Addressing Asthma Challenges in Sub-Saharan Africa

Asthma is a common lung disease that affects many children and adults. It can cause problems like wheezing, coughing, and shortness of breath. Sometimes, people with asthma have sudden worsening of their symptoms, which may require medical attention. While asthma can run in families, many people who develop it do not have any family history of the disease. Environmental factors, like air pollution and allergens, also play a role in causing asthma. In many parts of sub-Saharan Africa, asthma is found in about 9-20% of the population, and this rate has been increasing in recent years.

In low- and middle-income countries, asthma is often not diagnosed or treated properly. This leads to serious health problems and can affect children’s growth, their ability to attend school, and their future job opportunities. Poor asthma control can also lead to high medical costs, putting families at risk of financial hardship.

Diagnosing and managing asthma in sub-Saharan Africa is tough. Doctors usually look at the symptoms and may try different Treatments to see what works. Tests like lung function tests might help, but these resources are often lacking. Many Healthcare workers are not trained to identify asthma, and healthcare systems are not set up to manage long-term conditions well. There is no cure for asthma, but the goal of treatment is to keep symptoms under control and prevent flare-ups.

Effective asthma treatments usually involve daily "preventer" medications to reduce inflammation in the lungs and "reliever" medications to ease symptoms during an asthma attack. Inhalers are the most common way to deliver these medications. These treatments are safe and effective and can prevent severe asthma attacks, which is crucial since many asthma-related deaths are preventable.

While inhalers are recognized as essential medications by the World Health Organization, accessories like spacer devices-which help make inhalers more effective-are not widely available.

In response to the problems surrounding asthma care in sub-Saharan Africa, efforts have focused on improving the health system's capabilities. This includes creating guidelines, training healthcare staff, and increasing access to medications. For example, a health organization in Sudan started a program to improve asthma management in hospitals, which led to fewer emergency visits and hospital admissions. However, similar initiatives are rare, and many efforts to make treatments more available have not succeeded.

One significant challenge is that many people do not seek out care for asthma. This might be due to the way asthma is viewed within Communities. Stigma plays a big role here. In wealthier countries, stigma related to asthma can lead to delayed diagnoses and reluctance to use inhalers. In sub-Saharan Africa, there is limited awareness about asthma stigma, but it is beginning to be recognized as a concern.

In Tanzania, children with asthma face social avoidance, while in Sudan, young women with asthma have difficulty finding marriage partners due to the stigma. In Uganda, there are beliefs that asthma is contagious, leading families to hide their asthmatic children. In Kenya, many parents do not accept the asthma diagnosis for their children, fearing the use of inhalers and the need for long-term treatment.

Stigma, defined as a mark of disgrace associated with a particular circumstance, quality, or person, can cause people to feel labeled negatively. This often leads to individuals feeling devalued, making it harder to navigate their health and social environments. Understanding stigma as a process influenced by various social factors can help address the challenges faced by asthma patients.

Recent research looked into how stigma affects people with asthma in Sudan and Kenya. The studies aimed to understand how ready healthcare systems are to help those with chronic respiratory diseases, such as asthma. Although stigma was not the primary focus, it became a significant theme throughout the research.

#Study Overview

The research included two studies that examined asthma management in Sudan and Kenya. The first study in Sudan looked at how healthcare systems are working to manage chronic lung diseases, while the second study in Kenya explored how healthcare facilities handle patients presenting with respiratory symptoms.

In Sudan, the study involved various health facilities and communities to gather insights into experiences, needs, and potential improvements to asthma care. In Kenya, researchers focused on government healthcare facilities to assess their readiness to handle cases of chronic respiratory diseases.

Participants in both studies included community members, patients, healthcare workers, and volunteers. Data collection occurred through interviews and focus group discussions, allowing researchers to gather detailed information about asthma care and the related stigma.

#Key Findings

#Drivers and Facilitators of Stigma

Participants shared different views about what causes asthma. A common belief is that asthma is hereditary, which can lead people to think it is incurable. Others fear that asthma is contagious, associating it with respiratory diseases like tuberculosis (TB), which is often stigmatized.

Such perceptions can also contribute to viewing those with asthma as weak or unable to lead productive lives. Participants noted that having asthma can limit job opportunities and even affect education. People with asthma may be viewed as a financial burden due to potential medical expenses, which can lead to them being seen as less valuable in their families or communities.

#Stigma Marking

When people receive an asthma diagnosis, they often react negatively. Participants reported that some individuals refuse to accept the label of asthma, preferring terms like "allergy." This rejection is influenced by societal views about asthma being seen as a shameful condition.

Perceptions also vary among different social groups. Some people with lower education levels may attribute asthma to bad luck or witchcraft, while others, regardless of education, may resist accepting an asthma diagnosis.

#Stigma Manifestations

Many individuals with asthma reported hiding their condition, trying to appear healthy and suppressing their symptoms. This concealment stems from a fear of being judged or discriminated against. Many only disclose their condition to close family members, while fearing that others will avoid them or treat them differently if they know about their asthma.

In both countries, perceptions of asthma as an infectious disease led to avoidance behaviors. Patients often felt that community members would distance themselves from them due to fears of transmission. This stigma not only affects their mental well-being but also their ability to seek treatment and manage their condition effectively.

#Outcomes of Stigma

The anticipation of stigma leads many individuals not to seek help for their asthma symptoms. People fear being diagnosed and the visibility that comes with using an inhaler, which can lead to delays in seeking proper care. Instead of getting medical help, some opt for home remedies or traditional treatments.

In both countries, the stigma surrounding asthma can result in a lack of trust between healthcare providers and patients. This affects how patients communicate their symptoms and can lead to incomplete histories being shared, hindering effective treatment.

Healthcare workers reported challenges in getting patients to accept their asthma diagnosis, which can limit their willingness to follow treatment guidelines. Many patients may instead self-medicate without proper guidance, thinking they have allergies rather than asthma, which can lead to worsening health.

#Conclusion

The underdiagnosis and lack of treatment for asthma in many areas of the Global South represent significant health concerns. Stigma is a major barrier to accessing care, influencing individuals to hide their conditions and delay seeking help.

Efforts to improve asthma care should address both the supply side-by enhancing healthcare availability-and the demand side-by reducing stigma and educating communities about asthma. Fostering better understanding of asthma can encourage individuals to seek care, accept diagnoses, and adhere to treatments.

While there are challenges to overcome, it is essential to create a supportive environment where individuals with asthma feel valued and empowered to manage their health effectively.