Comparative Management of Childhood Asthma in Urban and Rural Settings in Sub-Saharan Africa

Abstract

BACKGROUND: Asthma is a common chronic respiratory condition affecting children all over the world. Challenges are encountered to access and implement standard asthma management in different countries and geo-locations. AIM: To assess and compare the management of childhood asthma in urban and rural settings in Enugu State, Nigeria." METHODS: This study was conducted in Enugu State. The minimum sample size was calculated to be 480 with an attrition rate of 10%. The multistage sampling method was used to select two local government areas - Enugu-North (urban) and Awgwu (rural) and further selected two schools each from each of the geo-locations. Ethical approval was obtained for the study. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 23 with mainly Chi-square statistics and P < 0.05. RESULTS: Urban participation rate was 65.1%, while rural was 93.9%. Equal sex distribution was noted in the urban setting, while a male preponderance of 2.4:1 was noted in rural. The mean age in urban was 8.53 ± 1.5 years, while in rural, it was 10.04 ± 2.0 years. Doctor or Nurse's diagnosis of asthma was low (urban - 35.7%; rural - 10.7%). Counseling on patients' asthma condition-urban (60.7%) compared to rural (11.1%). The written asthma management plan was 17.9% urban and 0% rural. Use of inhalation short-acting beta-agonist was 21.4% urban and 3.7% rural. Inhalation corticosteroid was 0% in both settings. Oral corticosteroid, spacer device, nebulizer, and controller medications were only in urban 21.4%, 17.9%, 28.6%, and 14.3%, respectively. Regular follow-up visits were 14.3% in urban and 7.4% in rural. CONCLUSION: Standard asthma management adherence was poor, especially in the rural setting. A scale-up intervention training and awareness are needed for healthcare providers and the public. Materials and medications should be made available, accessible, and affordable for both geo-locations.