Using quality improvement project to improve childhood asthma outcomes in low resource setting

Abstract

Introduction: Childhood asthma outcomes are largely unknown in sub-Saharan Africa.

Objective: As part of a quality improvement project designed during an ERS fellowship, we sought to monitor health outcomes in children attending a newly established paediatric asthma clinic.

Methods: Clinical data (July 2020-January 2021) among children followed up for asthma at a sub-Saharan secondary hospital was extracted and analysed. The final outcome analysis included patients reviewed at least twice during the period of evaluation.

Results: Of 50 patients referred to the clinic, 31(62%) were judged to have asthma. Out of these, 16/31 (51.6%) were below 6 years, 9/31 (29.0%) were 6-11years, while 6 (19.4%) were aged between 12 and 20 years. Inhaler use at baseline was 26/31 (83.9%) with only 10/31 (32.3%) being on inhaled corticosteroids(ICS). Use of ICS improved to 29 (93.5%) over the period of assessment. The average c-ACT and ACT scores were 18 and 14.3 respectively at baseline improving to 19 and 20 over the period of assessment. No association was found between parental level of education (P-value 0.57), having medical insurance (p-value 0.51), having a parent/sibling with asthma/atopy (p-value 1.0) and having ICS at outcome.

Conclusion: Having a dedicated paediatric asthma service in Sub-Saharan Africa improved the use of ICS in children. Quality improvement methodology plays an important role in healthcare service development in low income settings.