Asthma

Asthma is an increasing problem in low- and middle-income countries and is a particular problem in urban areas, which are growing rapidly in many African countries.

Health systems in low- and middle-income countries have been designed to deliver care for curable infectious diseases, such as malaria, pneumonia, and diarrhoea, and lack the resources to effectively diagnose and treat long-term health problems. There has been very little previous research exploring how best to provide long-term asthma care in low-income countries, such as Malawi.

With funding from the Medical Research Council (MRC), Professor Mortimer and his team carried out a randomised controlled trial to evaluate an enhanced asthma care package for children, designed to address common challenges in asthma management in Malawi.

The package included a standardised patient assessment, optimisation of inhaler treatment and asthma education, delivered by non-clinical staff. Children receiving the enhanced care package had improved asthma outcomes after three months compared to those receiving standard care in a government hospital outpatient clinic. 'Enhanced care' children reported fewer asthma symptoms, and asthma attacks leading to emergency health care attendance and school absence were decreased by 70 per cent.

Inhalers are the recommended treatment for asthma in Malawi but their use is limited by fears and misbeliefs in the community, lack of knowledge and confidence among health care staff, and poor availability in primary health care.

The team (some of whom are pictured above) will share the trial results with local community leaders, health care staff and policy makers to help address these issues. They plan to increase knowledge levels about asthma and inhaler treatment, through dissemination sessions tailored specifically for each of these groups, delivered by experienced and credible Malawian facilitators who will connect effectively with the target audiences. By working together, to strengthen asthma-related networks at community, health systems and policy level, Professor Mortimer and his team have an exciting opportunity to build on their research. These important partnerships can produce real improvements in care for asthmatic patients and their families in Malawi.