Improving access to asthma care for children and adolescents in Uganda

改善乌干达儿童和青少年获得哮喘护理的机会

• 批准号: MR/X031713/1
• 负责人: Rebecca Nantanda
• 金额: $ 81.03万
• 依托单位: Makerere University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FX031713%2F1
• 关键词: Improving; access; asthma; care; children

Asthma is the commonest long-term disease in children across the world, but mainly affects those in low-income countries like Uganda. They suffer from severe and frequent asthma symptoms and attacks, and this leads to very frequent emergency clinic visits and hospital admissions. A lot of scare financial resources are spent on these visits, children miss school, and their caregivers miss work, driving families deeper into poverty and contributing to the widening health gap within and between countries. Both the affected children and their caregivers experience psychosocial challenges including stigma, which contributes to the overall poor quality of life of the affected persons and their families. The uncontrolled asthma symptoms also increase the risk of developing other long-term diseases like Chronic Obstructive Pulmonary Disease. Therefore, it is extremely important that children with asthma symptoms are identified early and given appropriate care to minimize the physical, economic and psychosocial problems described above. However, evidence from research in Uganda and similar countries shows that many children with asthma symptoms are not diagnosed and/or treated appropriately even when they frequently interface with health systems. This is partly due to the inadequate knowledge and skills of healthcare providers, and lack of innovative and locally relevant ways to improve identification of children with asthma symptoms. This study aims to understand whether innovations like checking every child and adolescent visiting primary care health facilities for asthma symptoms can lead to an increase in the number of children diagnosed with asthma, and whether education about asthma directed to patients and their caregivers can lead to improvements in the understanding of asthma, use of medicines and subsequent reduction in frequency of symptoms. The study will describe how and whether the training and mentoring of healthcare workers in the health facilities can lead to improvements in identifying and managing children with asthma symptoms. The study will also describe the psychosocial challenges faced by children and adolescents with asthma, and their caregivers. The health facilities in the study site (Jinja district in South Eastern Uganda) will be randomly divided into two groups. In one group, the healthcare workers will be given a standard form to be used to check for asthma symptoms among children and adolescents who will present with symptoms of lung diseases such as cough and difficult breathing. The second group will continue their usual practices of care. Data on the number of children diagnosed with asthma before and during the study will be collected and compared to determine whether the routine checking for asthma symptoms can increase the number of children diagnosed with asthma. A similar approach will be used in another study in which community health workers will be oriented about asthma and participate in educating the patients about asthma and asthma care, and how this can lead to better health for the affected children. In addition, healthcare workers in one health facility will be trained and mentored on diagnosis and management of the children and adolescents with asthma. The process will also involve holding discussions on the best approaches to be used, and documentation of the whole process to derive lessons which can be used in future similar research aimed at finding out if training and mentorship can lead to good control of asthma symptoms. This will be a pilot study. The data on psychosocial challenges will be collected by conducting individual and group explorative interviews. It is anticipated that the findings from the study will inform efforts to integrate asthma care into routine primary care services using evidence-based interventions.

哮喘是世界各地儿童最常见的长期疾病，但主要影响乌干达等低收入国家的儿童。他们患有严重且频繁的哮喘症状和发作，这导致他们经常去急诊室就诊和入院。大量稀缺的财政资源被花在这些访问上，孩子们无法上学，他们的照顾者也无法工作，导致家庭陷入更深的贫困，并导致国家内部和国家之间的健康差距不断扩大。受影响的儿童及其照顾者都面临着包括耻辱在内的社会心理挑战，这导致受影响者及其家人的整体生活质量较差。不受控制的哮喘症状还会增加患慢性阻塞性肺病等其他长期疾病的风险。因此，尽早发现患有哮喘症状的儿童并给予适当的护理以尽量减少上述身体、经济和社会心理问题非常重要。然而，来自乌干达和类似国家的研究证据表明，许多患有哮喘症状的儿童即使经常与卫生系统接触，也没有得到适当的诊断和/或治疗。部分原因是医疗保健提供者知识和技能不足，以及缺乏创新和当地相关的方法来改善对患有哮喘症状的儿童的识别。本研究旨在了解诸如检查每个到初级保健医疗机构就诊的儿童和青少年是否有哮喘症状等创新是否会导致被诊断患有哮喘的儿童数量增加，以及针对患者及其护理人员的哮喘教育是否可以带来改善了解哮喘、使用药物以及随后减少症状发生的频率。该研究将描述医疗机构中医护人员的培训和指导如何以及是否能够改善对患有哮喘症状的儿童的识别和管理。该研究还将描述患有哮喘的儿童和青少年及其照顾者所面临的心理社会挑战。研究地点（乌干达东南部金贾区）的卫生机构将被随机分为两组。在一组中，医护人员将获得一份标准表格，用于检查出现咳嗽和呼吸困难等肺部疾病症状的儿童和青少年是否有哮喘症状。第二组将继续他们通常的护理做法。将收集研究之前和研究期间被诊断患有哮喘的儿童数量的数据并进行比较，以确定哮喘症状的常规检查是否可以增加被诊断为哮喘的儿童的数量。另一项研究将采用类似的方法，其中社区卫生工作者将以哮喘为导向，并参与对患者进行有关哮喘和哮喘护理的教育，以及如何为受影响的儿童带来更好的健康。此外，一所医疗机构的医护人员将接受有关哮喘儿童和青少年诊断和管理的培训和指导。该过程还将涉及就使用的最佳方法进行讨论，并记录整个过程，以得出可用于未来类似研究的经验教训，旨在查明培训和指导是否可以很好地控制哮喘症状。这将是一项试点研究。将通过进行个人和小组探索性访谈来收集有关心理社会挑战的数据。预计该研究的结果将为使用循证干预措施将哮喘护理纳入常规初级保健服务提供信息。