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Naidoo KL, Dladla S, Mphahlele RE, Mosler G, Muyemayema S, Ssemata AS, Mkutumula E, Adeyeye OO, Goodman O, Kuyinu Y, Nantanda R, Addo-Yobo E, Owusu SK, Arhin B, Ticklay I, Mujuru HA, Grigg J, Masekela R. A cross-country qualitative analysis of teachers' perceptions of asthma care in sub-Saharan Africa. NPJ Prim Care Respir Med 2023; 33:31. [PMID: 37741822 PMCID: PMC10517916 DOI: 10.1038/s41533-023-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023] Open
Abstract
Asthma is the most common chronic respiratory disease among school-going adolescents worldwide. However, the burden of severe asthma is highest in Sub-Saharan Africa. This study aimed to explore teachers' perceptions of asthma care across six African countries. We conducted focus group discussions (FGDs) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. FGDs were conducted in Kumasi(Ghana), Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda), and Harare (Zimbabwe) between 01 November 2020 and 30 June 2021. We identified two key themes related to asthma care; barriers to asthma care and suggestions to improve the care of adolescents with asthma. Barriers reported by teachers included a lack of knowledge and skills among themselves, adolescents, and caregivers. In addition, some traditional beliefs of teachers on asthma exacerbated challenges with asthma care in schools. Regarding suggestions, most teachers identified a need for all-inclusive asthma training programmes for teachers, adolescents and caregivers, focusing on acute episodes and mitigating triggers. Utilising teachers with personal experiences with asthma to advocate and support these initiatives was suggested. Further suggestions included the need for annual screening to enable early identification of adolescents with asthma and clarify restrictions on teachers administering asthma medications. Teachers across African schools identify multiple barriers to asthma care. Structured school education programs and annual asthma screening are key to addressing some barriers to care.
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Affiliation(s)
- Kimesh Loganathan Naidoo
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Sindisiwa Dladla
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Reratilwe Ephenia Mphahlele
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Gioia Mosler
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sophie Muyemayema
- Child and Adolescent Health Unit (CAHU), Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Andrew Sentoogo Ssemata
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Mkutumula
- Malawi Liverpool Wellcome Programme, Queen Elizabeth Central Hospital, College of Medicine, Chichiri, Malawi
| | - Olayinka Olufunke Adeyeye
- Lagos State University College of Medicine Ikeja, Lagos, Nigeria
- Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Olayinka Goodman
- Lagos State University College of Medicine Ikeja, Lagos, Nigeria
- Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Yetunde Kuyinu
- Lagos State University College of Medicine Ikeja, Lagos, Nigeria
- Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel Addo-Yobo
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Bernhard Arhin
- Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ismail Ticklay
- Child and Adolescent Health Unit (CAHU), Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
- Parirenyatwa Group of Hospitals, Causeway, Harare, Zimbabwe
| | - Hilda Angela Mujuru
- Child and Adolescent Health Unit (CAHU), Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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School-based self-management intervention using theatre to improve asthma control in adolescents: a pilot cluster-randomised controlled trial. Pilot Feasibility Stud 2022; 8:67. [PMID: 35321754 PMCID: PMC8941818 DOI: 10.1186/s40814-022-01031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Children with poorly controlled asthma have higher rates of unplanned healthcare use and school absences, as well as lower rates of medication adherence and knowledge. They also feel less comfortable using their medication at school, due to social fears and bullying. In this study, this was addressed through two school-based self-management interventions piloted to determine which one to use in a full trial. Methods We sought to assess the feasibility and acceptability of two school-based self-management intervention aimed at improving asthma control. Schools in London were randomised to (i) a theatre workshop for the whole year group aimed at raising awareness of asthma in schools, followed by self-management workshops for children (full intervention), (ii) theatre workshop alone (theatre only), or (iii) usual care (controls). Opt-out consent was obtained from parents. The study was a cluster randomised pilot trial, using London schools as the unit of allocation. Our primary aim was to assess the feasibility of delivering a self-management intervention in schools aimed at improving the asthma control test (ACT) score at 6 months. Secondary outcomes included acceptability of the school-based interventions, suitability of the theatre intervention and the full intervention with the self-management workshops, and generation of randomised data to inform future power calculations. Data were analysed by generalised mixed-effect models. Results The recruitment strategy for this trial was effective. Five schools were randomised to full intervention (189 children), four to theatre only (103 children), and six to controls (83 children). Asthma control test (ACT) score at baseline and 6 months was obtained from 178/358 participating children. Compared with the controls, there were no large differences found in ACT score with the full intervention; knowledge and perception of asthma improved though. GP and hospital visits increased in the full intervention group. Compared with controls, ACT score was unchanged in the theatre only group. Conclusion The asthma self-management intervention trial in schools is feasible and acceptable. The full intervention consisting of both theatre and self-management workshop for asthmatics tended to be better suited to improve outcomes than the theatre intervention on its own. This full intervention should be the one carried forward into a main trial if funding for further research was sought. Further work is needed to understand why there was evidence that unscheduled visits to healthcare professionals increased with the full intervention. Trial registration The study was registered on the clinical trials database on 14th May 2018 (ID NCT03536416). Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01031-1.
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Pité H, Carvalho S, Morais-Almeida M. The challenges and facilitators of self-management in pediatric asthma. Curr Opin Allergy Clin Immunol 2021; 21:135-143. [PMID: 33560741 DOI: 10.1097/aci.0000000000000731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Self-management education in asthma can dramatically reduce asthma morbidity, but specific pediatric challenges need to be addressed. The purpose of this review is to discuss the most recent and significant advances regarding self-management interventions in pediatric asthma. RECENT FINDINGS Recent evidence supports school-based programs including asthma self-management skills for children to significantly improve asthma control. A defined theoretical intervention framework, parent involvement, child satisfaction, and running the intervention outside the child's own free time are suggested drivers of successful implementation. Real-time telemedically delivered asthma education may also improve asthma-related outcomes in children. Moreover, mobile applications supporting self-management are generally welcomed by children and parents. Current evidence supports the use of models of health behaviors change in mobile application design and content development; self-monitoring alone is ineffective but useful when coupled with decision support for proactive care. SUMMARY School-based and e-health interventions are potential facilitators for the implementation of successful self-management asthma programs, providing access to large numbers of children with asthma. This supports the healthcare practitioners to work together with researchers to promote these interventions, while following current recommendations for the effective transition of children into competent and confident adults to continue to successfully self-manage their asthma.
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Affiliation(s)
- Helena Pité
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
- CEDOC, Chronic Diseases Research Center, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sara Carvalho
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital and CUF Tejo Hospital, Lisbon, Portugal
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