Asthma in young children in Uganda: caregivers’ and healthcare workers’ understanding and practices in diagnosis and management. A FRESHAIR qualitative study

Abstract Asthma is the commonest chronic childhood illness but in young children, it is under/mis-diagnosed leading to avoidable morbidity and mortality. We explored the caregivers’ and health care providers’ understanding and practices around diagnosis and management of asthma in children less than 5 years, and how they contribute to diagnostic delays and inappropriate care of the affected children. Semi-structured interviews with 17 healthcare providers and 8 caregivers were conducted. Data were thematically analysed. Most caregivers described their children as having recurrent cough, difficult breathing, and wheezing, commonly triggered by a common cold and cold weather. They visited several health facilities but were not told the diagnosis and often ineffective antibiotics and cough syrups were prescribed/used. Family social and economic stress and frustration with the healthcare system was common. Healthcare providers never considered asthma in children with recurrent respiratory symptoms but primarily diagnosed pneumonia and prescribed antibiotics. Tuberculos and malaria were suspected in some children with recurrent respiratory illness, and malaria medicine was prescribed. Recurrent respiratory symptoms without respiratory distress were regarded as a simple illness. In conclusion, the study identified major gaps in understanding of asthma symptoms amongst healthcare providers leading to misdiagnosis and mistreatment of children with asthma. Caregivers carefully and comprehensively describe asthma symptoms, but the health system is not responsive to their needs that could help in diagnosis of asthma and appropriate care.