathione S-transferase activity was increased by 30%, 6 h after T. S injection. These data demonstrate that administration of T. S. differentially affect CYP isoforms in the liver of rats and that T. S. selectively suppresses CYP3A2 and CYP1A2 gene expression.