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Labaeka AA, Falade AG, Addo-Yobo EOD, Mortimer K, Zurba L, Lesosky M, Ellwood P, Asher MI. Decreased prevalence and severity of asthma symptoms among adolescents in Ibadan, Nigeria, 1995-2018. Int J Tuberc Lung Dis 2023; 27:925-930. [PMID: 38042979 PMCID: PMC10719893 DOI: 10.5588/ijtld.23.0138] [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: 04/05/2023] [Accepted: 06/27/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: Phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC) documented increased asthma symptoms among Nigerian 13-14-year old adolescents. We investigated the trend further using the Global Asthma Network (GAN) surveillance.METHODS: Using ISAAC methodology, GAN Phase I data on symptoms and risk factors for asthma and asthma management were obtained from February to July 2018.RESULTS: There were 2,897 adolescents from 23 secondary schools. For current wheeze, there was an absolute prevalence fall per decade of -1.4 with -1 standard error (SE) in 16 years from 2002 (ISAAC Phase III) to 2018 (GAN Phase I). This pattern was evident for prevalence of reported asthma ever, severe asthma symptoms and night cough with ≥1 SE. During the 23-year interval between ISAAC Phase I and GAN Phase I, there was a fall (≥1 SE) in the absolute prevalence of reported asthma ever, severe asthma symptoms and night cough, except for severe asthma symptoms (-0.2 SE). Respectively 36% and 43% of symptomatic adolescents purchased and used salbutamol and prednisolone.CONCLUSION: The prevalence and severity of asthma symptoms remain high among adolescents in Ibadan. This could be mitigated by improved access to affordable and effective asthma treatments.
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Affiliation(s)
- A A Labaeka
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - A G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - E O D Addo-Yobo
- Kwame Nkrumah University of Science and Technology, Kumasi, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - K Mortimer
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, University of KwaZulu Natal, Durban
| | - L Zurba
- Spirometry Training Services Africa, Durban
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - P Ellwood
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - M I Asher
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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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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Boboltz A, Kumar S, Duncan GA. Inhaled drug delivery for the targeted treatment of asthma. Adv Drug Deliv Rev 2023; 198:114858. [PMID: 37178928 DOI: 10.1016/j.addr.2023.114858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/14/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
Asthma is a chronic lung disease affecting millions worldwide. While classically acknowledged to result from allergen-driven type 2 inflammatory responses leading to IgE and cytokine production and the influx of immune cells such as mast cells and eosinophils, the wide range in asthmatic pathobiological subtypes lead to highly variable responses to anti-inflammatory therapies. Thus, there is a need to develop patient-specific therapies capable of addressing the full spectrum of asthmatic lung disease. Moreover, delivery of targeted treatments for asthma directly to the lung may help to maximize therapeutic benefit, but challenges remain in design of effective formulations for the inhaled route. In this review, we discuss the current understanding of asthmatic disease progression as well as genetic and epigenetic disease modifiers associated with asthma severity and exacerbation of disease. We also overview the limitations of clinically available treatments for asthma and discuss pre-clinical models of asthma used to evaluate new therapies. Based on the shortcomings of existing treatments, we highlight recent advances and new approaches to treat asthma via inhalation for monoclonal antibody delivery, mucolytic therapy to target airway mucus hypersecretion and gene therapies to address underlying drivers of disease. Finally, we conclude with discussion on the prospects for an inhaled vaccine to prevent asthma.
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Affiliation(s)
- Allison Boboltz
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States
| | - Sahana Kumar
- Biological Sciences Graduate Program, University of Maryland, College Park, MD 20742, United States
| | - Gregg A Duncan
- Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, United States; Biological Sciences Graduate Program, University of Maryland, College Park, MD 20742, United States.
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Khattab A, Madkour A, Ambaram A, Smith C, Muhwa CJ, Mecha JO, Alsayed M, Beekman MJHI. Over-prescription of short-acting β 2-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study. Curr Med Res Opin 2022; 38:1983-1995. [PMID: 36031882 DOI: 10.1080/03007995.2022.2100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The extent of short-acting β2-agonist (SABA) overuse in Africa remains poorly documented. As part of the SABA use IN Asthma (SABINA) III study, we assessed SABA prescriptions/clinical outcomes in 3 African countries. METHODS Data on disease characteristics/asthma treatments were collected from patients (≥12 years) using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma) and practice type (primary/specialist care). Multivariable regression models analyzed associations between SABA prescriptions and outcomes. RESULTS Data from 1778 patients (mean age, 43.7 years) were analyzed. Most patients were female (62.4%) and had moderate-to-severe asthma (63.3%), with 57.1 and 42.9% of patients treated in specialist and primary care, respectively. Asthma was partly controlled/uncontrolled in 66.2% of patients, with 57.9% experiencing ≥1 severe exacerbation in the previous 12 months. Overall, 46.5% of patients were prescribed ≥3 SABA canisters in the preceding 12 months (over-prescription); 26.2% were prescribed ≥10 canisters. SABAs were purchased over-the-counter by 32.6% of patients, of whom 79.3% had received SABA prescriptions; 71.9% and 40.1% for ≥3 and ≥10 canisters, respectively. Higher SABA prescriptions (vs. 1-2 canisters) were associated with increased incidence rate of severe exacerbations and lower odds of having at least partly controlled asthma (except 3-5 canisters). CONCLUSIONS Findings from this African cohort of the SABINA III study indicate that SABA over-prescription and SABA over-the-counter purchase are common and associated with poor asthma-related outcomes. This highlights the need for healthcare providers/policymakers to align clinical practices with the latest treatment recommendations.
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Affiliation(s)
- Adel Khattab
- Pulmonary Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Madkour
- Pulmonary Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anish Ambaram
- Department of Pulmonology, Gateway Centre for Respiratory and Gastrointestinal Disease, Durban, South Africa
| | - Clifford Smith
- Morningside Mediclinic, Sandton, Johannesburg, South Africa
| | - Chakaya J Muhwa
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jared O Mecha
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Mohamed Alsayed
- Medicinal Department, AstraZeneca, Dubai, United Arab Emirates
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Magwenzi P, Rusakaniko S, Sibanda EN, Gumbo FZ. Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa. Respir Res 2022; 23:254. [PMID: 36123720 PMCID: PMC9487077 DOI: 10.1186/s12931-022-02170-y] [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: 09/10/2021] [Accepted: 09/09/2022] [Indexed: 08/29/2023] Open
Abstract
Background Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of ‘asthma’ defined by symptoms is high compared to ‘doctor diagnosed asthma’. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges? Methods The Arksey and O’Malley’s framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The ‘Preview, Question, Read, Summarise’ system was used and a narrative report was used to summarise the findings. Results A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening. Conclusion This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02170-y.
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Affiliation(s)
- P Magwenzi
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe.
| | - S Rusakaniko
- Family Medicine, Global and Public Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
| | - E N Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, 113, Kwame Nkrumah Avenue, Harare, Zimbabwe
| | - F Z Gumbo
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
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Alanazi BM, Alshammari HS, Alshammari NE, Al Ghazwi K, Khalifa NE, Abdallah MH, Alshameri NA, Hussein W, Alshammari F. The Effect of Patient Education Interventions on Asthma Management in Hail Region. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2021. [DOI: 10.18311/ajprhc/2021/28546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
<p>The rising importance of educating asthma patients about their medication and devices and how to use them and the impact of this knowledge on controlling the disease and improving the quality of life has attracted great interest from researchers in assessing the current situation of dealing with the disease in their community. The purpose of this study is therefore to assess the knowledge of asthma patients about their medication and devices, highlight the problems in the advice provided by health-care providers to asthma patients and study the potential impact of education on the management of asthma. The study was also designed to encourage health-care providers to provide appropriate education for patients and develop an educational program for the management of asthma. A cross-sectional study was conducted using two types of questionnaire, the first directed at asthmatic patients to assess their knowledge and the other directed at health-care providers to assess the challenges, which they faced in advising patients. The results showed that patients’ awareness of asthma was of a medium level. Moreover, the level of challenges faced by health-care providers when advising patients to teach them how to use asthma medications and devices was also of a medium level. The most significant problems were time and lack of patient interest. The findings explained that asthmatic patients in Hail region need improvement in their level of awareness about the use of asthma medications and devices in order to achieve a higher degree of disease control, which will be achieved through the development and implementation of an educational program by health-care providers.</p>
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Dahmash EZ. Physicians' Knowledge and Practices Regarding Asthma in Jordan: A Cross-Sectional Study. Front Public Health 2021; 9:712255. [PMID: 34532307 PMCID: PMC8438149 DOI: 10.3389/fpubh.2021.712255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Asthma is a chronic non-communicable disease that causes significant morbidity and mortality and requires ongoing clinical care. Appropriate knowledge by physicians is vital in the management of asthma. Therefore, this study aims to explore and identify the gaps in physicians' knowledge and practices concerning the management of asthma. Methods: A cross-sectional study using an online survey was conducted in Jordan to understand the gap in knowledge and practices in the management of asthma among physicians. A previously validated questionnaire was employed, the Physicians' Practice Assessment Questionnaire (PPAQ). The knowledge questions based on the Global Initiative for Asthma (GINA) guidelines were used to assess knowledge and practice among the study's participants. Predictors of good practice were identified using logistic regression. Results: A total of 271 physicians participated in this survey. The overall knowledge among physicians scored above 78%. However, gaps were pertinent to identifying the signs of asthma attacks that accounted for 61.9% of the participants, whereas only 67.6% of the physicians knew the drugs used for the management of asthma. The study revealed alarming results when practices were assessed, with the overall percentage of physicians applying the required practices did not exceed 57.1 ± 25.7%. Logistic regression analysis to determine predictors of good practice showed that out of several independent variables, physicians who see 6–10 asthma patients per day are five times more likely to follow the guidelines' recommendations in their practice; senior physicians (>50 years old) and those who see 1–5 asthma patients daily are around two times more likely to follow the guidelines (p 0.001). Conclusions: The findings of this study identified the need to transform knowledge into practice. This could be achieved through professional education and constant reminders to physicians in a simple form, as well as a clinical audit of practice. There is a need for novel knowledge transfer approaches to induce behavioral and practice change toward the management of asthma.
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Affiliation(s)
- Eman Z Dahmash
- Department of Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
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Ndarukwa P, Chimbari MJ, Sibanda E. Protocol for a scoping review to evaluate the extent of utilisation of healthcare services by asthma patients in sub-Saharan African countries. BMJ Open 2021; 11:e046294. [PMID: 34408032 PMCID: PMC8375731 DOI: 10.1136/bmjopen-2020-046294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Health systems in sub-Saharan African (SSA) countries are fragile and centralised. Consequently, majority of people have restricted access to healthcare services. Given the rise in the prevalence and burden of asthma in SSA, it is imperative to scrutinise the utilisation of healthcare services by people with asthma. We aim to understand, through this review, the extent of utilisation of healthcare services by asthma patients in SSA countries. METHODS AND ANALYSIS Arksey and O'Malley's scoping review methodology framework will be used to guide the conduct of this scoping review. We will conduct a search of the literature on the electronic databases: Medline, (using PubMed interface), EMBASE, EBSCOHOST, Web of Science and Google Scholar, grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Registration of the proposed scoping review on the PROSPERO has indicated that no similar work has been or is being done elsewhere. We will review studies published on the subject from January 2009 to May 2020 in SSA. ETHICS AND DISSEMINATION The proposed scoping review will contribute towards the knowledge base on utilisation of healthcare services particularly for people with asthma. This will provide a better understanding of the extent of utilisation of healthcare services by asthma patients and ultimately contribute to improvement of quality of care for people suffering from asthma. The results from the review will enlighten and guide healthcare practitioners and researchers on developing appropriate and feasible interventions to increase the utilisation of healthcare services by asthma patients in resource-constrained settings in SSA countries. Results of this scoping review will be disseminated through a peer-reviewed publication, conference presentations and a 1-day stakeholder meeting. PROSPERO REGISTRATION NUMBER CRD42020154127.
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Affiliation(s)
- Pisirai Ndarukwa
- Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Health Sciences, BIndura University of Science Education, Bindura, Zimbabwe
| | - Moses John Chimbari
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Elopy Sibanda
- Medical School, National University of Science and Technology Faculty of Medicine, Bulawayo, Zimbabwe
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Ozoh OB, Eze JN, Garba BI, Ojo OO, Okorie EM, Yiltok E, Okoli CV, Hammangabdo A, Beran D. Nationwide survey of the availability and affordability of asthma and COPD medicines in Nigeria. Trop Med Int Health 2020; 26:54-65. [PMID: 32985028 DOI: 10.1111/tmi.13497] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE(S) To determine the availability and affordability of asthma and COPD medicines across Nigeria. METHODS This was a cross-sectional survey conducted in 128 pharmacies (51 in public sector hospitals, 51 private sector community pharmacies and 26 charity or big private hospitals) across the six geopolitical zones of Nigeria using the WHO/Health Action Initiative method. The proportion of pharmacies where medicines were available, the median retail prices of originator and generics and affordability were analysed. A medicine was available if found in ≥ 80% of surveyed pharmacies. Unaffordability was defined as paying> 1 day's wage (> US$1.68) for a standard 30-day supply of the medicine. RESULTS The available medicines were oral corticosteroids and oral salbutamol which are not on the WHO Essential Medicine List. Medicines were found more frequently in private than public pharmacies and in the southern than northern zones. Inhalable corticosteroid was not available at any public pharmacy nationwide. None of the EML medicines were affordable. The least number of days' wages for a 30-day supply of any inhalable corticosteroid-containing medication was 3.5 days. CONCLUSIONS There are very limited availability and affordability of recommended asthma and COPD medicines across Nigeria with disparity across regions. Medicines that were available and affordable are not recommended and are harmful for long-term use. This underpins the need for engagement of all stakeholders for the review of existing policies regarding access to asthma and COPD medicines to improve availability and affordability.
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Affiliation(s)
- Obianuju B Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Joy N Eze
- Department of Pediatrics, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital Ituku Ozalla, Enugu, Nigeria
| | - Bilkisu I Garba
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Oluwafemi O Ojo
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Esther Yiltok
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Chinyere V Okoli
- Department of Paediatrics, Nyanya General Hospital, Abuja, Nigeria
| | - Ahmed Hammangabdo
- Department of Medicine, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
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Ndarukwa P, Chimbari MJ, Sibanda EN. Algorithm for asthma diagnosis and management at Chitungwiza Central Hospital, Zimbabwe. Pan Afr Med J 2020; 37:85. [PMID: 33244348 PMCID: PMC7680228 DOI: 10.11604/pamj.2020.37.85.19543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 05/27/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction asthma is a chronic inflammatory and a heterogeneous condition of respiratory system whose pathogenesis is linked with variable structural changes. The clinical manifestation of asthma includes attacks of breathlessness, cough, chest tightness and wheezing. Provision of basic equipment and test for asthma diagnosis and access to essential medicines by asthmatic patients reduces morbidity and mortality rates. Significant progress has been made in the diagnosis and management of asthma in other countries but not in the health care delivery system in Zimbabwe. Therefore, the aim of this study was to develop algorithm for asthma diagnosis and management for Zimbabwe. Methods a two stage Delphi model was used to collect data in order to develop an algorithm of asthma diagnosis and management. A baseline interview with 44 doctors was done to understand their experiences and knowledge regarding asthma diagnosis and management. We collected data using the KoBo Collect Toolbox installed on Android mobile phone and transferred the data to an Excel 2016 spreadsheet for cleaning. The data was qualitatively analysed and themes were constructed. These themes were further explored in stage two at an algorithm development workshop which was led by 4 medical expert panellists in order to develop consensus on the information to be included in the algorithms for asthma diagnosis and management. A total of 15 doctors and 30 nurses participated at the workshop. Results doctors who attended the workshop described the challenges in asthma diagnosis and management that they experienced. These challenges were attributed to lack of basic equipment such as spirometers and Peak Expiratory Flow Meters and tests which included IgE tests, Skin Allergen Tests and RAST. Asthma diagnosis clinical history and management was based on the doctors' knowledge. The doctors indicated the need for refresher courses to update their knowledge on asthma diagnosis and enhance their diagnostic skills. A draft algorithm framework for asthma diagnosis was developed at the workshop and later refined by the core-research team. The final algorithm described in this paper was circulated for further contributions and endorsement by the asthma experts. Conclusion we established the need for doctors to receive constant refresher courses on asthma diagnosis for upskilling. We recommend adoption by the Zimbabwe's Ministry of Health and Child Care of the asthma diagnostic algorithm we developed.
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Affiliation(s)
- Pisirai Ndarukwa
- University of KwaZulu Natal, College of Health Sciences, School of Nursing and Public Health, Durban, South Africa
| | - Moses John Chimbari
- University of KwaZulu Natal, College of Health Sciences, School of Nursing and Public Health, Durban, South Africa
| | - Elopy Nimele Sibanda
- Asthma, Allergy and Immunedsyfunction Clinic, 113 Kwame Nkrumah Ave, Harare, Zimbabwe
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Amorha KC, Idoko KE, Okonta MJ, Ukwe CV. Knowledge and practice of the Global Initiative for Asthma report among community pharmacists in a Nigerian State. Pan Afr Med J 2020; 37:83. [PMID: 33244346 PMCID: PMC7680245 DOI: 10.11604/pamj.2020.37.83.18897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/29/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction few studies have been conducted to evaluate pharmacists´ knowledge and practice of the asthma guidelines. The Global Initiative for Asthma (GINA) report was developed to reduce practice variability and to improve the quality of asthma care. This study aimed to assess the knowledge and practice of the GINA report among community pharmacists in a Nigerian State. Methods this cross-sectional survey was conducted among community pharmacists in Enugu State, Nigeria (May to July, 2018). Data were collected with a 39-item structured self-administered questionnaire and analyzed using the IBM SPSS Version 21.0. Descriptive statistics were used to summarize data. Inferential statistics utilized the Pearson Chi-Square test where applicable, with statistical significance set at P < 0.05. Results a total of 89 community pharmacists in Enugu State participated in the study (76.7% participation rate). More than half of them were less than 40 years old (60.7%), male (59.6%) and only had the Bachelor of Pharmacy (B.Pharm) degree (83.1%). About a tenth of the community pharmacists (10.1%) reported that they stock the peak flow meter. Few of them (2.2%) utilized the Asthma Control Test™ in their practice. After categorization, less than half of the community pharmacists had good knowledge of asthma (34.8%) and demonstrated good practice of the GINA report (11.2%). Conclusion the community pharmacists had poor knowledge of asthma and demonstrated poor practice of the GINA report. With adequate knowledge of the guidelines, community pharmacists can assist patients with making informed decisions and proffer appropriate recommendations to physicians.
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Affiliation(s)
- Kosisochi Chinwendu Amorha
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Kingsley Emeka Idoko
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Mathew Jegbefume Okonta
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Chinwe Victoria Ukwe
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
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Alem K, Gebeyehu S, Arega Y. Risk Factors and Treatment Types for Asthma Severity Among Adult Patients. J Asthma Allergy 2020; 13:167-177. [PMID: 32440162 PMCID: PMC7217635 DOI: 10.2147/jaa.s246464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/23/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify the risk factors and treatment types for asthma severity among adult patients by applying a retrospective study design. MATERIALS AND METHODS The symptoms of asthma and corresponding medication prescription were addressed by descriptive statistics, and an ordinal logistic regression model was applied to identify the risk factors of asthma severity based on the data obtained from chronic follow-up of 422 adult asthma patients from September 11, 2012, to July 8, 2016, at the University of Gondar Teaching Hospital (UOGTH). RESULTS From 422 study units, the more commonly presenting asthma symptoms were coughing and wheezing expressed by 52.13% and 50.9%, respectively. For the treatment type given to the patients, oxygen and prednisolone were highly distributed drugs to the patients in chronic illness, medication and follow-up clinic of the University of Gondar Teaching Hospital (UOGTH) which were expressed by 73.5% and 35.5%, respectively. The proportional odd logit model was used to analyse asthma severity in patients; patients who were female (OR=1.68), a rural resident (OR=1.56), regular physical exercise (OR=2.39), allergen to pet (OR=3.17), had asthma in childhood (OR=2.27), had a family history (OR=1.89), and had depression (OR=2.31) were more likely to increase asthma severity than others, and patients who were in case with regular cooker, dry season was less likely to increase asthma severity. CONCLUSION Generally, the study presented the most common asthma symptoms and treatment types correspondingly. The study also showed that demographic, environmental, genetic, and health-related factors have a significant effect on asthma severity.
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Affiliation(s)
- Kidanemariam Alem
- Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Sefinew Gebeyehu
- Department of Statistics, College of Natural and Computational Sciences, Adigrat University, Adigrat, Ethiopia
| | - Yibeltal Arega
- Department of Statistics, College of Natural and Computational Sciences, University of Gondar, Gondar, Ethiopia
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Ozoh OB, Aderibigbe SA, Ayuk AC, Desalu OO, Oridota OE, Olufemi O, Egbagbe E, Babashani M, Shopeyin A, Ukwaja K, Dede SK. The prevalence of asthma and allergic rhinitis in Nigeria: A nationwide survey among children, adolescents and adults. PLoS One 2019; 14:e0222281. [PMID: 31518382 PMCID: PMC6743776 DOI: 10.1371/journal.pone.0222281] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/26/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Asthma is an important cause of morbidity and mortality worldwide and information on the prevalence of asthma in Nigeria is inconsistent. Nationally representative data, important for health planning is unavailable. We aimed to determine the current prevalence of asthma and allergic rhinitis in Nigeria. MATERIALS AND METHODS A cross-sectional population survey conducted between June 2017 and March 2018 across five cities representing five geo-political zones in Nigeria. Validated screening questionnaires were used to identify persons with asthma and allergic rhinitis respectively. Asthma was defined as physician diagnosed asthma, clinical asthma and by presence of wheeze in the last 12 months respectively. Socio-demographic information, tobacco smoking, sources of household cooking fuel were also obtained. RESULTS A total of 20063 participants from 6024 households were screened. The prevalence (95% confidence interval) of physician diagnosed asthma, clinical asthma and wheeze was 2.5% (2.3-2.7%), 6.4% (6.0-6.64%) and 9.0% (8.6-9.4%) respectively. The prevalence of allergic rhinitis was 22.8% (22.2-23.4%). The prevalence of asthma and rhinitis increased with age (prevalence of clinical asthma: 3.1% (2.8-3.4%), 9.8% (9.1-10.5) and 10.7% (9.4%-12.0) among 6-17 years, 18-45 years and >45 years respectively). Prevalence also varied across different cities with the highest prevalence of clinical asthma occurring in Lagos (8.0%) and the lowest in Ilorin (1.1%). The frequency of allergic rhinitis among persons with clinical asthma was 74.7%. Presence of allergic rhinitis, family history of asthma, current smoking and being overweight were independent determinants of current asthma among adults. CONCLUSION The prevalence of asthma and allergic rhinitis in Nigeria is high with variabilities across regions and age groups. The number of persons with clinical asthma in Nigeria (approximately 13 million) is likely to rank among the highest in Africa. This warrants prioritization by stakeholders and policy makers to actively implement risk reduction measures and increase investment in capacity building for the diagnosis and treatment of asthma and allergic rhinitis.
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Affiliation(s)
- Obianuju B. Ozoh
- Department of Medicine, College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Lagos State, Nigeria
- * E-mail: ,
| | - Sunday A. Aderibigbe
- Department of Public Health, College of Health Sciences, University of Ilorin, Kwara State, Nigeria
| | - Adaeze C. Ayuk
- Department of Paediatrics, College of Medicine, University of Nigeria Teaching Hospital, Enugu State, Nigeria
| | - Olufemi O. Desalu
- Department of Medicine, College of Health Sciences, University of Ilorin, Kwara State, Nigeria
| | - Olufela E. Oridota
- Lagos University Teaching Hospital, Lagos State, Nigeria
- Department of Community Medicine and Child Health, College of Medicine, University of Lagos, Lagos State, Nigeria
| | | | - Eruke Egbagbe
- Department of Medicine, College of Medicine, University of Benin, Edo State, Nigeria
| | - Musa Babashani
- Department of Medicine, College of Medicine, Aminu Kano University, Kano State, Nigeria
| | | | - Kingsley Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital Abakiliki, Ebonyi State, Nigeria
| | - Sandra K. Dede
- Lagos University Teaching Hospital, Lagos State, Nigeria
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Kibirige D, Sanya RE, Nantanda R, Worodria W, Kirenga B. Availability and affordability of medicines and diagnostic tests recommended for management of asthma and chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review. Allergy Asthma Clin Immunol 2019; 15:14. [PMID: 30899279 PMCID: PMC6407228 DOI: 10.1186/s13223-019-0329-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/20/2019] [Indexed: 01/02/2023] Open
Abstract
Background Early accurate diagnosis and sustainable availability of affordable medicines and diagnostic tests is fundamental in optimal management of asthma and chronic obstructive pulmonary disease (COPD). We systematically reviewed original research articles about availability and affordability of medicines and diagnostic tests recommended for management of asthma and COPD in sub-Saharan Africa (SSA). Methods We searched PubMed, Scopus and African Journal Online for original research articles conducted in SSA between 2000 and March 2018 containing information about availability and affordability of any recommended medicine and diagnostic test for asthma and COPD. Results The search yielded 9 eligible research articles. Availability of short-acting beta agonists (SABA), inhaled corticosteroids (ICS) and short acting anti-muscarinic agents (SAMA) ranged between 19.9-100%, 0-45.5% and 0-14.3% respectively. Combination of ICS-long acting beta agonists (LABA) were available in 0-14.3% of facilities surveyed. There was absence of inhaled long acting anti-muscarinic agents (LAMA) and LAMA/LABA combinations. Spirometry and peak expiratory flow devices were available in 24.4-29.4% and 6.7-53.6% respectively. Affordability of SABA and ICS varied greatly, ranging from < 2 to 107 days' wages while ICS-LABA combinations, SAMA and oral theophylline plus leukotriene receptor antagonists cost 6.4-17.1, 13.7 and 6.9 days' wages respectively. Conclusion Availability and affordability of medicines and diagnostics recommended for the management of asthma and COPD is a big challenge in SSA. Research about this subject in this region is still limited. More robustly performed studies are required to further understand the magnitude of inequity in access to these medicines and diagnostic tests in SSA and also to formulate simple pragmatic solutions to address this challenge.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, P.O.BOX 14130, Kampala, Uganda.,2Non-communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Richard E Sanya
- 2Non-communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Rebecca Nantanda
- 3Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.,4Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Division of Pulmonology, Department of Medicine, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Bruce Kirenga
- 3Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Division of Pulmonology, Department of Medicine, Mulago National Referral and Teaching Hospital, Kampala, Uganda
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Adeniyi BO, Adebayo AM, Ilesanmi OS, Obaseki DO, Akinwalere OO, Erhabor GE. Knowledge of spacer device, peak flow meter and inhaler technique (MDIs) among health care providers: an evaluation of doctors and nurses. Ghana Med J 2018; 52:15-21. [PMID: 30013256 DOI: 10.4314/gmj.v52i1.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Metered dose inhalers are cornerstone in effective management of bronchial asthma when correctly used. Most studies hitherto have focused on assessing patient's knowledge of inhaler technique. We sought to assess the knowledge of inhaler technique, spacer device and peak flow meter among doctors and nurses in a tertiary healthcare institution in Nigeria. Method A cross sectional survey of nurses and doctors from emergency department, family and internal medicine; who were attending a continuous professional development lecture, was carried out. From a total of 100 questionnaires administered, we retrieved 87 of which 75 were completed, giving a response rate of 75%. It was a self-administered questionnaire. Data was analysed with SPSS version 21.0. Descriptive statistics were done. Association was examined using chi-square test. Result Mean age of respondent was 35.8 years ± 8.7, 47(62.7%) were < 40 years, 33(44%) were male, nurses were 30(40.0%). Only 28(37.3%) had ever used a peak flow meter. Only 4(14.3%) used peak flow meter frequently, while 12(26.7%) checked patient's inhaler technique often. Only 9 out of the 75 (12%) participants all of who are doctors knew at least 3 essential steps of the techniques in using the metered dose inhaler correctly. None of the participants got all the steps for the use of pMDI totally correct. Conclusion Knowledge regarding the use of the metered dose inhaler and spacer device was poor. Health practitioners should have constant reminders in the form of continuous medical education to update their knowledge regarding correct inhaler technique. Funding self-funded.
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Affiliation(s)
- Bamidele O Adeniyi
- Department of Medicine, Respiratory Unit, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Ayodeji M Adebayo
- Department of Community Medicine, University of Ibadan, Oyo State, Nigeria
| | - Olayinka S Ilesanmi
- Department of Community Health, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Daniel O Obaseki
- Department of Medicine, Respiratory Unit, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Olubukola O Akinwalere
- Department of Medicine, Respiratory Unit, Federal Medical Centre, Owo, Ondo State, Nigeria
| | - Gregory E Erhabor
- Department of Medicine, Respiratory Unit, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Abstract
BACKGROUND Diabetes is a noncommunicable disease that has attained great significance in the sub-Saharan region, with Nigeria being the most affected. Many persons with the condition suffer a reduced life expectancy and quality of life. Diabetes places an extra burden on the individuals and families affected, especially for the majority of patients unable to access quality health care. OBJECTIVE To describe the elements of diabetes management in Nigeria, areas for improvement, and proposed strategies to optimize care. METHODS A systematic literature search was performed on diabetes in Nigeria. Local and nonindexed literature, PubMed, and Google Scholar were used to source information on the subject. FINDINGS Diabetes-related morbidity and mortality continue to increase due to population expansion, urban migration, declining physical activity, and dietary factors. The organization of diabetes care is poorly coordinated, especially at the primary and secondary tiers of the public health care system, with consequent poor outcomes. Thus life expectancy (just about 50 years), which is low in the region, is further reduced by the double jeopardy of communicable (eg, tuberculosis, HIV/AIDS, and malaria) and noncommunicable diseases, such as diabetes and its closely related comorbidity, hypertension. CONCLUSIONS The way forward is to improve maternal and child care, promote screening of at-risk populations, and develop strategies for primary prevention and early intervention to optimize glycemic control. Greater commitment to health care by the government and nongovernmental organizations and greater awareness by Nigerians should facilitate the desired improvements in disease prevention and glycemic control in those who are already affected.
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Affiliation(s)
- Olufemi A Fasanmade
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.
| | - Samuel Dagogo-Jack
- Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN
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Belachew SA, Tilahun F, Ketsela T, Achaw Ayele A, Kassie Netere A, Getnet Mersha A, Befekadu Abebe T, Melaku Gebresillassie B, Getachew Tegegn H, Asfaw Erku D. Competence in metered dose inhaler technique among community pharmacy professionals in Gondar town, Northwest Ethiopia: Knowledge and skill gap analysis. PLoS One 2017; 12:e0188360. [PMID: 29176836 PMCID: PMC5703544 DOI: 10.1371/journal.pone.0188360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND When compared to systemic administration, if used correctly inhalers deliver a smaller enough percent of the drug right to the site of action in the lungs, with a faster onset of effect and with reduced systemic availability that minimizes adverse effects. However, the health professionals' and patients' use of metered dose inhaler is poor. OBJECTIVE This study was aimed to explore community pharmacy professionals' (pharmacists' and druggists') competency on metered dose inhaler (MDI) technique. METHOD A cross sectional study was employed on pharmacy professionals working in community drug retail outlets in Gondar town, northwest Ethiopia from March to May 2017. Evaluation tool was originally taken and adapted from the National Asthma Education and Prevention Programmes of America (NAEPP) step criteria for the demonstration of a metered dose inhaler to score the knowledge/proficiency of using the inhaler. RESULT Among 70 community pharmacy professionals approached, 62 (32 pharmacists and 30 druggists/Pharmacy technicians) completed the survey with a response rate of 85.6%. Only three (4.8%) respondents were competent by demonstrating the vital steps correctly. Overall, only 13 participants got score seven or above, but most of them had missed the essential steps which included steps 1, 2, 5, 6, 7 or 8. There was a significant difference (P = 0.015) in competency of demonstrating adequate inhalational technique among respondents who took training on basic inhalational techniques and who did not. CONCLUSION This study shown that, community pharmacy professionals' competency of MDI technique was very poor. So as to better incorporate community pharmacies into future asthma illness management and optimize the contribution of pharmacists, interventions would emphasis to improve the total competence of community pharmacy professionals through establishing and providing regular educational programs.
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Affiliation(s)
- Sewunet Admasu Belachew
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Fasil Tilahun
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Tirsit Ketsela
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Asnakew Achaw Ayele
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Amanual Getnet Mersha
- Department of Gynecology and obstetrics, School of Medicine, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Daniel Asfaw Erku
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
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Ayele Y, Engidawork E, Bayisa T. Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia. BMC Res Notes 2017; 10:314. [PMID: 28743293 PMCID: PMC5526241 DOI: 10.1186/s13104-017-2645-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background Inhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma. However, underutilization of ICSs is common and little is known about factors contributing toward this undesirable use. Methods A cross-sectional study was conducted through interview and chart review among persistent asthmatic patients attending chest clinic of Tikur Anbessa Specialized Hospital from 1 May to 31 September 2014. A total of 131 eligible patients who attended the clinic during study period were included in the study. A multivariate logistic regression was used to examine the association between independent and dependent variables. Results Overall, extent of underutilization of ICSs was found to be 68%. Monthly income, comorbidity and types of ICSs products prescribed showed significant association with reported underutilization. Patients’ reported reasons for underutilization includes; unaffordability (44%), using only when symptoms exacerbate (21%), fear of side effects (10%), practitioners’ recommendation (10%) and unavailability of ICSs in the local market (7%). Physicians also stated unaffordability, fear of side effects and dependency, lack of local guideline for asthma management and unavailability of ICSs as the contributing factors. Conclusion In this setting, extent of underutilization of ICSs was found to be high and seems the result of complex interaction of various factors. Financial problem combined with inconsistent availability of ICSs in the local market, patients’ poor knowledge of asthma and ICSs, negative attitude toward ICSs, absence of local guidelines for asthma management are found to be essential elements dictating an extent of ICSs use. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2645-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohanes Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia.
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tola Bayisa
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Ayuk AC, Uwaezuoke SN, Ndukwu CI, Ndu IK, Iloh KK, Okoli CV. Spirometry in Asthma Care: A Review of the Trends and Challenges in Pediatric Practice. Clin Med Insights Pediatr 2017; 11:1179556517720675. [PMID: 28781518 PMCID: PMC5521334 DOI: 10.1177/1179556517720675] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Given the rising incidence of noncommunicable diseases (NCDs) globally, especially bronchial asthma, there is the need to reduce the associated morbidity and mortality by adopting an objective means of diagnosis and monitoring. AIM This article aims to review the trends and challenges in the use of spirometry for managing childhood bronchial asthma especially in developing countries. METHODS We conducted a literature search of published data on the use of spirometry for the diagnosis of childhood bronchial asthma with special emphasis resource-poor countries. RESULTS Guidelines for the diagnosis and treatment of childhood asthma recommend the use of spirometry, but this is currently underused in both tertiary and primary care settings especially in developing countries. Lack of spirometers and proper training in their use and interpretation of findings as well as a dearth of asthma guidelines remains core to the underuse of spirometry in managing children with asthma. Targeting education of health care staff was, however, observed to improve its utility, and practical implementable strategies are highlighted. CONCLUSIONS Spirometry is not frequently used for asthma diagnosis in pediatric practice especially in resource-poor countries where the NCD burden is higher. Strategies to overcome the obstacles are implementable and can make a difference in reducing the burden of NCD.
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Affiliation(s)
- Adaeze C Ayuk
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Samuel N Uwaezuoke
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Chizalu I Ndukwu
- Department of Pediatrics, College of Medicine, Nnamdi Azikiwe University, Awka, Nigeria
- Department of Pediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Ikenna K Ndu
- Department of Pediatrics, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Kenechukwu K Iloh
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Chinyere V Okoli
- Department of Pediatrics, Nyanya General Hospital, Abuja, Nigeria
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Desalu OO, Adeoti AO, Ogunmola OJ, Fadare JO, Kolawole TF. Quality of acute asthma care in two tertiary hospitals in a state in South Western Nigeria: A report of clinical audit. Niger Med J 2016; 57:339-346. [PMID: 27942102 PMCID: PMC5126747 DOI: 10.4103/0300-1652.193860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: To audit the quality of acute asthma care in two tertiary hospitals in a state in the southwestern region of Nigeria and to compare the clinical practice against the recommendations of the Global Initiative for Asthma (GINA) guideline. Patients and Methods: We carried out a retrospective analysis of 101 patients who presented with acute exacerbation of asthma to the hospital between November 2010 and October 2015. Results: Majority of the cases were females (66.3%), <45 years of age (60.4%), and admitted in the wet season (64.4%). The median duration of hospital stay was 2 days (interquartile range; 1–3 days) and the mortality was 1.0%. At admission, 73 (72.3%) patients had their triggering factors documented and 33 (32.7%) had their severity assessed. Smoking status, medication adherence, serial oxygen saturation, and peak expiratory flow rate measurement were documented in less than half of the cases, respectively. Seventy-six (75.2%) patients had nebulized salbutamol, 89 (88.1%) had systemic corticosteroid, and 78 (77.2%) had within 1 h. On discharge, 68 (67.3%) patients were given follow-up appointment and 32 (31.7%) were reviewed within 30 days after discharge. Less than half were prescribed an inhaled corticosteroid (ICS), a self-management plan, or had their inhaler technique reviewed or controller medications adjusted. Overall, adherence to the GINA guideline was not satisfactory and was very poor among the medical officers. Conclusion: The quality of acute asthma care in our setting is not satisfactory, and there is a low level of compliance with most recommendations of asthma guidelines. This audit has implicated the need to address the non-performing areas and organizational issues to improve the quality of care.
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Affiliation(s)
| | | | | | - Joseph Olusesan Fadare
- Department of Pharmacology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
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Nduka SO, Anetoh MU, Amorha KC, Henry OO, Okonta MJ. Use of simulated patient approach to assess the community pharmacists' knowledge of appropriate use of metered dose inhaler. J Basic Clin Pharm 2016; 7:116-119. [PMID: 27999471 PMCID: PMC5153888 DOI: 10.4103/0976-0105.189435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
RATIONALE The pharmacist charged with the responsibility of drug administration and counseling should have the basic knowledge and skills necessary to demonstrate the use of metered dose inhalers (MDIs) to asthma patients for the maximization of treatment outcomes. OBJECTIVE This study was designed to evaluate the community pharmacists' knowledge of the appropriate use of MDIs in Anambra State, Nigeria. METHODS The study was carried out in two major cities in Anambra State, Nigeria, using 41 registered community pharmacists. A simulated patient approach utilizing two adequately trained pharmacy students were used. Obtained data were analyzed using independent t-test and one-way ANOVA through SPSS version 18. RESULTS The pharmacists had a mean demonstration score of 45.45%. Step number seven of the correct use of MDI, which involves breathing in and depressing the canister was the most demonstrated step (90.2%) while step 4 which involves tilting the head back slightly was the least demonstrated (14.6%) by the pharmacists. Among five identified critical steps in asthma guideline used, two were well demonstrated (75.6% and 90.2%): one averagely demonstrated (51.2%) and two poorly demonstrated (39% and 31.7%). Sociodemographic characteristics did not influence the demonstration ability of the pharmacists in this study. CONCLUSION The study indicated that community pharmacists lacked the adequate knowledge of appropriate use of MDI. Training programs for pharmacists focusing on the use of such devices will enable them to educate patients on the effective use of MDIs in patients with asthma.
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Affiliation(s)
- Sunday O Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Maureen U Anetoh
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Kosisochi C Amorha
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Okechukwu O Henry
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Mathew J Okonta
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Enugu State, Nigeria
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Out-of-Pocket Costs of Asthma Follow-Up Care in Adults in a Sub-Saharan African Country. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/768378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asthma care imposes economic burden on affected patients. Patient costs for asthma care have not been documented in Africa. We aimed to determine the out-of-pocket cost of asthma follow-up care incurred by patients in Nigeria. We conducted a cross-sectional study in three tertiary hospitals in southeastern and northwestern Nigeria. Poorly controlled asthma patients attending a follow-up visit in the respiratory clinic of the hospitals were surveyed. Sociodemographic, health-seeking behavior, and cost data were collected using a structured questionnaire. Of the 110 patients who completed the study, 56 (51%) were females. Also, 72 (65%) of the patients had known about their asthma illness for more than four years. Mean annual direct cost of asthma care was US$368.4 (±228) per patient. Medication cost accounted for the majority (87%) of this cost. Patient costs of care incurred did not differ significantly across age (P = 0.15), education (P = 0.23), marital status (0.49), residence (P = 0.47), or gender (P = 0.65) categories. We conclude that direct cost of care was found to be substantial among poorly controlled asthma patients. Further studies to estimate the costs incurred by patients with exacerbation and differing severity of the disease should be conducted.
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Oladeji S, Nwawolo C, Adewole O. Allergic rhinitis among adult bronchial asthmatic patients in lagos, Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2013; 3:1-14. [PMID: 25453016 PMCID: PMC4220476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) and asthma are different manifestations of allergic disease of the airway. Both can exist together or as separate disease entity in an individual. However, it is not known if the coexistence of the two diseases can make asthmatic control difficult or not in the black population. OBJECTIVE To determine the prevalence of allergic rhinitis in asthmatics and its effects on bronchial asthmatic control among adult Nigerians.. DESIGN A prospective case-control study. SETTING Lagos University Teaching Hospital, Lagos, Nigeria. SUBJECTS Cases were 160 adult patients with confirmed bronchial asthma and controls were 160 subjects without bronchial asthma. METHODS Structured questionnaire adapted from the European Community Respiratory Health Survey was applied. Allergic rhinitis was clinically diagnosed if watery rhinorrhea, nasal blockage, and excessive bout of sneezing, itching of eye, ear, nose or throat were present. RESULTS Amongst the asthmatics, 133 (83%) had concomitant allergic rhinitis while 30 (19%) controls had allergic rhinitis(x(2)=137.81, p<0.001). Seventy eight (59%) cases with allergic rhinitis had uncontrolled asthma while 9 (33%) cases without allergic rhinitis had uncontrolled asthma (x(2) = 8.8731, p=0.012). CONCLUSION The prevalence of allergic rhinitis among adult asthmatics was high and the co-existence of allergic rhinitis was significantly associated with poor asthmatic control.
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