Asthma in Uganda

Asthma is a long term condition that is caused by inflammation of the lungs and airways. Symptoms vary, the most common is constriction of the bronchial tracts causing airflow obstruction with the associated symptoms of wheezing, coughing, chest tightness and shortness of breath. Asthma is thought to be caused by exposure to allergens and irritants. The World Health Organization says that asthma cases are on the rise in Africa possibly due to urbanization and air pollution.

Asthma attacks are graded varying from mild to severe and persistent. Moderate persistent asthma will cause  a decrease in exercise capacity. Severe persistent asthma that has continual symptoms with frequent attacks and frequent symptoms at night will limit activity. A person's asthma does not necessarily have the same severity all the time. With good management the symptoms can be reduced. Asthma that starts in childhood may also become less severe (see Physical Effects of Asthma).

World Asthma Day 3rd May 2016: A nurse demonstrates the use of an inhaler at an event in  Entebbe.

The Prevalence of asthma and characteristics of primary school children with asthma in Kampala district study found that prevalence of asthma was 13.8% amongst children 8 - 14 years of age. The study reported that common triggers for asthma attacks were:

use of charcoal as cooking fuel, attendance of school in the Peri-urban divisions, family history of asthma and keeping an animal in the house overnight.

A further study, Factors associated with asthma among under-fives in Mulago hospital, Kampala Uganda: a cross sectional study, reports the following common causes for asthma:

The study results show that atopy (the predisposition to other allergies), prematurity and socioeconomic status, are important factors in development and/or exacerbation of asthma symptoms in young children.

The report notes that asthma is associated with a high level of education of the caretaker. The report continues:

Level of education was used as a crude indicator of socioeconomic status. Researchers in developed countries have shown that asthma is associated with low socioeconomic status. However, in low income countries, the prevalence of asthma is higher among the affluent. This is thought to be due to adapting the Western life styles where children are exposed to allergens, infections, motor vehicle pollution and irritants, from early infancy.

It is estimated that 4.4% of adults in East Africa are affected by Asthma (see Estimated Burden of Fungal Disease in Uganda.

In the blog John and Dayna in Uganda – Challenges in the diagnosis and treatment of Asthma the writer describes some of the problems health practitioner face when diagnosing asthma:

• Clinicians being afraid to give a patient (or the parent) a diagnosis of asthma. They feel that it is easier to call it “unstable airways disease” or “chronic bronchitis” or “airway hyperactive disease” due to the stigma associated with a firm diagnosis of asthma.
• Many drugs are too expensive for patients and therefore they tend to use cheaper ones or none at all.

Preventative medications are expensive in Uganda. This article on Asthma Patients in Uganda Resort to Herbs Over High Cost of Treatment  describes a common situation:

Rebecca Kabuya is among the patients who use traditional herbs for treatment whenever she gets attack.
Here’s a story she shared with the Continent Observer’s Joseph Elunya.
I’ am a 22 year-old girl and a student in my final year at University, in Uganda. I have been battling with asthma since my childhood and I have used various medications whenever I am attacked. Having asthma, is a very big problem, because whenever its cold like today, my chest gets congested and sometimes I end up fainting.
Whenever I get the attack, my father has to rush me for treatment, and usually they have to inject me two times so that my condition can normalize.
I usually get the attacks if I am in a new environment that I am not used to or when it’s too cold. I formerly used Amophlene and Salbutamol, for treatment, but these days I no longer use them because they are too costly and also have side effects.
For now I have resorted to use donkey and camel’s milk as a remedy whenever I’ am attacked by asthma. I also use traditional herbs especially the ones which are being sold by Indians in Kampala.
These traditional herbs are good because they are cheap and they don’t have side effects which is synonymous with the drugs they used to inject me with.
Dr. Martin Okot a lung health expert and President of Uganda Thoracic Society says the treatment for asthma costs about US$15. He however declined to state whether the treatment is affordable.

In an interview with Dr Harriet Mpairwe and Mutebi Muhammad entitled Uganda: Lifestyle to Blame for Rise in Asthma Cases the following points are noted:

The current international treatment guidelines recommend inhaled medication (inhalers) for asthma patients but they are not readily available in Uganda.
"Most children are being treated with oral tablets since they are cheaper but they come with many side effects like palpitation (shaking of the body) and the heart pounding heavily and at fast rates," she says.
...
There are no home remedies that treat asthma except for the controllers and relievers after assessment by a clinician. When a person develops an attack, they are given salbutamol inhaler relievers which immediately clear the blockage in the airway. There are daily basis inhalers called controllers. These may include Beclomethasone and Prednisolone that help in the management of the symptoms but do not treat asthma.
"There are herbalists who claim to have herbal medicines that treat asthma but I cannot recommend people to use them because we are not sure what is contained in the medicines," says Mutebi.

In summary, asthma is a condition that has stigma attached to the diagnosis. Additionally the recommended preventative treatments for asthma are expensive costing around US$15 per month. Cheaper medications that target the whole body have bad side effects. As a result people are resorting to the unproven treatments of herbalists. It is fortunate that the risk of dying from an asthma attack is very low (see the Global Asthma Report).

In The Dangers of Untreated Astma Dr. Mayank Shukla describes the following dangers:

Over time, untreated asthma can also lead to lung scarring and loss of the surface layer of the lungs. The tubes of the lungs become thicker and less air is able to pass through. The airway muscles become enlarged and less able to relax. This lung damage may be permanent and irreversible. Treating asthma with a daily controller medication will prevent long term lung dysfunction and reduce the dangers of untreated asthma.
In severe cases, untreated asthma can lead to death, when the airways close and the rescue medications don’t work fast enough to open them up. In New York City alone, about 150 people each year die of asthma (NYC Department of Health and Mental Hygiene). Is your asthma under control?

 For more information see the Global Initiative for Asthma (GINA). You can get your own 2016 Pocket Guide for Asthma Management and Prevention here.