10 May 2012

Uganda: Asthma Patients Getting Wrong Medication


When the former national chairman of the Forum for Democratic Change Mr John Butime passed on late last month, newspaper reports pointed at complications that may have resulted from his asthma, diabetes and hypertension.

It is not unusual to hear of people dying due to complications arising out of diabetes or hypertension. The newspaper reports aside, we do not know the exact cause of Butime's death since we never got access to the postmortem report. However, if these reports of asthma mean anything, they brought to the fore a medical condition that is often neglected.

Butime's death occurred just ten days before World Asthma Day which is observed every first Tuesday of May (May 1 in the case of 2012), but about which not many Ugandans know anything. It also came nearly two months since the publication of findings from a study on the proportion of asthma cases among adult patients in the chest, accident and emergency (A&E) units at Mulago hospital, and patterns of asthma medications and prescriptions.

Asthma is a disease of the airways (bronchial tubes) characterised by wheezing, a high-pitched whistling sound heard especially when breathing out. Asthma can also involve shortness of breath or coughing, particularly in children. Asthma "attacks" can be triggered by a cold, exercise, or exposure to smoke.

While it is a common chronic disease with debilitating effects, in Uganda, the proportion of the condition in healthcare facilities, and the extent to which asthma management guidelines are followed, is unknown. However, it affects an estimated 235 million people worldwide.

It was, therefore, of great significance when scientists Bruce Kirenga and Okot Nwang sought to establish the proportion and management of asthma patients at Mulago. Writing in the March 1 edition of the African Health Sciences journal, the duo wrote that 144 out of 792 clients who visited the chest clinic in 2009 were diagnosed with asthma.

During the same period 416 out of the 16,800 clients in the A&E department had asthma. The study concluded that "Generally, appropriate asthma treatment was low, both at the chest clinic and A&E department but it was worse at the emergency department. For example, over 50% of the patients received oral salbutamol therapy instead of inhaled salbutamol."

With studies elsewhere recognizing cost as being an obstacle to proper asthma medication, especially in the developing world, Kirenga and Okot reached similar conclusions for Uganda, as inhaled medications are more expensive than tablets. For instance, three months before the Mulago study, a report by the Medicines Price Monitor indicated that only 8% of public health facilities in Uganda had the essential inhaled salbutamol.

The Mulago study did not put a price on the cost of inhaled salbutamol other than stating that the cost was high. But when I inquired around pharmacies in Kampala, the current cost of a dose of this medicine is between Shs 13,000 and 15,000, which is higher than what many average Ugandans can afford.

Meanwhile, many asthma patients are getting the wrong prescriptions because of the ignorance that is rampant among clinicians. Current guidelines do not recommend an antibiotic unless there is evidence of bacterial infection; yet more than half of the patients received an antibiotic.

About 16 months since the lapse of the study period, the situation has barely changed. I believe that as a country, we need to improve the diagnosis and management of asthma and one of the things the government can do is to increase stocking of asthma medicines in health centres, where majority of Ugandans go.

The author works with the Future Health Systems Research Consortium at Makerere University School of Public Health.

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