Childhood asthma in Uganda: experiences of healthcare providers and caregivers in diagnosis and management. A FRESH AIR qualitative study

Asthma is the most common chronic childhood illness, however, many young children with asthma symptoms remain undiagnosed and/or misdiagnosed as pneumonia. We explored caregivers' and health care providers' understanding and practices around diagnosis and management of asthma in children less than 5 years. We conducted a cross-sectional study in primary care facilities in Uganda between June and August 2016. In-depth interviews with 25 participants, including caregivers (CGs) of young children with recurrent respiratory symptoms, healthcare workers (HCWs) and herbalists were triangulated. The findings indicated that all CGs described recurrent cough, wheeze and breathing difficulties in their children, which is suggestive of asthma, but were primarily diagnosed with pneumonia, bronchiolitis or bronchitis, and treated with antibiotics. This was in conformity with the HCWs' responses regarding their (HCWs) practices in management of children with respiratory illnesses. HCWs indicated that they did not diagnose asthma in young children but used terms like hyper-reactive airways disease or allergic cough. Caregivers were frustrated with the healthcare system due to lack of clear diagnoses and ineffective treatments. HCWs expressed frustration with unavailability of inhaled asthma medicines. The study highlighted major gaps in HCWs' practices in the management of asthma in young children leading to under-diagnosis of asthma and over-diagnosis of pneumonia., and overuse of antibiotics. Despite caregivers seeking care, their children did not get the right care, partly due to health system challenges including HCW competencies. Strategies for health system strengthening including improving HCWs' competences and availability of inhaled asthma medicines are urgently needed.