Abstract:
Asthma is a global health burden, with over 300 million people affected. Guidelines
provide a framework of reference by healthcare workers for the management and
improvement of care for patients. The Ministry of Health has provided the Kenya
Asthma Management Guidelines to help reduce the mortality and morbidity of
asthma. This study assessed adherence to national asthma guidelines and short-term
patient outcomes at Mama Lucy Kibaki Hospital, Kenya in the management of acute
asthma and identified barriers to their implementation. A mixed-methods study was
conducted that incorporated a retrospective design that quantitatively reviewed the
medical records of 135 children aged 3-18 years in which data on initial assessment,
severity classification, treatment adherence, and outcomes over a one year from June
2022 to June 2023 was collected while qualitative methods of data collection
included key informant interviews (KIIs) from twenty-six healthcare workers and
three focused groups discussions (FGDs) that highlighted insights on the challenges
to implementation of guidelines were done. Quantitative data were collected using a
validated data abstraction sheet, while qualitative data from FGDs and KIIs were
transcribed, coded, and securely managed. Ethical approval from the appropriate
institutions were obtained, and informed consent were obtained where applicable,
with strict measures implemented to ensure confidentiality and data protection
throughout the study. Quantitative data were analysed using R version 4.3.3, while
qualitative data were thematically analysed. Among the 135 children enrolled, the
median age was 4 years, with 55.6% male versus 44.4% female participants. Most
(76.3%) were inpatients with an average hospital stay of 4 days. Severity
classification adherence was low (11.1%), while 60.7% received oxygen, 82.2%
antibiotics, and 77% systemic corticosteroids. Nebulisation was used in 86.7 %, but
only 0.7% received an inhaler with a spacer and mask. Follow-up at the paediatric
respiratory clinic was booked for only 29.6%, while 72.6% were discharged on oral
antibiotics. Pneumonia was the most common comorbidity (75.6%), significantly
increasing hospital stay (p < 0.0001). The mortality was low at 1.5% and most of the
patients improved after management. Challenges to implementing guidelines
included shortages of resources, training deficiencies, and operational constraints.
The healthcare workers pointed out gaps in the availability of essential medications,
equipment, and printed protocols, while the high patient loads were associated with
poor adherence. A significant gap exists between national asthma management
guidelines and their implementation in practice, while outcomes were influenced by
co-morbidities that need further study. Addressing challenges like inadequate
resources and training is key to improving adherence and patient outcomes.
