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Taherian MR, Fatemian F, Halimi A, Soleimani Y, Jorjani G, Nozari P, Mosavi Jarrahi A, Nazari SSH, Al-Yateem N, Al-Marzouqi A, Humid A, Rahman SA. Prevalence of asthma among children and adolescents in WHO's Eastern Mediterranean Region: a meta-analysis of over 0.5 million participants. BMC Public Health 2024; 24:2148. [PMID: 39112964 PMCID: PMC11308745 DOI: 10.1186/s12889-024-18716-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/25/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE This study aims to evaluate the epidemiology of asthma among children and adolescents in the Eastern Mediterranean Region. METHODS Exhaustive searches were conducted across databases, including PubMed, Scopus, Web of Knowledge Core Collection, Embase, and Google Scholar. The selection criteria included studies reporting asthma prevalence in individuals aged 0 to 19 years, using validated questionnaires. Data were extracted and synthesized using the DerSimonian and Laird random effects model. RESULTS The overall prevalence of asthma in Eastern Mediterranean Regional Office (EMRO) countries, among the 514,468 children and adolescents included in this meta-analysis, was 10.61%, synthesized from 95 studies. Among the countries studied, Qatar exhibited the highest prevalence at 16.69%, followed by Saudi Arabia at 16.57%, Iraq at 16.22%, Oman at 15.20%, and Afghanistan at 14.90%. Adolescents showed a slightly higher prevalence of asthma at 10.10% compared to children at 9.70%. Boys exhibited a higher prevalence at 11.48% compared to girls at 9.75%. Urban areas demonstrated a higher prevalence at 11.27% than rural areas at 8.29%. CONCLUSION Efforts to reduce asthma prevalence in Arab countries and address underdiagnosis in African nations within the EMRO are crucial. Targeted interventions should focus on addressing environmental triggers and improving access to healthcare. Enhanced diagnostic capabilities and healthcare infrastructure are necessary in African countries. Collaborative action is essential to alleviate the asthma burden and promote respiratory health across the EMRO region.
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Affiliation(s)
- Mohammad Reza Taherian
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farbod Fatemian
- Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aram Halimi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yaser Soleimani
- Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Goljamal Jorjani
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Nozari
- Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Safety Promotion and Injury Prevention Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | | | - Aysha Humid
- College of Health Sciences, University of Sharjah, Sharjah, UAE.
| | - Syed Azizur Rahman
- Department of Health Care Management, College of Health Sciences, University of Sharjah, University of Sharjah, UAE.
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Chakaya J, Mecha J, Beekman M. Over-prescription of short-acting β 2-agonists remains a serious health concern in Kenya: results from the SABINA III study. BMC PRIMARY CARE 2023; 24:141. [PMID: 37422638 PMCID: PMC10329295 DOI: 10.1186/s12875-023-02030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 03/09/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Despite a high asthma burden in Kenya, insights into asthma management practices, including prescription of short-acting β2-agonists (SABAs), are lacking. Therefore, this study describes patient demographics, disease characteristics, and asthma treatment patterns in the Kenyan cohort of the SABA use IN Asthma (SABINA) III study. METHODS Patients with asthma (aged ≥ 12 years) with medical records containing data for ≥ 12 months prior to the study visit from 19 sites across Kenya were included in this cross-sectional study and classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma [GINA] recommendations) and practice type (primary/specialist care). Data on severe exacerbation history, prescribed asthma treatments, and over-the-counter (OTC) SABA purchases in the 12 months before the study visit and asthma symptom control at the time of the study visit were collated using electronic case report forms. All analyses were descriptive in nature. RESULTS Overall, 405 patients were analyzed (mean age, 44.4 years; female, 68.9%), of whom 54.8% and 45.2% were enrolled by primary care clinicians and specialists, respectively. Most patients were classified with mild asthma (76.0%, GINA treatment steps 1-2) and were overweight or obese (57.0%). Only 19.5% of patients reported full healthcare reimbursement, with 59% receiving no healthcare reimbursement. The mean asthma duration of patients was 13.5 years. Asthma was partly controlled/uncontrolled in 78.0% of patients, with 61.5% experiencing ≥ 1 severe exacerbation in the preceding 12 months. Crucially, 71.9% of patients were prescribed ≥ 3 SABA canisters, defined as over-prescription; 34.8% were prescribed ≥ 10 SABA canisters. Additionally, 38.8% of patients purchased SABA OTC, of whom 66.2% purchased ≥ 3 SABA canisters. Among patients with both SABA purchases and prescriptions, 95.5% and 57.1% had prescriptions for ≥ 3 and ≥ 10 SABA canisters, respectively. Inhaled corticosteroids (ICS), ICS with a long-acting β2-agonist fixed-dose combination, and oral corticosteroid bursts were prescribed to 58.8%, 24.7%, and 22.7% of patients, respectively. CONCLUSIONS SABA over-prescription occurred in almost three-quarters of patients, with over one-third of patients purchasing SABA OTC. Therefore, SABA over-prescription is a major public health concern in Kenya, underscoring an urgent need to align clinical practices with latest evidence-based recommendations.
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Affiliation(s)
- Jeremiah Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
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Dardouri M, Bouguila J, Sahli J, Ajmi T, Mtiraoui A, Zedini C, Mallouli M. Assessing the impact of a family empowerment program on asthma control and medication use in children with asthma: A randomized controlled trial. J SPEC PEDIATR NURS 2021; 26:e12324. [PMID: 33421315 DOI: 10.1111/jspn.12324] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE In pediatric asthma, family empowerment education has been beneficial for the quality of life, pulmonary function, and family functioning. Few studies addressed the impact of a family empowerment program on asthma symptom control, acute healthcare use (AHCU), and medication use in children with asthma. This study aimed to assess the effect of a family empowerment intervention on asthma symptom control, AHCU, inhaler technique, and controller adherence in children with asthma. DESIGN AND METHODS A single-center study using a randomized controlled design was conducted in a university hospital in the center of Tunisia from May 2018 to September 2019. Eighty-two families were randomly assigned to the intervention group (n = 41) of 8 weeks of group training sessions, or to the control group (n = 41) of usual care education. Thirty-seven families in the intervention group and 39 families in the control group received allocated intervention at baseline. Thirty-four families in each group completed the study at the 12-month follow-up. RESULTS At baseline, the intervention and control groups were statistically comparable (p > .05). At follow-up, there were significant differences between the intervention and the control group in asthma symptom control, χ2 (1, N = 34) = 9.950, p = .002, and inhalation technique, χ2 (1, N = 34) = 5.916, p = .01. For AHCU and adherence to asthma controller, there was no significant difference between groups, χ2 (1, N = 34) = 3.219, p = .07, χ2 (1, N = 34) = 0.541, p = .46, respectively. The difference within time in asthma symptom control and inhalation technique was significant (p = 10-3 , p = .001; respectively). PRACTICE IMPLICATIONS This study demonstrated that a family empowerment program significantly improved asthma symptom control and inhaler technique in children with asthma aged 7-17 years. This intervention could be clinically useful and time-saving for pediatric nurses.
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Affiliation(s)
- Maha Dardouri
- Research Laboratory LR12ES03 "Quality of Care and Management of Maternal Health Services," Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, Sousse, Tunisia
| | - Jihene Bouguila
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.,Pediatric Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Jihene Sahli
- Department of Family and Community Medicine, Research Laboratory LR12ES03 "Quality of Care and Management of Maternal Health Services," Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Thouraya Ajmi
- Department of Family and Community Medicine, Research Laboratory LR12ES03 "Quality of Care and Management of Maternal Health Services," Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Ali Mtiraoui
- Department of Family and Community Medicine, Research Laboratory LR12ES03 "Quality of Care and Management of Maternal Health Services," Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Chekib Zedini
- Department of Family and Community Medicine, Research Laboratory LR12ES03 "Quality of Care and Management of Maternal Health Services," Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Manel Mallouli
- Department of Family and Community Medicine, Research Laboratory LR12ES03 "Quality of Care and Management of Maternal Health Services," Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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Bouchriti Y, Elghazali O, Kharbach A, Gougueni H, Haddou MA, Achbani A. Characteristics of Patients with Asthma and Asthma Control: A Retrospective Analysis of Reported Data from Primary Healthcare Centers in Agadir city, Morocco (2013 - 2019). JOURNAL OF CLINICAL AND EXPERIMENTAL INVESTIGATIONS 2021. [DOI: 10.29333/jcei/9566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Dardouri M, Sahli J, Ajmi T, Mtiraoui A, Bouguila J, Mallouli M. Quality of Life Determinants in Children and Adolescents with Mild to Moderate Asthma in Tunisia. Compr Child Adolesc Nurs 2020:1-11. [PMID: 32687718 DOI: 10.1080/24694193.2020.1789240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/25/2020] [Indexed: 01/31/2023]
Abstract
Chronic childhood asthma is a leading cause of poor quality of life. Factors associated with this major asthma outcome were controversial. The aim of this study is to assess the quality of life of children and adolescents with mild to moderate asthma and to determine the factors associated with quality of life impairment in this population. This was a descriptive study carried out in the pediatric outpatient clinic of a University Hospital in the center of Tunisia over a period of 3 months (April-June 2018). Participants were children with mild to moderate asthma aged 7 to 17 years. The Pediatric Asthma Quality of Life Questionnaire was used to assess quality of life. Binary logistic regression was performed to identify predictors of asthma-related quality of life. A total of 90 children participated in the study. Almost 68% of children were aged 7 to 11, and nearly 32% were adolescents. The mean of PAQLQ total score was 4.7 ± 1.2. The final logistic regression model demonstrated that asthma symptoms control had the greatest impact on quality of life, followed by acute health care use in the past 12 months (p = .007; p = .01, respectively). The child gender and the parent's quality of life were also associated with the child's quality of life (p = .02; p = .008, respectively). This study revealed that children and adolescents with mild to moderate asthma had a moderate quality of life score. Asthma symptoms control, acute health care use, gender, and parent's quality of life determined the quality of life of children with asthma. Family-based asthma training programs that target family functioning and asthma outcomes are required.
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Affiliation(s)
- Maha Dardouri
- Laboratoire de Recherche Qualité des Soins et Management des Services de Santé Maternelle LR12ES03, Faculté de Médecine de Sousse Ibn El Jazzar, Université de Sousse, Sousse, Tunisie
| | - Jihene Sahli
- Laboratoire de Recherche Qualité des Soins et Management des Services de Santé Maternelle LR12ES03, Faculté de Médecine de Sousse Ibn El Jazzar, Université de Sousse, Sousse, Tunisie
| | - Thouraya Ajmi
- Laboratoire de Recherche Qualité des Soins et Management des Services de Santé Maternelle LR12ES03, Faculté de Médecine de Sousse Ibn El Jazzar, Université de Sousse, Sousse, Tunisie
| | - Ali Mtiraoui
- Laboratoire de Recherche Qualité des Soins et Management des Services de Santé Maternelle LR12ES03, Faculté de Médecine de Sousse Ibn El Jazzar, Université de Sousse, Sousse, Tunisie
| | - Jihene Bouguila
- Service de Pédiatrie, Hôpital Universitaire Farhat Hached, Sousse, Tunisie
| | - Manel Mallouli
- Laboratoire de Recherche Qualité des Soins et Management des Services de Santé Maternelle LR12ES03, Faculté de Médecine de Sousse Ibn El Jazzar, Université de Sousse, Sousse, Tunisie
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Dardouri M, Sahli J, Ajmi T, Mtiraoui A, Bouguila J, Mallouli M. Factors Associated with Acute Health Care Use in Children and Adolescents with Asthma. Compr Child Adolesc Nurs 2020; 44:122-133. [PMID: 32302238 DOI: 10.1080/24694193.2020.1742249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Asthma is a leading cause of acute health care use (AHCU) as defined by hospitalization and emergency department visits (ED). Little was known about factors associated with asthma-related AHCU. This study aimed to identify factors determining AHCU in children and adolescents with asthma. A descriptive study was conducted among children with mild to severe asthma referred to the pediatric outpatient clinic of "Farhat Hached" University Hospital of Sousse (Tunisia) over a period of three months (April-June 2018). We collected data regarding clinical information, the number of hospitalizations and ED visits related to asthma in the past 12 months, asthma management behaviors, and quality of life of children. Multivariable logistic regression was performed using SPSS (20.0). A total of 90 children have participated in the study. The percentage of children aged 7 to 11 years was higher than the percentage of adolescents aged 12 to 17 years (67.8%; 32.2%, respectively). The final logistic regression model demonstrated that asthma severity and inhaler technique increased the odds of AHCU (OR a = 4.6; 95% CI: 1.1-18.1; p = .03, OR a = 2.9; 95% CI: 1.1-7.8; p = .02, respectively). Also, increased quality of life score reduced the odds of AHCU (OR a = 0.6; 95% CI: 0.4-0.9; p = .01). These results suggest that the organization of programs targeting the management of these factors can reduce the workload on hospital services and emergencies.
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Affiliation(s)
- Maha Dardouri
- Faculté de Médecine de Sousse "Ibn El Jazzar", Laboratoire de recherche LR12ES03 «Qualité des soins et management des services de santé maternelle», Université de Sousse, Sousse, Tunisia
| | - Jihene Sahli
- Faculté de Médecine de Sousse "Ibn El Jazzar", Laboratoire de recherche LR12ES03 «Qualité des soins et management des services de santé maternelle», Université de Sousse, Sousse, Tunisia
| | - Thouraya Ajmi
- Faculté de Médecine de Sousse "Ibn El Jazzar", Laboratoire de recherche LR12ES03 «Qualité des soins et management des services de santé maternelle», Université de Sousse, Sousse, Tunisia
| | - Ali Mtiraoui
- Faculté de Médecine de Sousse "Ibn El Jazzar", Laboratoire de recherche LR12ES03 «Qualité des soins et management des services de santé maternelle», Université de Sousse, Sousse, Tunisia
| | - Jihene Bouguila
- Service de Pédiatrie, Hôpital Universitaire "Farhat Hached", Sousse, Tunisia
| | - Manel Mallouli
- Faculté de Médecine de Sousse "Ibn El Jazzar", Laboratoire de recherche LR12ES03 «Qualité des soins et management des services de santé maternelle», Université de Sousse, Sousse, Tunisia
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Chokhani R, Razak A, Waked M, Naing W, Bakhatar A, Khorani U, Gaur V, Gogtay J. Knowledge, practice pattern and attitude toward asthma management amongst physicians from Nepal, Malaysia, Lebanon, Myanmar and Morocco. J Asthma 2020; 58:979-989. [PMID: 32174204 DOI: 10.1080/02770903.2020.1742351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This survey aimed to understand the physicians' practice pattern and challenges faced while treating their patients with asthma in five countries-Malaysia, Nepal, Myanmar, Morocco and Lebanon. METHODS Questionnaire-based data was gathered from internal medicine doctors (209), general practitioners (206), chest physicians (152) and pediatricians (58) from 232 locations from across the five countries. RESULTS Of the 816 physicians, 374 physicians encountered at least 5 asthma patients daily. Approximately, 38% physicians always used spirometry for diagnosis and only 12% physicians always recommended Peak flow meter (PFM) for home-monitoring. Salmeterol/fluticasone (71%) followed by formoterol/budesonide (38%) were the most preferred ICS/long-acting beta2-agonists (LABA); Salbutamol (78%) was the most preferred reliever medication. 60% physicians said >40% of their patients were apprehensive to use inhalers. 72% physicians preferred a pressurized metered-dose inhaler (pMDI) to a dry powder inhaler (DPI) with only a third of them using a spacer with the pMDI. 71% physicians believed that using similar device for controller and reliever can be beneficial to patients. Skipping medicines in absence of symptoms (64%), incorrect inhaler technique (48%) and high cost of medication (49%) were considered as major reasons for non-adherence by most physicians. Incorrect inhaler technique (66%) and nonadherence (59%) were considered the most common causes of poor asthma control. CONCLUSIONS There are opportunities to improve the use of diagnostic and monitoring tools for asthma. Non-adherence, incorrect inhaler technique and cost remain a challenge to achieve good asthma control. Asthma education, including correct demonstration of inhaler, can potentially help to improve inhaler adherence.
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Affiliation(s)
- Ramesh Chokhani
- Respiratory Medicine, Norvic International Hospital, Kathmandu, Nepal
| | - Abdul Razak
- Medicine, MAHSA University, Selangor, Malaysia
| | - Mirna Waked
- Clinical Medicine, St. George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Win Naing
- Department of Respiratory Medicine, Yangon specialty hospital/University of Medicine, Yangon, Myanmar
| | | | - Urvi Khorani
- Global Medical Affairs, Cipla Ltd, Mumbai, India
| | - Vaibhav Gaur
- Global Medical Affairs, Cipla Ltd, Mumbai, India
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Ozoh OB, Ayuk AC, Ukwaja KN, Desalu OO, Olufemi O, Aderibigbe SA, Egbagbe E, Oridota OE, Dede SK, Shopeyin A, Babashani M. Asthma management and control in Nigeria: the asthma insight and reality Nigeria (AIRNIG) study. Expert Rev Respir Med 2019; 13:917-927. [PMID: 31365287 DOI: 10.1080/17476348.2019.1651201] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The state of asthma management and asthma control at the population level in Nigeria is unknown. We aimed to determine the level of asthma control and asthma management practices in Nigeria. Methods: A cross-sectional population-based study of 405 participants with current asthma (physician-diagnosed with use of asthma medication or asthma symptoms in the preceding 12 months). We determined the level of asthma control, self-perception of asthma control, health-care use, missed work/school, and medication use. Results: Asthma was controlled in 6.2% of the participants. Night-time awakening and limitation in activity in the preceding 4 weeks were reported by 77.5% and 78.3%, respectively, 56.3% and 14.1% missed work/school and had emergency room visits, respectively, and 11.6% and 38.8% used inhaled corticosteroid and short-acting beta-2 agonist, respectively, in the preceding year. About a third (34.3%) had spirometry ever performed and 46.7% had training on inhaler technique. Nearly 90% with uncontrolled asthma had self-perception of asthma control between somewhat and completely controlled. Conclusion: The level of asthma control in Nigeria is poor with a high burden of asthma symptoms and limitation in activities. This calls for a broad-based approach for the improvement in asthma care that encompasses education and access to medications.
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Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos , Lagos State , Nigeria.,Department of Medicine, Lagos University Teaching Hospital , Lagos State , Nigeria
| | - Adaeze C Ayuk
- Department of Paediatrics, College of Medicine, University of Nigeria Teaching Hospital , Enugu State , Nigeria
| | - Kingsley N Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital Abakiliki , Ebonyi State , Nigeria
| | - Olufemi O Desalu
- Department of Medicine, College of Health Sciences, University of Ilorin , Kwara State , Nigeria
| | - Olajumoke Olufemi
- Department of Community Medicine, Lagos University Teaching Hospital , Lagos State , Nigeria
| | - Sunday A Aderibigbe
- Department of Public Health, College of Medicine, University of Ilorin , Kwara State , Nigeria
| | - Eruke Egbagbe
- Department of Medicine, College of Medicine, University of Benin , Edo State , Nigeria
| | - Olufela E Oridota
- Department of Community Medicine, Lagos University Teaching Hospital , Lagos State , Nigeria.,Department of Community Medicine and Child Health, College of Medicine, University of Lagos , Lagos State , Nigeria
| | - Sandra K Dede
- Department of Medicine, Lagos University Teaching Hospital , Lagos State , Nigeria
| | - Azeezat Shopeyin
- Department of Community Medicine, Lagos University Teaching Hospital , Lagos State , Nigeria
| | - Musa Babashani
- Department of Medicine, College of Medicine, Aminu Kano University , Kano State , Nigeria
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Ménard S, Jbilou J, Lauzier S. Family caregivers' reported nonadherence to the controller medication of asthma in children in Casablanca (Morocco): Extent and associated factors. J Asthma 2018; 55:1362-1372. [PMID: 29336706 DOI: 10.1080/02770903.2017.1414235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Recent statistics show a relatively high prevalence of asthma among Moroccan children and a weak control over their symptoms. To our knowledge, no research has been carried out to document adherence to the controller treatment in this population. This study aims 1) to assess the extent of children's nonadherence to the controller treatment of asthma in an urban region of Morocco as reported by a family caregiver, and 2) to identify the associated factors. METHODS We conducted a cross-sectional study among caregivers of asthmatic children (2-12 years old) in different health and education facilities of Casablanca-Settat. We administered face-to-face questionnaires incorporating validated instruments (Medication Adherence Rating Scale-Asthma (MARS-A), Beliefs about Medicines Questionnaire (BMQ), Asthma Knowledge Questionnaire). Univariate and multivariate log-binomial regressions evaluating the association between several factors and reported nonadherence were performed (prevalence ratios (PR) and 95% confidence intervals (CI)). RESULTS Through two public hospitals, three private medical clinics, and one private school, 103 caregivers were recruited. Low adherence to the controller treatment of asthma was reported by 48% of the caregivers (MARS-A <45). In the multivariate model, caregivers with the lowest level of knowledge about asthma were almost three times more likely to report low adherence compared to caregivers with the highest level (PR = 2.93; 95% CI: 1.14-7.52). CONCLUSIONS This study highlights the finding that low adherence is widespread in this context and also the importance of targeting caregivers' knowledge of asthma for interventions.
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Affiliation(s)
- Sandra Ménard
- a Department of Social and Preventive Medicine, Faculty of Medicine , Laval University , Quebec , QC , Canada
| | - Jalila Jbilou
- b Research Professor, Centre de formation médicale du Nouveau-Brunswick , Moncton , NB , Canada ; Associate Professor, School of Psychology, Université de Moncton , Monction , NB , Canada
| | - Sophie Lauzier
- c Researcher, Population Health and Optimal Health Practices Research Unit, CHU de Québec-Université Laval Research Center , QC , Canada ; Assistant Professor, Faculty of Pharmacy, Laval University , Quebec , QC , Canada
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Ahmed R, Robinson R, Mortimer K. The epidemiology of noncommunicable respiratory disease in sub-Saharan Africa, the Middle East, and North Africa. Malawi Med J 2017; 29:203-211. [PMID: 28955434 PMCID: PMC5610297 DOI: 10.4314/mmj.v29i2.24] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Noncommunicable diseases (NCDs) are a major and increasing global health issue. The World Health Organization (WHO) estimates that NCDs represent 63% of all global deaths of which 3.9 million are due to chronic respiratory diseases (CRDs) and Chronic Obstructive Pulmonary Disease (COPD) in particular. COPD is now the third most common cause of death globally; 90% of these deaths occur in Low and Middle Income Countries (LMICs). COPD affects 329 million people, almost 5% of the world's population. In addition, asthma affects 334 million people, again representing almost 5% of the world's population. There is limited literature published on the epidemiology of COPD and Asthma from Sub-Saharan Africa (SSA) and Middle East and North Africa (MENA). Both diseases are under-diagnosed and underestimated in both SSA and MENA regions. The burden of COPD in sub-Saharan Africa is disputed and reports offer variable prevalence estimates, ranging from 4.1% to almost 22.2%. SSA and MENA countries report similar mortality rates from COPD of 18 per 100,000 population (2001 data). Asthma is a less common cause of death than COPD but is a major cause of morbidity; WHO estimates that there are 250,000 deaths per year from asthma, mainly in LMICs and it remains in the top twenty causes of disability in children globally. Risk factors for CRD are genetic and environmental; the latter dominated by air pollution exposures including tobacco smoke, household air pollution, outdoor air pollution and occupational exposures.
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Affiliation(s)
- Rana Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ryan Robinson
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Sadeq M, Abouqal R, ElMarnissi A. Secular trends in consultations for asthma in early childhood, the 16 administrative regions of Morocco, 2004-2012. BMC Public Health 2015; 15:905. [PMID: 26381603 PMCID: PMC4574130 DOI: 10.1186/s12889-015-2262-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/12/2015] [Indexed: 12/15/2022] Open
Abstract
Background Little is known about asthma trend in Morocco, particularly in early childhood. Furthermore, when dealing with asthma related environmental risk factors in Morocco, decision-making focus is in one region R9, while 16 regions make up the country. This work aims at studying 9-year trends in consultations for asthma in under-5 children in the 16 individual regions with respect to area and age group. Methods Direct method use, based on the only available national data from the open access files of the ministry of health, standardizing data for three age groups (0–11 ; 12–23 and 24–59 months). We compared age-adjusted rates, stratified by area (urban and rural areas) within each region (Wilcoxon's signed ranks test), and between all regions emphasizing on R9. Secular trends are examined (Kendall's rank correlation test). We also compared directly standardized rates as a rate ratio for two study populations (that of R9 and any region with highest rates). We finally compared rates by age group in selected regions. Results Secular increase in prevalence rates was shown in both urban and rural Morocco, particularly in urban areas of R10, R14, R16 and R5, and in rural areas of R14 and R16. In urban area of R10 (the highest age-adjusted prevalence rates area) the rates showed secular increase from 6.82 at 95 % CI = [6.44 to 7.19] per 1000 childhood population in 2004 to 20.91 at 95 % CI = [20.26 to 21.56] per 1000 childhood population in 2012 (P = 0.001). Rates were higher in urban than rural Morocco, particularly in R8, R9, R10, R14, R15 ; R6 was an exception. Rates in R10 were 1.63 higher than that in R9 in 2004 and rose to be 2.55 higher in 2012 ; rates in urban area of R14, about 3 times lower than that in R9 in 2004, increased to be similar in 2012. The highest-prevalence age group varied according to region and area. Discussion The regions that worth decision making attention are the urban areas of R10 (the highest prevalence rates Moroccan area, showing continuous increase), of R9, of R14 and the rural area of R6. The rates in the urban area of R9 (a current continuous decision making focus) remained high but stable within the study period and less important than those in R10. Environmental factors (biological particules, non-biological particules or gazes) are suspected.The potential unavailability of treatment at regular basis at the primary health care centers may reduce frequency of consultations for asthma in early childhood : outpatients may consult only if asthma causes problems in an attempt to get free medicines ; chances of outpatients' follow-up by the primary health care center's physicians are therefore reduced and optimal asthma control is not achieved. Conclusion Social, health care policy and environmental factors, to which decision-making has to be responsive, are suspected to be affecting both frequency of and time secular trend in consultations for asthma in early childhood in Morocco. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2262-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mina Sadeq
- Environmental Epidemiology Unit, National Institute of Hygiene, Ministry of Health, 27 Avenue Ibn Battota, BP 769, Rabat, Morocco.
| | - Redouane Abouqal
- Laboratory of Biostatistiques, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, University Mohammed V. Rabat, Rabat, Morocco.
| | - Abdelilah ElMarnissi
- Service of Studies and Health Information, Direction of Planning and Financial Ressources, Ministry of Health, Rabat, Morocco.
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Nantanda R, Ostergaard MS, Ndeezi G, Tumwine JK. Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study. BMC Pediatr 2014; 14:285. [PMID: 25431036 PMCID: PMC4254222 DOI: 10.1186/s12887-014-0285-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/23/2014] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Little attention has been paid to asthma in 'under-fives' in Sub-Saharan Africa. In 'under-fives', acute asthma and pneumonia have similar clinical presentation and most children with acute respiratory symptoms are diagnosed with pneumonia according to the WHO criteria. The mortality associated with acute respiratory diseases in Uganda is high but improving, dropping from 24% in 2004 to 11.9% in 2012. We describe the immediate clinical outcomes of children with acute asthma and pneumonia and document the factors associated with prolonged hospitalization and mortality. METHODS We enrolled 614 children aged 2 to 59 months with acute respiratory symptoms presenting at the emergency paediatric unit of Mulago hospital. Clinical histories, physical examination, blood and radiological tests were done. Children with asthma and bronchiolitis were collectively referred to as 'Asthma syndrome'. Hospitalized children were monitored every 12 hours for a maximum of 7 days. Survival analysis was done to compare outcome of children with asthma and pneumonia. Cox regression analysis was done to determine factors associated with prolonged hospitalization and mortality. RESULTS Overall mortality was 3.6%. The highest case fatality was due to pneumocystis jirovecii pneumonia (2/4) and pulmonary tuberculosis (2/7). None of the children with asthma syndrome died. Children with 'asthma syndrome' had a significantly shorter hospital stay compared to those with pneumonia (p<0.001). Factors independently associated with mortality included hypoxemia (HR = 10.7, 95% CI 1.4- 81.1) and severe malnutrition (HR = 5.7, 95% CI 2.1- 15.8). Factors independently associated with prolonged hospitalization among children with asthma syndrome included age less than 12 months (RR = 1.2, 95% CI 1.0-1.4), hypoxemia (RR = 1.4, 95% CI 1.2-1.7), and severe malnutrition (RR = 1.5 95% CI 1.3-1.8). Similar factors were associated with long duration of hospital stay among children with pneumonia. CONCLUSION This study identified a sharp decline in acute respiratory mortality compared to the previous studies in Mulago hospital. This may be related to focus on and treatment of asthma in this study, and will be analysed in a later study. Bacterial pneumonia is still associated with high case fatality. Hypoxemia, severe malnutrition, and being an infant were associated with poor prognosis among children with acute asthma and pneumonia and need to be addressed in the management protocols.
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Affiliation(s)
- Rebecca Nantanda
- />Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
- />Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Marianne S Ostergaard
- />The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grace Ndeezi
- />Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - James K Tumwine
- />Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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Lavaud F, Dutau G. Spores fongiques atmosphériques et allergies respiratoires. REVUE FRANCAISE D ALLERGOLOGIE 2013. [DOI: 10.1016/j.reval.2013.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Prevalence of asthma in North Africa: the Asthma Insights and Reality in the Maghreb (AIRMAG) study. Respir Med 2010; 103 Suppl 2:S2-11. [PMID: 20122625 DOI: 10.1016/s0954-6111(09)70022-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Bronchial asthma is the most frequent chronic respiratory disease in both adults and children. The prevalence and burden of asthma vary considerably between different regions of the world. Information on asthma in Africa is fragmentary and relatively old. OBJECTIVE The objective of this cross-sectional epidemiological survey was to determine the prevalence and burden of asthma in the North African countries of Algeria, Morocco and Tunisia using the methodology developed in the Asthma Insights and Reality (AIR) programme. METHODS A general population sample was generated using a stratified sampling method based on randomly-generated lists of telephone numbers. The target sample consisted of 10,000 households in each country, which were contacted by telephone. A structured interview was proposed. Two screening questions were asked to identify subjects with asthma. Subjects who met these criteria were then questioned in more detail about their asthma. RESULTS Of 30 350 households contacted, 1090 subjects with asthma were identified of whom 872 provided complete data. The age- and gender-adjusted prevalence of asthma was 3.45% [95% CI: 3.09 3.80%] in Algeria, 3.89% [95% CI: 3.52 4.27%] in Morocco and 3.53% [95% CI: 3.18 3.89%] in Tunisia. Prevalence was highest in children and older adults, and in urban areas. Annual incidence rates ranged between 28/10,000 in Tunisia and 46/10,000 in Algeria. 74.3% of adults reported being handicapped by their asthma all or most of the time, 26.4% reported a visit to a hospital emergency department in the previous year and 23.9% absence from work or school due to asthma. 48.0% reported that their sleep was very or quite disturbed by asthma. CONCLUSIONS The prevalence of asthma in the Maghreb countries is moderate, but its impact is high.
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