Millions of adolescents across Africa may be unknowingly battling asthma because they have not been diagnosed by a clinician and therefore are not receiving the treatment they need, new research has revealed. This was discovered in a study.
The findings, published last week in the journal Lancet, show that little data is available on the scale of asthma, even though it is one of the most common causes of chronic respiratory death on the continent. It is extremely important for this continent.
Asthma, which affects the lungs and causes breathing difficulties, often begins in childhood or adolescence. According to the National Library of Medicine, part of the U.S. government, it is a disease that affects many adolescents around the world, with an estimated 76 million young people suffering from the disease in 2019.
Scientists say there is no cure for childhood-onset asthma, but treatment can reduce symptoms, which often persist into adulthood.
Here’s what we know about why a silent asthma epidemic may be harming children in some African countries.
Young people in South Africa may be facing an undiagnosed asthma epidemic, a new report finds (File: Sebabatso Mosamo/AP)
What did the study find?
A research team led by researchers from Queen Mary University of London (QMUL) found that 12 per cent of adolescents in six African countries have severe asthma symptoms, but the vast majority (80 per cent) are diagnosed by health professionals. I discovered that I had not been diagnosed.
The study was conducted from 2018 to 2021 and was conducted among children aged 12 to 14 attending schools in urban areas in Blantyre, Malawi, Durban, South Africa, Harare, Zimbabwe, Kampala, Uganda, Kumasi, Ghana, and Lagos, Nigeria. Focused on 20,000 people. . Durban had the highest number of students with asthma symptoms, while Blantyre had the lowest.
One-third of students who have already been diagnosed with asthma and have severe symptoms do not consider their symptoms to be serious and lack knowledge about asthma treatment, making it difficult for them to control their symptoms. The study found that he did not take any medication for this purpose.
“Adolescence is a particularly interesting age to focus on,” QMUL’s Gioia Mosler, who served as research manager for the study, told Al Jazeera. “This is the time of life when the prevalence of asthma is highest, and this is also the time when we all form many perceptions about our health and our bodies that we carry with us into adulthood. ”
The researchers said it was impossible to generalize the results because the situation in each African city was different. But Mosler noted that extrapolating their results could mean that about 15 million young people in sub-Saharan Africa have undiagnosed asthma symptoms.
Researchers used questionnaires at an early stage and then conducted more rigorous lung function tests typically used for clinical diagnosis of asthma to determine which children were likely to have the disease. I decided.
Traffic pollution in Kenya’s cities such as Nairobi (above) may be driving the rise in asthma cases (File: Sayyid Abdul Azim/AP)
What is asthma? Why is it plaguing African cities?
Asthma is a chronic, often lifelong respiratory disease characterized by acute inflammation of the airways and airflow obstruction, affecting 262 million people worldwide, according to the World Health Organization (WHO) .
About half of those affected may be in Africa. According to a 2013 study housed in the archives of the U.S. National Library of Medicine, the most recent estimates are from 2010, when 119 million people on the continent were expected to suffer from asthma. .
Asthma can be caused by particles from pollen, dust, combustion waste and other substances. Common symptoms include difficulty breathing, wheezing, chest tightness, and cough.
Although rare, severe asthma can be fatal. According to the WHO, about 455,000 people died from the disease in 2019, mostly in low- to middle-income countries. Mortality rates in Africa are unclear, although country-level studies have been conducted. In Uganda, for example, asthma causes an estimated 19 deaths per 1,000 people per year. In contrast, Mexico recorded 10.41 deaths per 100,000 people, according to the study.
Although the exact cause of asthma is unknown, asthma may be hereditary. Environmental factors such as weather changes and air pollution are also common triggers associated with the development of asthma.
The high number of asthma cases in African cities is related to the continent’s rapid urbanization and increased pollution.
At least two-thirds of the world’s population lives in cities. However, Africa has one of the fastest urbanization rates in the world (3.5% growth compared to an average annual growth rate of 1.8%), with large cities expanding and small towns also growing.
While this presents economic opportunities, the expansion of urban centers also reduces air pollution caused by concentrated energy use, vehicle exhaust, uncollected waste, and many other factors that can cause asthma. means an increase in pollution.
According to the Clean Air Foundation, South Africa’s high incidence of asthma is likely linked to the high number of cases of bronchitis. The country relies on polluting coal-fired power plants for electricity, and air pollution levels are among the worst in Africa.
Researchers say the climate crisis is also increasing asthma cases. Experts say vulnerable children could be more exposed to dust and wildfires that are intensifying globally due to global warming.
South Africa’s reliance on coal to power its power plants has some of the worst air pollution in Africa, and is thought to be linked to the rise in asthma cases (File: Dennis Farrell /AP)
How prevalent is asthma in Africa?
According to a 2013 study, the total number of asthma patients on the continent increased from 94 million in 2000 to 119 million in 2010.
In Africa, young people account for about 14 percent of asthma cases, but the numbers vary widely. In Nigeria, children account for about 13 percent of cases, and in South Africa, children account for about 20 percent.
Several studies have shown that disproportionately high rates of premature death and severe cases of asthma in Africa and other low-income countries are primarily due to inadequate health systems, resulting in underdiagnosis and undertreatment. It is shown that it is being done.
How is asthma treated?
Asthma is ideally managed using a two-pronged approach. One is a short-acting inhaler or a pill that expands the airways to allow more air into the lungs during an attack. There are also long-term treatments that come in the form of preventive inhalers or tablets and are used daily to prevent attacks from occurring.
However, in most African countries, asthma cases are treated on a crisis basis rather than managed over time, the researchers said.
Even if the symptoms are alleviated for a short period of time, treatment costs can be high. In Nigeria, which is experiencing the worst economic crisis in a generation, the cost of an inhaler has nearly tripled in the past year alone, from about 2,800 naira ($1.70) to 7,500 naira ($4.57). Amid the recession, pharmaceutical giant GlaxoSmithKline pulled out of the country, leading to shortages of its popular brand of inhalers.
Why are cases not detected?
According to researchers, many cases of asthma go undiagnosed due to a general lack of knowledge about the severity of asthma and how to effectively manage it.
In the QMUL-led study, researchers found that only half of young people who had previously been diagnosed with asthma knew that young people die from asthma in their country. . More than half of them didn’t know that using a spacer (a simple plastic breathing tube with a valve) in their inhaler allows the drug to reach their lungs much more easily.
Furthermore, despite economic growth associated with rapid urbanization, poverty and economic inequality remain problems across Africa, meaning that many people lack access to health care.
According to UNICEF, about 60% of urban dwellers in Africa live in slums. Researchers say many adolescents living in these settings lack access to regular health checkups or even emergency treatment.
Rebecca Nantanda, a senior researcher at the Makerere University Lung Institute (MLI) who led the study in Uganda, told Al Jazeera that delayed diagnosis puts children and young people at greater risk of developing serious lung complications due to lack of care. He said it means.
One serious condition that can be caused by untreated asthma is chronic obstructive pulmonary disease (COPD), which causes daily wheezing and mucus-filled coughs. Untreated asthma not only causes physical symptoms, Nanthanda added, but can also negatively impact children’s ability to connect with their peers, as they tend to miss school frequently.
“[Asthma]affects other activities such as education, sports and play. It also affects their mental and psychological health due to stigma, chronic illness, stress, worry and anxiety.” she said.
What is the solution?
In the long term, managing urban air quality is essential to reducing the number of people with asthma, WHO says.
Meanwhile, researchers are calling on African governments to increase investment in asthma treatments, investing in long-term and short-term treatments rather than just spending money on quick-acting treatments. It is increasing.
“While most hospitals may focus on treating asthma attacks and exacerbations, it costs more for patients and the health care system,” MLI’s Nanthanda said. “Governments need to invest in proper long-term care for people with asthma because it will be cheaper and more affordable in the long run.”
It is also important to work with pharmaceutical companies and other major companies to negotiate subsidies for asthma drugs and diagnostics, he added.
QMUL’s Mosler said one way to specifically combat underdetection is to increase awareness of asthma among students in schools.
“Mobile clinics that visit schools can be a very effective method of screening,” Mosler said, referring to a method that has been tested with some success in low-quality areas of the United States. Mentioned.
“Mobile clinics can provide diagnosis and treatment directly in schools for people with symptoms. In most African cities, enrollment rates at the start of secondary education are good. … (It is) a problem “It could provide a great way to address this,” she said.
