Prevalence of uncontrolled asthma and its associated factors among adult asthmatic patients attending hospitals in Burao City, Somaliland

Abstract

Objective This study aims to determine the prevalence of uncontrolled asthma and its associated factors among adult asthmatic patients attending hospitals in Burao, Somaliland, in 2025. Method A cross-sectional study was conducted at four hospitals from May 1 to June 15, 2025, among 363 adult asthma patients selected using systematic random sampling. Data were collected using a structured, interviewer-administered questionnaire. Asthma diagnosis was confirmed by spirometry performed within 3 months before enrollment, demonstrating reversible airflow obstruction. Descriptive statistics summarized the sample characteristics. Variables with p < 0.25 in bivariable analysis were entered into multivariable logistic regression. Model fit was assessed using the Hosmer-Lemeshow test ( p = 0.423), and multicollinearity was checked using the variance inflation factor (VIF < 2 for all variables). A p -value < 0.05 was considered statistically significant. Result Out of 382 adult asthma patients approached, 363 were included in the study, yielding a response rate of 98.4%. The mean age of participants was 47.6 ± 9.98 years, with 56.8% being male. Uncontrolled asthma was identified in 57.9% of the participants. Multivariable analysis revealed significant associations with poor medication adherence (AOR = 27.89; 95% CI: 7.75–100.30; p < 0.001), persistent asthma severity (AOR = 3.42; 95% CI: 1.27–9.23; p = 0.015), a family history of asthma (AOR = 27.51; 95% CI: 2.51–301.60; p < 0.001), biomass fuel use (AOR = 8.56; 95% CI: 3.08–23.78; p < 0.001), and occupational dust exposure (AOR = 68.65; 95% CI: 3.80–1239.19; p = 0.004). Due to small cell counts for dust exposure ( n = 40 exposed) and family history ( n = 113 with family history, including only 1 well-controlled case), these estimates have wide confidence intervals and should be interpreted cautiously. Exact logistic regression was performed as a sensitivity analysis, which confirmed the direction and statistical significance of these associations. The presence of air conditioning was also associated with increased odds (AOR = 6.26; 95% CI: 1.44–27.21; p = 0.014). Good asthma knowledge approached significance as a protective factor (AOR = 0.45; 95% CI: 0.20–1.04; p = 0.060). Conclusion The burden of uncontrolled asthma in Burao City is high, with modifiable factors such as medication adherence and follow-up care playing a vital role. Targeted interventions addressing these factors are crucial to improving asthma control in this setting.