Knowledge and perceptions of asthma in Zambia: a cross-sectional survey

Public interest in online searching of asthma information: insights from a Google trends analysis

BACKGROUND

Google Trends (GT) is a free tool that provides insights into the public's interest and information-seeking behavior on specific topics. In this study, we utilized GT data on patients' search history to better understand their questions and information needs regarding asthma.

METHODS

We extracted the relative GT search volume (RSV) for keywords associated with asthma to explore information-seeking behaviors and assess internet search patterns regarding asthma disease from 2004 to 2024 in both English and Persian languages. In addition, a correlation analysis was conducted to assess terms correlated with asthma searches. Then, the AutoRegressive predictive models were developed to estimate future patterns of asthma-related searches and the information needs of individuals with asthma.

RESULTS

The analysis revealed that the mean total RSV for asthma-related keywords over the 20-year period was 41.79 ± 6.07. The researchers found that while asthma-related search volume has shown a consistent upward trend in Persian-speaking countries over the last decade, English-speaking countries have experienced less variability in such searches except for a spike during the COVID-19 pandemic. The correlation analysis of related subjects showed that "air pollution", "infection", and "insomnia" have a positive correlation with asthma. Developing AutoRegressive predictive models on retrieved Google Trends data revealed a seasonal pattern in global asthma-related search interest. In contrast, the models forecasted a growing increase in information-seeking behaviors regarding asthma among Persian-speaking patients over the coming decades.

CONCLUSIONS

There are significant differences in how people search for and access asthma information based on their language and regional context. In English-speaking countries, searches tend to focus on broader asthma-related topics like pollution and infections, likely due to the availability of comprehensive asthma resources. In contrast, Persian speakers prioritize understanding specific aspects of asthma-like symptoms, medications, and complementary treatments. To address these divergent information needs, health organizations should tailor content to these divergent needs.

Role of digital education through smartphones in improving knowledge among asthma patients: A preliminary study

Asthma is a chronic inflammatory airway disorder and is among the top ten causes of morbidity and mortality in Indonesia, highlighting the need for effective management strategies. This study aimed to evaluate changes in asthma knowledge levels before and after using the "Paru Sehat" smartphone application for digital education. A quasi-experimental study using a pre- and post-test design was conducted over three months at the outpatient clinic of Universitas Sumatera Utara Hospital, Medan, Indonesia, among asthma patients aged over 18 years. The patients completed the Patient Asthma Knowledge Questionnaire (PAKQ) before installing the "Paru Sehat" application to establish baseline knowledge. Once a week, patients received reminders to access materials covering an asthma overview, peak flow meter use, medication differences, and management techniques. After four weeks of intervention, the participants' knowledge was reassessed using the PAKQ. Data were analyzed using either paired Student's t-test or Wilcoxon test to assess the improvement in knowledge. The results showed increases in knowledge about asthma in general, asthma triggers, and asthma diagnosis domains, with the median score in each domain rising by one point (p=0.003, p=0.001, and p=0.002, respectively). The asthma management domain exhibited the largest change, with a median increase of two points (p<0.001). The total scores increased by an average of five points (p<0.001), indicating an overall improvement in patient knowledge about asthma. The "Paru Sehat" application demonstrated significant potential in enhancing asthma knowledge across multiple domains. Further research is warranted to explore the long-term effectiveness of the application in diverse populations and settings, ultimately contributing to improved asthma management and patient outcomes.

Prevalence, severity and risk factors for asthma in school-going adolescents in KwaZulu Natal, South Africa

BACKGROUND

Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and risk factors for asthma in adolescents in an LMIC.

METHODS

A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021.

RESULTS

A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01.

CONCLUSION

Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.

Over-prescription of short-acting β2-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study

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.

Challenges in the Management of Childhood Asthma in the Developing World

Childhood asthma poses significant health and psychological burden on children and parents alike. Care of children with asthma requires a firm partnership and understanding between parents and physicians with regular medications and outpatient visits. Though asthma is less common in the developing world, it is more commonly associated here with severe symptoms. Environmental and economic factors, and lack of education adversely affect efficient care of children with asthma. Poor education and understanding of disease, inadequate trained pediatricians, and lack of resources for pulmonary function testing in children hamper early diagnosis of asthma in children. Hence, children frequently receive symptomatic management for acute episodes instead of long-term preventive therapy. Misconceptions regarding side effects and possible dependence on inhaled medications are frequently seen in the caretakers. This leads to abundant use of alternative medicines. Increasing ambient air pollution due to rapid urbanization and industrial growth in developing countries also adversely affects the pulmonary health of children with asthma. Community-wide campaigns are needed to improve the awareness of parents about childhood asthma and safety of inhaled medications. States should make efforts to improve infrastructure needs of children with asthma.

Knowledge and perception about asthma among students in a Nigerian single-sex secondary school

INTRODUCTION

Asthma is prevalent among children and adolescents. Few studies have assessed the knowledge and perceptions of asthma among adolescents.

OBJECTIVES

This study assessed the knowledge and perception about asthma among secondary school students in an all-girls school in Nigeria.

METHODS

This cross-sectional study was conducted in a Nigerian secondary school in Enugu State (February 2020). In Senior Secondary School (SS1, SS2 and SS3), students could be in one of three specialized classes: Sciences, Humanities and Business. A self-administered structured questionnaire was filled by conveniently sampled students in SS1 and SS2. Inferential statistics utilized the Pearson's chi-square test and multiple linear regression with statistical significance set as P < 0.05.

RESULTS

Three hundred and eighty-eight (388) students participated in the study (mean age = 14.64 ± 0.93 years). Majority of the students were in Science class (n = 299; 77.1%). There was high awareness about asthma (n = 384; 99.0%). More than half of them had good asthma knowledge (n = 279; 71.9%); close to three-fifths had favourable perception of asthma (n = 222; 57.2%). More students in SS2 had good knowledge of asthma compared to those in SS1 (76.7% vs. 67.2%; ꭓ²  = 4.338; P = 0.037). More students in Science class had favourable perceptions about asthma compared with those in Humanities and Business class (60.5% vs. 48.1% vs. 25.0%; ꭓ²  = 7.458; P = 0.024).

CONCLUSION

Majority of the students were aware about asthma and had good knowledge of the disease while close to three-fifths had favourable perceptions about asthma.

A community-based cross-sectional study on knowledge, attitude, and perceptions about asthma among healthy adults in rural South India

Background:

Evidence suggests that proper knowledge and perceptions about asthma result in a positive correlation with compliance with medications and regular medical follow-up. Assessing the level of knowledge, attitude, and perception (KAP) in the community is essential for planning public health interventions. There is a lacuna on community-based KAP study on asthma in rural India, as most of the existing evidence is from hospital-based studies in an urban setting.

Methods:

We interviewed 280 healthy adults from 14 villages in South India using the Chicago community asthma survey-32 (CCAS-32) questionnaire. We noted the frequency distribution of responses to the questions and scored KAP on symptoms, triggers, and treatment, and performed bivariate and multivariate analyses.

Results:

The mean age was 37.7 years ranging from 18 to 62 years. Almost half of them (47%) had primary or middle school education. 40.7% and 57.9% believed severe headache and tightness of chest were symptoms of asthma, respectively. Similarly, 38.2% and 48.4% thought asthma was a hereditary and contagious disease, respectively, whereas 41.8% of perceived asthma medications could be addictive. Having witnessed “patients with asthma” was associated with KAP on symptoms and triggers while younger age and having a relative with asthma were associated with KAP on treatment independently. Participants who had relatives with asthma were three times [(OR 3.04; 95% (1.5–6.1)] more likely to have good KAP compared to their counterparts.

Conclusion:

Asthma knowledge and perceptions are sparse in rural India. Adequate investments in public awareness are the need of the hour.

An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial

BACKGROUND

Shortages of clinical staff make chronic asthma care challenging in low-income countries. We evaluated an outpatient asthma care package for children, including task-shifting of asthma management roles.

METHODS

We conducted a non-blinded individually randomised controlled trial at a tertiary-level government hospital in Blantyre, Malawi. Children aged 6-15 years diagnosed with asthma were recruited from outpatient clinic, stratified by Childhood Asthma Control Test (cACT) score and allocated 1:1 from a concealed file, accessed during electronic questionnaire completion. The intervention, delivered by non-physicians, comprised clinical assessment, optimisation of inhaled treatment, individualised asthma education. The control group received standard care from outpatient physicians. Primary outcome for intention-to-treat analysis was change in cACT score at 3 months. Secondary outcomes included asthma exacerbations requiring emergency healthcare and school absence.

FINDINGS

Between September 2018 and December 2019, 120 children (59 intervention; 61 control) were recruited; 65.8% males, with mean (SD) age 9.8 (2.8) years, mean (SD) baseline cACT 20.3 (2.6). At 3 months, intervention children (n=56) had a greater mean (SD) change in cACT score from baseline (2.7 (2.8) vs 0.6 (2.8)) compared with standard care participants (n=59); a difference of 2.1 points (95% CI: 1.1 to 3.1, p<0.001). Fewer intervention children attended emergency healthcare (7.3% vs 25.4%, p=0.02) and missed school (20.0% vs 62.7%, p<0.001) compared with standard care children.

INTERPRETATION

The intervention resulted in decreased asthma symptoms and exacerbations. Wider scale-up could present substantial benefits for asthmatic patients in resource-limited settings.

TRIAL REGISTRATION NUMBER

PACTR201807211617031.

Algorithm for asthma diagnosis and management at Chitungwiza Central Hospital, Zimbabwe

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.