Improving access to asthma care for children and adolescents in Uganda

哮喘是全世界儿童中最常见的长期疾病，但主要影响乌干达等低收入国家的儿童。他们患有严重和频繁的哮喘症状和发作，这导致非常频繁的紧急诊所就诊和住院。在这些访问上花费了大量的财政资源，儿童错过了学校，他们的照顾者错过了工作，使家庭更深地陷入贫困，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包括污名在内的心理社会挑战，这导致受影响的儿童及其家庭的总体生活质量较差。不受控制的哮喘症状也会增加患其他长期疾病的风险，如慢性阻塞性肺病。因此，极为重要的是，早期发现有哮喘症状的儿童并给予适当护理，以尽量减少上述身体、经济和社会心理问题。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。这在一定程度上是由于卫生保健提供者的知识和技能不足，以及缺乏与当地相关的创新方法来改进对患有哮喘症状的儿童的识别。这项研究的目的是了解像检查每个儿童和青少年到初级保健卫生机构就诊的哮喘症状这样的创新是否会导致被诊断患有哮喘的儿童数量的增加，以及针对患者及其护理人员的哮喘教育是否会导致对哮喘的理解、药物的使用和随后症状频率的减少。这项研究将描述对卫生机构的卫生保健工作者进行培训和指导如何以及是否能够改善对患有哮喘症状儿童的识别和管理。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社会心理挑战。研究地点（乌干达东南部金贾地区）的卫生设施将被随机分为两组。在一组中，医护人员将获得一份标准表格，用于检查儿童和青少年的哮喘症状，这些儿童和青少年将出现咳嗽和呼吸困难等肺部疾病的症状。第二组将继续他们的常规护理。研究前和研究期间被诊断为哮喘的儿童数量数据将被收集和比较，以确定哮喘症状的常规检查是否会增加被诊断为哮喘的儿童数量。将在另一项研究中采用类似的方法，在这项研究中，社区卫生工作者将以哮喘为导向，并参与对患者进行关于哮喘和哮喘护理的教育，以及如何使受影响的儿童获得更好的健康。此外，将对一个保健设施的保健工作者进行关于诊断和管理患有哮喘的儿童和青少年的培训和指导。这一过程还将涉及讨论将采用的最佳方法，并记录整个过程，以得出可用于今后类似研究的经验教训，这些研究旨在查明培训和指导是否能导致良好控制哮喘症状。这将是一项试点研究。关于心理社会挑战的数据将通过进行个人和小组探索性访谈来收集。预计这项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。

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.