An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial

Rylance, Sarah, Chinoko, Beatrice, Mnesa, Bright, Jewell, Christopher, Grigg, Jonathan and Mortimer, Kevin ORCID: https://orcid.org/0000-0002-8118-8871 (2021) 'An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial'. Thorax, Vol 76, Issue 5.

Text An enhanced care package - Malawian children - Sarah Rylance.docx - Accepted Version Available under License Creative Commons Attribution Non-commercial. Download (60kB)

Abstract

Background
Shortages of clinical staff make chronic asthma care challenging in low-income countries. We evaluated an outpatient asthma care package for children, including task-shifting of asthma management roles.

Methods
We conducted a non-blinded individually randomised controlled trial at a tertiary-level government hospital in Blantyre, Malawi. Children aged 6-15 years, diagnosed with asthma were recruited from outpatient clinic, stratified by Childhood Asthma Control Test (cACT) score, and allocated 1:1 from a concealed file, accessed during electronic questionnaire completion. The intervention, delivered by non-physicians, comprised; clinical assessment, optimisation of inhaled treatment, individualised asthma education. The control group received standard care from outpatient physicians. Primary outcome for intention-to-treat analysis was change in cACT score at 3-months. Secondary outcomes included asthma exacerbations requiring emergency health care and school absence.
Registration: Pan African Clinical Trials Registry: PACTR201807211617031

Findings
Between September 2018 to December 2019, 120 children (59 intervention; 61 control) were recruited; 65.8% males, with mean (SD) age 9.8 (2.8) years, mean (SD) baseline cACT 20.3 (2.6). At 3-months: intervention children (n=56) had a greater mean (SD) change in cACT score from baseline (2.7 (2.8) vs 0.6 (2.8)) compared to standard care participants (n=59); a difference of 2.1 points (95% CI: 1.1-3.1, p<0.001). Fewer intervention children attended emergency health care (7.3% vs 25.4%, p=0.02) and missed school (20.0% vs 62.7%, p<0.001), compared to standard care children.

Interpretation
The intervention resulted in decreased asthma symptoms and exacerbations. Wider scale-up could present substantial benefits for asthmatic patients in resource-limited settings.

Item Type:	Article
Additional Information:	This article has been accepted for publication in Thorax 2021, following peer review, and the Version of Record can be accessed online at 10.1136/thoraxjnl-2020-216065 © Authors 2021 Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) http://creativecommons.org
Subjects:	WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WF Respiratory System > WF 100 General works WS Pediatrics > WS 100 General works WS Pediatrics > Diseases of Children and Adolescents > By System > WS 280 Respiratory system
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1136/thoraxjnl-2020-216065
Depositing User:	Julie Franco
Date Deposited:	25 Jan 2021 12:19
Last Modified:	04 Jun 2021 09:55
URI:	https://archive.lstmed.ac.uk/id/eprint/16590

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