Primary health care providers’ knowledge and practices on asthma management within Dar es salaam region health facilities
Date of Award
Master of Medicine (MMed)
Family Medicine (East Africa)
Background: Asthma is a common chronic health problem worldwide with considerable variation in the way it is managed. In the sub- Saharan Africa there is substantial gaps in asthma care; countries like Tanzania with inadequate health care structure are lagging far behind in both correct diagnosis and management of asthma. The increasing prevalence of asthma within populations is attributed to a number of the following factors; Patient behavior, Health service structure and access, Environmental factors and Provider's knowledge and practices. There is lack of required standard asthma care under provider's factors, hindering effective control of the disease. This could be attributed to lack of awareness among health care professionals on internationally available management protocols, which have proven to be effective when disseminated and incorporated for implementation into clinical practice. In the sub-Saharan Africa the competence of primary care provider in managing asthma has been put in question with varying quality of care among the providers. Few studies in sub Saharan Africa and perhaps none in Tanzania have investigated the quality of delivery of asthma care with a particular focus on the provider factor.
Objectives: Determine the primary health care providers' knowledge in diagnosing and managing asthma patients according to the existing guidelines; evaluate the actual practice involved in managing asthma patients and design a questionnaire tool that would be educative on current standards of asthma care during the interview process.
Methodology: A cross sectional descriptive survey study was designed to interview the eligible primary health care providers in health facilities within the three districts of Dar es Salaam region. 100 Primary care providers (PHCPs) were statistically identified as sufficient sample size for the study of 384 (PHCPs) target population. The structured questionnaire was administered and the initial responses were systematically coded and analyzed by computer SPSS software program; the findings were statistically analyzed for significance taken at P value < 0.05 within 95% confidence limits. Cross tabulation of data, bi variate and linear correlation analysis were applied in determining the values of important outcome variables.
Results: The survey involved 110 PHCPs, the response rate was 90%and therefore 100 PHCPs responded. Assistant medical officers (NON MDs) contributed a major clinical work force in most of health facilities surveyed by 70% as compared to Medical officers(MDs) 30% (P=0.006). 5.3% of MDs were practicing in public hospitals with remaining majority practicing in private hospitals (P=0.001). The awareness among PHCPs on GINA or other international guideline on asthma care was far below at 3% despite handling a significant volume of asthma patients in their practices which accounted for 7% among disease conditions seen in an average week. The actual performance of PHCPs on Asthma KAP study was below average score by 89%; while 13% of MDs and 1.4% of NON MDs were only above average score. (P=0.041) The organization level for asthma care within all surveyed health facilities was below average score by 98% and this is thought to be one of the important factors that impacted negatively on asthma KAP among the PHCPs.
Conclusion: There urgent need to formulate local/national guideline on current asthma care management which should be disseminated and incorporated into daily clinical practice by PHCP; on the other hand the organization infrastructure for asthma care is in pathetic state in most health facilities which calls for reversal of this declining trend by concerned stakeholders so as to minimize its deleterious impact in asthma care.
Rwegasha, J. C. (2008). Primary health care providers’ knowledge and practices on asthma management within Dar es salaam region health facilities (Unpublished master's dissertation). .