A study on physicians’ knowledge and practices of asthma management in Angola

A study on physicians’ knowledge and practices of asthma management in Angola

Authors

  • Nsiku Lutete Instituto Superior Politécnico de N’Dalatando, Kwanza Norte, Angola; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; CICS-UBI – Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
  • Margarete Arrais Department of Pulmonology, Military Hospital Luanda, Angola; Centro de Investigação em Saúde de Angola - CISA, Caxito, Bengo, Angola https://orcid.org/0000-0001-6611-4260
  • Jorge M.R.Gama Centre of Mathematics and Applications, Faculty of Sciences, University of Beira Interior, Covilhã, Portugal
  • Luis Taborda-Barata Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal; CICS-UBI – Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; UBIAir - Clinical & Experimental Lung Centre, UBIMedical, University of Beira Interior, Covilhã, Portugal; Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal

Keywords:

knowledge, practice, asthma, Angolan physicians

Abstract

Background: Asthma is the most common chronic non-communicable disease in children and one of the most common in adults, and the majority of asthma-related deaths are attributed to middle- and low-income countries. Physicians’ knowledge and practice have been recognized as fundamental elements in the approach to the asthmatic patient with an impact on the treatment and control of the disease. This study aimed to assess the knowledge and practice of Angolan physicians in the management of asthma, as well as to identify the main gaps.
Methods: It was a cross-sectional study carried out in Angola. The data were collected through an online questionnaire to assess the knowledge about asthma among the physicians and the Physicians Practice Assessment Questionnaire. Categorical variables were described with frequencies and percentages. All associations between good practice and possible predictors were established with logistic regression analysis. P<0.05 was considered statistically significant.
Results: A total of 204 physicians throughout Angola participated; the majority of whom were female, aged ­between 31 and 40, and from the Luanda province. The average percentage of correct answers for all domains was 65.8% (±SD11.1%). The lowest percentages were in the answers about the diagnosis, drugs, and the signs of an asthma attack. Out of the 204 participants, 81.9% of physicians confirmed seeing patients with asthma. The average percentage of them who reported practicing asthma management based on recommended guidelines was 59.8% (±SD27.8%). More than half of the physicians did not achieve that percentage. The lowest percentages of correct answers concerned assessment of the inhaler technique, provision of a written referral for asthma education, and use of the GINA guidelines to assess the patient’s asthma control. Concerning the predictors of best practices, our results showed that being a physician of older age and with more work experience, as well as having the category of specialist were significant predictors of adherence to recommended practices for asthma management.
Conclusions: The physicians’ level of knowledge about asthma was moderate, but there are important practical gaps in asthma management regarding standard guidelines.

References

Momtazmanesh S, Moghaddam SS, Ghamari SH, Rad EM, Rezaei N, Shobeiri P, et al. Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019. eClinicalMedicine. 2023;59(May). https://doi.org/10.1016/j.eclinm.2023.101936

Wang Z, Li Y, Gao Y, Fu Y, Lin J, Lei X, et al. Global, regional, and national burden of asthma and its attributable risk factors from 1990 to 2019: a systematic analysis for the Global Burden of Disease Study 2019. Respir Res. 2023;24(1). https://doi.org/10.1186/s12931-023-02475-6 PMID: 37353829

Global Initiative For Asthma (GINA). Global Strategy for Asthma Management and Prevention [Internet]. Global Initiative for Asthma. 2023. https://doi.org/10.1183/09031936.00138707 PMID: 20816182

Jayasooriya S, Stolbrink M, Khoo EM, Sunte IT, Awuru JI, Cohen M, et al. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis. 2023;27(9):658–67. https://doi.org/10.5588/ijtld.23.0203 PMID: 37608484

Yawn BP, Rank MA, Cabana MD, Wollan PC, Juhn YJ. Adherence to asthma guidelines in children, tweens, and adults at primary care settings: A practice-based network assessment. Mayo Clin Proc. 2016;9(4):411–21. https://doi.org/10.1016/j.mayocp.2016.01.010

Arrais M, Lulua O, Quifica F, Rosado-Pinto J, Gama JMR, Taborda-Barata L. Prevalence of asthma, allergic rhinitis and eczema in 6–7-year-old schoolchildren from Luanda, Angola. Allergol Immunopathol (Madr) [Internet]. 2019; https://doi.org/10.1016/j.aller.2018.12.002

Arrais M, Lulua O, Quifica F, Pinto R, Gama J, Taborda-Barata L. Prevalence of asthma and allergies in 13-14 year old adolescents from Luanda, Angola. Int J Tuberc Lung Dis. 2017;21(7):705–12. https://doi.org/10.5588/ijtld.16.0530

Obel KB, Jean K, Ntumba M, Kalambayi KP, Zalagile AP, Kinkodi D, et al. Prevalence and determinants of asthma in adults in Kinshasa. PLoS One. 2017;1–13. https://doi.org/10.1371/journal.pone.0176875

Kirenga BJ, Jong C De, Mugenyi L, Katagira W, Muhofa A, Kamya MR, et al. Rates of asthma exacerbations and mortality and associated factors in Uganda : a 2-year prospective cohort study. Thorax. 2018;73:983–5. https://doi.org/10.1136/thoraxjnl-2017-211157

Arrais M, Maricoto T, Lulua O, Quifica F, Gama JM, Brito M, et al. Factors associated with poor asthma symptom control in adult Angolan regularly seen at an outpatient respiratory clinic. Afr Health Sci. 2023;23(3):672–82. https://doi.org/10.4314/ahs.v23i3.78

Onyedum C, Ukwaja K, Desalu O, Ezeudo C. Challenges in the management of bronchial asthma among adults in Nigeria: A systematic review. Ann Med Health Sci Res. 2013;3(3):324. https://doi.org/10.4103/2141-9248.117927

Mortimer K, Reddel HK, Pitrez PM, Bateman ED. Asthma management in low and middle income countries: case for change. Eur Respir J [Internet]. 2022;60(3):1–17. https://doi.org/10.1183/13993003.03179-2021 PMID: 35210321

Janson S, Weiss K. A national survey of asthma knowledge and practices among specialists and primary care physicians. J Asthma. 2004;41(3):343–8. https://doi.org/10.1081/JAS-120026093 PMID: 15260468

Accordini S, Corsico AG, Braggion M, Gerbase MW, Gislason D, Gulsvik A, et al. The Cost of Persistent Asthma in Europe: An International Population-Based Study in Adults. Int Arch Allergy Immunol. 2013;160:93–101. https://doi.org/10.1159/000338998 PMID: 22948386

Price C, Agarwal G, Chan D, Goel S, Kaplan AG, Boulet LP, et al. Large care gaps in primary care management of asthma: A longitudinal practice audit. BMJ Open. 2019;9:e022506. https://doi.org/10.1136/bmjopen-2018-022506 PMID: 30696669

INE Angola. Instituto Nacional de Estatística [Internet]. [cited 2024 Feb 2]. https://www.ine.gov.ao (accessed 2024 Feb 2)

Plano de Desenvolvimento Nacional 2023-2027 [Internet]. [cited 2024 Feb 2]. https://www.mep.gov.ao/assets/indicadores/angola2050/20231030(3)_layout_Final_Angola_PDN 2023-2027-1.pdf (accessed 2024 Feb 2)

Eysenbach G. Improving the Quality of Web Surveys : The Checklist for Reporting Results of Internet E-Surveys ( CHERRIES ). J Med Internet Res. 2004;6(3):e34. https://doi.org/10.2196/jmir.6.3.e34

Adeniyi B, Ilesanmi O, Obaseki D, Desalu O, Betiku B, Erhabor G. Relationship between knowledge and quality of asthma care among physicians in South-West Nigeria. Niger J Clin Pract. 2017;20(5):566–72. https://doi.org/10.4103/1119-3077.206363 PMID: 28513515

Boulet LP, Devlin H, O’Donnell DE. The physicians’ practice assessment questionnaire on asthma and COPD. Respir Med [Internet]. 2011;105:8–14. https://doi.org/10.1016/j.rmed.2010.07.022 PMID: 20797841

Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth. 2017;11(5):S80–9. https://doi.org/10.4103/sja.SJA_203_17 PMID: 28616007

Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGeralde M, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31(1):143–78. https://doi.org/10.1183/09031936.00138707

Mortimer K, Masekela R, Ozoh OB, Bateman ED, Nantanda R, Yorgancıoğlu AA, et al. The reality of managing asthma in sub-Saharan Africa – Priorities and strategies for improving care. J Pan African Thorac Soc. 2022;3(3):105–20. https://doi.org/10.25259/jpats_37_2022

World Health Organization. Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care in Low-resource Settings. Geneva, Switzerland: WHO Press; 2020 [Internet]. [cited 2024 Feb 2]. www.who.int/publications/i/item/who-package-of-essential-noncommunicable-(pen)-disease-interventions-for-primary-health-care (accessed 2024 Feb 2)

Akinbami LJ, Salo PM, Cloutier MM, Wilkerson JC, Elward KS, Mazurek JM, et al. Primary care clinician adherence with asthma guidelines: the National Asthma Survey of Physicians. J Asthma. 2020;57(5):543–55. https://doi.org/10.1080/02770903.2019.1579831 PMID: 30821526

Dahmash EZ. Physicians’ Knowledge and Practices Regarding Asthma in Jordan: A Cross-Sectional Study. Front Public Heal. 2021;9(712255):1–7. https://doi.org/10.3389/fpubh.2021.712255 PMID: 34532307

Assiri H, Alkhaldi Y, Alsaleem S, Alqarni H. Knowledge, attitude and practices of PHC physicians in Aseer region regarding management of acute asthma. J Fam Med Prim Care. 2021;10:1882–9. https://doi.org/10.4103/jfmpc.jfmpc_1418_20 PMID: 29026777

Dairi MS. Physicians’ Knowledge and Practices Regarding Asthma: A Cross-Sectional Study in Saudi Arabia. Int J Gen Med. 2022;15:6671–80. https://doi.org/10.2147/IJGM.S369306

Pan Z, Yang T, Chi C, Chen Y, Liao J, Huang K, et al. An online survey of primary care physicians’ knowledge of common respiratory diseases in China. npj Prim Care Respir Med. 2022;32(1). https://doi.org/10.1038/s41533-022-00289-5 PMID: 35986011

Ozoh O, Ndukwu C, Desalu O, Adeyeye O, Adeniyi B. Knowledge and Practice Assessment, and Self Reported Barriers to Guideline Based Asthma Management Among Doctors in Nigeria. Niger J Clin Pract. 2019;22:692–700. https://doi.org/10.4103/njcp.njcp_569_18

Maricoto T, Monteiro L, Gama JMR, Correia-de-Sousa J, Taborda-Barata L. Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta-Analysis. J Am Geriatr Soc. 2019;67(1):57–66. https://doi.org/10.1111/jgs.15602 PMID: 30291745

Ferreira EF, Pascoal A, Silva P, Lourenço O, Valente S, Valente MJ, et al. Inhaler training and asthma knowledge are associated with a higher proportion of patients with correct inhaler technique in young but not in elderly asthmatic patients. J Asthma [Internet]. 2019;0(0):1–11. https://doi.org/10.1080/02770903.2019.1582063

Al-Hamaden RA, Abed A, Khader HA, Hasoun L, Al-Dulaimi AH, Alsayed AR. Knowledge and Practice of Healthcare Professionals in the Medical Care of Asthma Adult Patients in Jordan with a Particular Reference to Adherence to GINA Recommendations. J Multidiscip Healthc. 2024;17(January):391–404. https://doi.org/10.2147/JMDH.S433149

Ben AS, Elasmar K, Jdidi J. General practitioners’ management of childhood asthma in Sfax, Tunisia. Rev Mal Respir. 2022;39(10):839–47. https://doi.org/10.1016/j.rmr.2022.09.006

Cook DA, Pencille LJ, Dupras DM, Linderbaum JA, Pankratz VS, Wilkinson JM. Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants. PLoS One. 2018;13(1):1–12. https://doi.org/10.1371/journal.pone.0191943 PMID: 29385203

Gunaydin F, Karakaya G, Ediger D. How do we manage asthma? Assessment of knowledge, attitude, and practice patterns among pulmonologists and allergists. J Asthma. 2023;60(1):130–8. https://doi.org/10.1080/02770903.2022.2033261

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Published

13-09-2024

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Original Research Articles

How to Cite

1.
Lutete N, Arrais M, M.R.Gama J, Taborda-Barata L. A study on physicians’ knowledge and practices of asthma management in Angola. Multidiscip Respir Med [Internet]. 2024 Sep. 13 [cited 2024 Oct. 12];19(1). Available from: https://mrmjournal.org/index.php/mrm/article/view/968