Effectiveness of Parent-Targeted Health Education on Control of Asthma among Children attending Clinics at Moi Teaching and Referral Hospital, Kenya

Abstract

Asthma control is the extent to which the various manifestations of asthma have been reduced or removed by treatment. In developing countries including Kenya, many children continue to visit hospitals with acute symptoms of asthma, which is a pointer to poor control. This study sought to determine the effectiveness of targeted health education on the level of control among children with asthma attending clinics at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. A two phased study with Phase one: Cross-Sectional Study and Phase two: A Randomized Controlled Trial (RCT) study was carried out. A total of 166 children with asthma aged 6-11 years and their parents/caretakers were enrolled between August 2016 and October 2017 for baseline study. Subsequently between November 2017 and May 2018, 103 of these children and their parents/caretakers were involved in the RCT. The intervention for the RCT was video recorded health education. The main outcome was level of asthma control using childhood asthma control test (c-ACT). The secondary outcomes were factors associated with asthma control, knowledge and asthma perceptions among caretakers/parents; and health education material. Data was analysed using STATA with descriptive statistics being generated from the baseline study. Chi-square test or Fischer’s Exact test as appropriate and multivariate logistic regression were used to analyse for associations. Outcome analysis was done based on intention to treat. Level of significance was set at 95%. Ethical clearance was obtained from MTRH/ Moi University; and informed consent was sought from all participants. The median age of enrolled children was 8.17 years with males being the majority, 94 (56.6%). Using a cut off for FEV1/FVC at <0.9, 96.9% of children had airflow limitation. Using c-ACT, 92 (55.4% 95%CI: 47.5, 63.1) had well controlled asthma at baseline. At univariate analysis, having a medical insurance cover (p=0.034), dry season (p=0.036), and parental perception of asthma control (p=0.002) were significantly associated with good control of asthma. Acceptance that a child had asthma was associated with poor control of asthma, p=0.046. On multivariate logistic regression, a perception of a well-controlled child by the parent/caretaker correlated well with good level of control of asthma. Although about 50% of the caretakers had asthma medications at home, only a third felt their children had asthma. One hundred and fourteen (68.7%) had basic asthma knowledge. Syrups were preferred to inhalers by 71.1%, with 64.5% believing that inhalers were for the very sick. Only 36 (31%) felt preventer medications in asthma were necessary. Acceptance of asthma as a diagnosis and presence of asthma drugs were significantly associated with better knowledge of asthma, p-values 0.0001 and 0.009 respectively. The odds of improving asthma control for the intervention group was 2.7 [95%CI (0.79-9.07)] higher than the control group after a 6month follow up. In conclusion, about half of the children in this set up have good control of asthma with the observed status of asthma control being affected by parental/caretaker perception on asthma despite having good basic knowledge on asthma. Video recorded health education improved asthma control based on c-ACT in this cohort, although not to statistical significance. Adoption of the tool and its strengthening by having more individualized innovative methods is recommended to effectively address asthma perceptions among caretakers in resource poor settings.