Adherence to National Guidelines by Health Care Practitioners in the Management of Acute Asthma and Short-Term Outcomes among Children at Mama Lucy Kibaki Hospital, Keny

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.