Asthma in African Children: Causes, Symptoms and Care  

 

By Ibironke Taiwo. BNSc., RN. Freelance Health Writer. Medical and Editorial review by The DLHATeam.  

Bare chested African children (three boys and one girl) posing together outdoors.

 

Highlights

• Asthma is the most common non communicable chronic respiratory condition in African children, with an average prevalence of 14%. 

• Being a male child is a risk factor of having asthma in African countries 

• The misconception surrounding asthma in African countries, lack of access to health care facilities and cost of care promotes delays in accessing proper routine and emergency services for diagnosis and appropriate care. 

• Air pollution, exposure to tobacco smoke, allergic conditions like rhinitis, cold, sinusitis, being overweight or obese, and exposure to respiratory infections can exacerbate asthma symptoms in African children. 

• Community education, health provider training, health system changes, financial support, and policy reforms are needed to promote the treatment and management of Asthma in African countries. 

 

Introduction

Asthma is the most common non-communicable chronic respiratory disease among children globally. Its prevalence in Africa averages 14%, with wide inter-country variations. The average African prevalence though matches the global average. [1]  

Asthma is characterized by the inflammation and narrowing of the small airways in the lungs, leading to symptoms such as wheezing, shortness of breath, chest tightness, and coughing. These may keep your child from carrying out their daily activities, such as playing or attending school.   

According to the WHO, asthma affected an estimated 262 million people in 2019 and caused 455 000 deaths, most of which occurred in lower-middle income countries, such as most of sub-Saharan Africa. [2] 

Although the prevalence of asthma in African children varies across regions, urban areas typically show higher rates due to factors like air pollution, indoor allergens, and lifestyle changes.   

The management of asthma in African children could be difficult due to certain challenges such as underdiagnosis, lack of access to proper medications, poor faithfulness to treatment, and cultural beliefs affecting healthcare-seeking behaviour. These factors can contribute to uncontrolled asthma, frequent worsening, hospital admissions, and reduced quality of life of affected children.   

This article aims to give you basic information about many aspects of asthma in African children so that you will know how to identify the symptoms, prevent and manage the condition for better outcome and well-being of your child. Keep reading! 

   

Causes and risk factors of asthma in African children  

The exact cause of asthma is unknown. Researchers believe that it develops mostly during childhood, when your child's immune system is still developing. Below are some situations that are known to contribute to the occurrence of asthma in African children.    

• Family history: Your child is likely to have asthma if a close family member or relative, such as the father, mother, or siblings, has it.  

• Allergic conditions like rhinitis, cold, sinusitis, etc.  

• Living in the city where exposure to tobacco smoke and other sources of air pollution are higher compared to the countryside.   

• Exposure to tobacco before birth can also increase your child's chances of developing asthma.  

• Exposure to environmental allergens and irritants, house dust, molds, chemicals, fumes, or dust  

• Being overweight or obese   

• Early exposure to respiratory infections.  

• Early life events like low birth weight and prematurity  

• Being male: The actual reason behind this is not known, but researchers attribute this risk factor to the fact that the airway of a male child is smaller than that of a female child. [3] 

• Being black: This may mainly be due to the poor status of the social determinants of health and health systems in most sub-Saharan African countries.  

• Inadequate diagnostic investigation and treatment for chronic respiratory diseases  

 

How do I know if my child has asthma?  

The symptoms of asthma vary in children and range from mild to severe. It could even show various patterns in the same child at different times. In some cases, the symptoms could get worse, and this is referred to as an asthma attack. The following are the various symptoms that indicate that your child has asthma.   

• Coughing fits during play, at night, or after waking up  

• Rapid breathing or shortness of breath  

• Chest tightness  

• Wheezing (whistling sound) during breaths  

• Difficulty sucking (infants)  

• Chest retraction (occurs when soft areas around the ribs pull inwards when your child breathes in). This indicates that your child is finding it difficult to breathe,  

• Feeling weak or tired  

• Less energy during play  

• Irritability  

There can also be worse symptoms during an attack, which could be life-threatening. These are:  

• Severe coughing  

• Increased respiratory rate  

• Turning pale or blue on the face  

• Serious difficulty with breathing  

• Inability to speak  

In any of the above situations, it is advisable to get medical help immediately.  

 

Care of asthma in African children  

Asthma disease cannot be cured but can only be controlled (managed). It is important that you as a parent or guardian of an African child suffering from asthma talk with your doctor or other healthcare providers to develop an asthma care plan. [4] This should detail: 

• When and how your child should use asthma medication. 

• What to do when your child’s asthma gets worse. 

• When to seek immediate care for your child. 

It is very important that you understand the asthma care plan very well. So, ask your child’s healthcare provider all the questions that you may have. Also keep the plan safe and readily available to remind you and your child what to do in the case of an asthma occurrence.  

Be sure to give a copy of the plan to your child’s school officials (nurse, class teacher or principal) so that they are also aware of what to do in case of asthma symptoms during school hours. 

The care of asthma in children rests on four main pillars as follows: 

• Regular medical check up 

• Control of lifestyle factors that contribute to the condition 

• Use of medications 

• Educating/Counseling the child and their caregivers 

 

Regular medical check up 

Taking your child for regular medical check-up is vital for the control of asthma. It helps in the early detection of the disease and to exclude other respiratory diseases. It also helps to minimise fewer complications. 

 

Control of lifestyle factors that contribute to the condition 

You should make efforts to minimise your child’s exposure to environmental factors, such as irritants and tobacco smoke. These pose risks for asthma symptoms and should be controlled. 

 

Use of medications 

Medications are useful in the management and control of the occurrence of asthma. They reduce the intensity of symptoms and their possible worsening.  

Adverse effects and the likelihood of decline in lung function should always be assessed when on medications. 

 

Education and Counselling of the child and their caregivers 

Educational information should be provided on the use of inhalers and when to seek immediate treatment. These should be tailored according to the patient's circumstances and the situation of the healthcare system around them. 

Other comorbid conditions that may aggravate asthma in a patient should be diagnosed early and managed properly. Some of these are obesity, rhinitis, sinusitis, fungal infection of the lungs, gastroesophageal reflux disease (GERD), depression, stress, and low vitamin D levels [5]. 

  

Medications to treat asthma in children 

The main medication used in asthma patients is contained in an inhaler. This is a medical device used for delivering puffs of medicines into the lungs through breathing. The use of tablets and other treatment methods that may be coupled with the inhaler in severe cases.   

Inhalers used in asthma care are of different types and are used to relieve or prevent symptoms, or both, depending on the severity of your child's symptoms.   

• Reliever inhalers  

This type of inhaler, also known as a rescue inhaler, is known to act quickly in treating asthma symptoms and attacks, which is why your child should always carry their reliever inhaler with them every time. [6] 

Examples of reliever inhalers include short-acting beta-adrenergic drugs such as albuterol and short-acting anticholinergics such as ipratropium bromide [6]. These drugs act by opening up your child’s air passage to enable better breathing.  

Reliever inhalers are mostly blue.   

• Preventive inhaler  

This type of inhaler holds a low dose of steroids in the form of corticosteroids, [7] which work by preventing and reducing inflammation in your child's airways. Other examples of preventive inhalers include leukotriene modifiers and long-acting beta2 adrenergic drugs. [7] Traditionally, preventive inhalers are mostly brown. [8] But be mindful that there are several colour-coded inhalers with different medication combinations in the market and efforts are being made to universally standardise the colour codes for inhalers. [8]

All these asthma medications can have potential side effects such as rash or swelling, oral thrush, increased heart rate, nervousness, headache, and weight gain. If you notice any of these in your child, do well to speak to your healthcare provider to adjust or change their medication.  

  

Challenges of managing asthma in African children 

There are various cultural and socio-economic  factors influencing asthma care in African children. Some of these include:  

• Poor knowledge of asthma 

In most cases, especially in the rural areas of Africa, it is believed that asthma is caused by the wrath of God on a child, and this will cause the parents to look for spiritual care such as rituals and traditional healing practices to treat the condition rather than seek medical care. [9] In addition, some parents hide their asthmatic children at home for fear of being stigmatized by their community. 

These belief systems promote delays in accessing proper routine and emergency services for diagnosis and appropriate care. 

• Inadequate healthcare facilities  

The treatment of asthma usually begins with seeing a doctor or other healthcare providers for assessment and diagnosis. This is often not possible in low-income countries because of political, financial and other health system barriers. [10, 11] 

• Cost of care 

The cost of care of asthma, ranging from diagnosis to the purchase of medications and hospitalisation in cases of worsening of the condition, can be quite expensive. This cost may be out of reach of many African parents who pay more out-of-pocket for healthcare. [12] 

• Use of unproven treatment methods  

Parents are most likely to seek unproven methods of asthma treatment when they are unable to access medical care for whatever reason, and also when conventional treatments are considered ineffective.  In these situations, these parents result to using herbs which they believe is helpful in easing the breathing difficulties associated with asthma attacks.  

 

Prevention of asthma in African children  

The best way to prevent asthma in your child is to get rid or control the factors that could trigger it. The following are ways to do this:  

Avoiding triggers:  

• Avoid allergens and irritants. [13] 

• Avoid exposure to all varieties of smoke, including tobacco smoke.  

Vaccination: 

• Ensure that your child is fully vaccinated and takes flu shots yearly as available.

Maintain healthy living 

• Good hygiene: Teach your child to wash their hands often especially if around other kids with cold and flu. 

• Nutrition: Give your child healthy foods 

• Weigh: Help your child to keep a healthy weight 

• Active life: Encourage your child to be active 

Check-up:

• Check in as appointed with your child's healthcare provider.

  

Conclusion  

Asthma in African children is a common and serious health concern marked by inflammation and narrowing of the airways. It leads to respiratory symptoms such as wheezing, difficulty with breathing, chest tightness, and coughing. Heredity, environmental triggers, social and financial conditions, and limited healthcare access contribute to the challenges of managing asthma among African children. High prevalence rates in urban areas, underdiagnosis, lack of access to medications, poor treatment adherence, and cultural beliefs all impact the care of African children with asthma. The challenges working against better outcome of asthma treatment in African children can be addressed through education, improved healthcare access, environmental interventions, and culturally sensitive approaches. 

 

References: 

1. Naidoo, K. L., Dladla, S., Mphahlele, R. E., Mosler, G., Muyemayema, S., Ssemata, A. S., Mkutumula, E., Adeyeye, O. O., Moyo, M., Goodman, O., Kuyinu, Y., Nantanda, R., Ticklay, I., Mujuru, H. A., Grigg, J., & Masekela, R. (2023). Barriers to childhood asthma care in sub-Saharan Africa: a multicountry qualitative study with children and their caregivers. BMJ open, 13(9), e070784. Doi: 10.1136/bmjopen-2022-070784. Available from here. 

2. World Health Organization. Asthma. [Internet] May 6, 2024. Accessed July 23, 2024. Available from here. 

3. Trivedi M, Denton E. Asthma in Children and Adults-What Are the Differences and What Can They Tell us About Asthma? Front Pediatr. 2019 Jun 25; 7:256. doi: 10.3389/fped.2019.00256. Available from here. 

4. Cleveland Clinic. Childhood asthma. [January 18, 2023]. Accessed July 22, 2024 Available from here.

5.Goleva E, Searing DA, Jackson LP, Richers BN, Leung DY. Steroid requirements and immune associations with vitamin D are stronger in children than adults with asthma. J Allergy Clin Immunol. 2012 May;129(5):1243-51. doi: 10.1016/j.jaci.2012.01.044. Available from here.  

6. Asthma and lungs. Reliever inhalers. [Internet]. July 16, 2024. Accessed July 21, 2024. Available from here. 

7. Asthma and lungs UK. Preventer inhalers. [Internet]. July 16, 2024. Accessed July 21, 2024. Available from here.  

8. Jayakrishnan B, Al-Rawas OA. Asthma inhalers and colour coding: universal dots. Br J Gen Pract. 2010 Sep;60(578):690-1. doi: 10.3399/bjgp10X515449.Available from here.

9. Akinso, O., Adhikari, A., Yin, J., Chopak-Foss, J., & Shah, G. Childhood Asthma-Management Practices in Rural Nigeria: Exploring the Knowledge, Attitude, and Practice of Caregivers in Oyo State. Children, 2023. 10(6), 1043. doi: 10.3390/children10061043. Available from here. 

10. Mortimer K, Masekela R, Ozoh OB, Bateman ED, Nantanda R, Yorganc?o?lu AA, et al. The reality of managing asthma in sub-Saharan Africa – Priorities and strategies for improving care. J Pan Afr Thorac Soc 2022;3:105-20. doi: 10.25259/JPATS_37_2022. Available from here.

11. Jones TM. Reasons for inadequate health care vary. BMJ. 2000 Nov 4;321(7269):1159-60.  Available from here. 

12. Maduka D, Ughasoro JN, Eze AC, Ayuk IO, Uzoamaka A, Tagbo O. Economic burden of childhood asthma in children attending a follow-up clinic in a resource-poor setting of Southeast Nigeria. Paediatric Respiratory Reviews. 2021. Volume 37, p.74-79, doi: 10.1016/j.prrv.2020.01.001. Available from here.

13. Sharma GD. Pediatric asthma treatment and management. [Internet]. Last updated, May 24, 2024. Accessed July 22, 2024. Available from here.  

 

 

Published: August 8, 2024 

© 2024. Datelinehealth Africa Inc. All rights reserved. 

Permission is given to copy, use and share content for non-commercial purposes without alteration or modification and subject to source attribution.