Knowledge, attitudes, and behavior of the parents of asthmatic children in Maputo

"Asthma is a very bully disease" - patient experiences of living with chronic respiratory diseases in Cape Town, South Africa

BACKGROUND

Chronic respiratory diseases are common in Cape Town, South Africa. Yet the experiences of how adults with these conditions, such as asthma or COPD (chronic obstructive pulmonary disease), negotiate the health system are poorly understood. Qualitative methodology lends itself to investigate this question.

AIM OF STUDY

To explore the "emic" experiences of adults with CRDs in Cape Town when they were negotiating the health system using semi-structured interviews.

METHODS

Interviews were conducted following informed consent with purposively sampled adults who had attended public hospitals in Cape Town with chronic respiratory disease flare-ups. This work was nested in the quantitative "Diagnosing Airways Disease" study. The topic guide explored patients' experiences of accessing healthcare including receiving and interpretations of the diagnosis and management, and impacts on daily life. Interviews were conducted in Afrikaans, isiXhosa, or English; transcribed, and translated into English and thematically analysed until saturation.

RESULTS

Thirty-two interviews (16 in Afrikaans, 8 in isiXhosa, 8 in English) were completed in 2022. 17 women and 15 men participated. Most participants were older than 50 years (25/32), and most were unemployed (13/32) or retired (11/32). The identified themes were: Perceived causes of illness; experiences of healthcare; perceived risks and barriers when accessing healthcare; and impact on earnings. The perceived causes of their illness and risks were structural, and included air pollution, poor quality housing, occupational exposures, limited healthcare services, and fear of violence. These factors led to self-treatment, sharing of medicines, and delay in receiving a diagnosis. Many paid privately for treatments or services to overcome identified shortcomings of the public healthcare system, and many reported additional significant indirect costs. Being ill had a profound impact on income. The identified themes were explored through the lens of "structural violence", where "social structures stop individuals … from reaching their full potential" (Galtung, 1969).

CONCLUSION

In Cape Town structural elements such as stretched healthcare professionals, insufficiently enforced policies on e.g., housing or work-place exposures, poverty and crime made it difficult for participants to successfully navigate their illness experience. It forced some to pay out of pocket to receive perceived better healthcare privately.

Global Considerations in Asthma Treatment: Management in Low Resource Settings

Low-resource settings have a disproportionately higher burden of asthma due to factors that include environmental triggers, access to healthcare, availability of medications, and uncoordinated health systems. The application of guideline-based management can vary, which further impacts the treatment delivered. This chapter aims to outline the global landscape of asthma management, including cultural and social factors, with suggestions for interventions.

Disparities in assessments of asthma control between children, parents, and physicians

OBJECTIVE

Assessment of asthma control in children by physicians, patients and their parents was compared, assuming parents may underestimate symptoms in asthmatic children and exploring whether physicians tend to agree with them.

DESIGN

Asthma control perception was assessed in 4- to 11-year-old asthmatic children and their parents, using C-ACT, during 2011-2012. Pediatric pulmonologists used GINA guidelines for their assessment; pediatricians, not having spirometry, used the information given in addition to physical examination. The C-ACT scores given by the children and their parents were further analyzed separately, and compared with their physicians' assessment. Statistical methods, which also measured possible influence of different variables, included kappa, Chi-square, linear-by-linear association, McNemar test and logistic regression.

PATIENT SELECTION

The study comprised 354 parents and children aged 4-11 years with moderate-severe asthma; 129 (36.4%) were treated by 23 pediatricians; 225 (63.6%) by 11 pediatric pulmonologists.

RESULTS

The C-ACT was generally found valid in assessing asthma control (P < 0.001; κ 0.529; CI 0.441, 0.617) and showed that in 229/354 (53%) of children the asthma was uncontrolled. Nevertheless, of the 229 children who indicated their asthma was uncontrolled, 124 (54.1%) of their parents (κ 0.245; CI 0.15, 0.34) and 96 (41.9%) of their physicians believed it to be controlled (κ 0.331; 0.24, 0.43). Comparing the physician-child discordance vis-à-vis the parents, the significant difference was when 96/229 children (41.9%) and 34/126 parents (27.0%) indicated the asthma was uncontrolled while the physician determined it controlled (OR 1.95; 1.19, 3.24). There were no significant differences between pediatric pulmonologists and pediatricians.

CONCLUSIONS

In addition to increasing awareness of parents to symptoms in their asthmatic children, physicians should question the child appropriately, as well as using the children's responses to C-ACT as an information source for properly assessing asthma control.

Socio-epidemiological Aspects of Respiratory Allergic Diseases in Southern Africa

The prevalence of respiratory allergic diseases has been increasing in Southern Africa both in urban and in rural environments. Various factors may contribute toward this situation, namely, exposure to aeroallergens, such as grass pollens and house dust mites. However, other irritant environmental triggers, such as exposure to tobacco smoke and certain indoor and outdoor fumes, may also play a relevant part. Furthermore, certain parasitic and mycobacterial infections may act as allergic disease risk modifiers, although such an influence should be confirmed. Finally, certain cultural and socioeconomic factors may also influence accessibility to healthcare and adherence to treatment of these diseases.

Asthma and allergies in schoolchildren of Maputo

AIM

The study aimed to determine prevalence and severity of asthma, rhinitis and eczema in Maputo, Mozambique.

METHODS

The International Study of Asthma and Allergies (ISAAC) protocol was applied in 27 schools in urban, suburban and semi-rural areas.

RESULTS

A total of 2630 completed questionnaires were obtained from students aged 13-14 years, and 2383 from schoolchildren aged 6-7 years. The prevalence of current asthma was 13.3% in the two groups, the prevalence of rhinoconjuctivitis and eczema was 23% and 10% in teenagers and 8.8% and 8.5% respectively in children 6-7 years old. Overall, 35% of the adolescents and 23.8% of children were found to have at least one atopic condition or asthma in the last year. In symptomatic adolescents, the conditions were: rhinoconjuctivitis (41.3%), asthma (20%) and eczema (12.4%). In symptomatic children, asthma was the principal condition (36.2%), followed by eczema (20.3%) and rhinoconjunctivitis (19.1%). In adolescents, asthma was more frequently associated with rhinoconjuctivitis (28%). About 4% of all surveyed children had three atopic conditions associated. In adolescents, past year rhinitis was more frequent and severe in the urban area. Hay fever was commoner in the semi-urban area. Eczema was significantly more recurrent in suburban and semi-rural area. Exercise-induced wheeze, nocturnal cough and ever asthma were more reported in children of suburban area.

CONCLUSION

Asthma and allergic diseases are important public health problems in Maputo and improvement in prevention and management plans are required.