An evidence-based, multi-stakeholder approach to improve asthma care in Malawi

Clinical Research Results Abstract Research Idea Abstract Service Development & Evaluation Abstract AIM and OUTLINE of CONTEXTPoor asthma control is often due to underuse of inhaled corticosteroid. In Malawi, this commonly results from poor inhaler availability, shortage of medical staff, and low compliance due to limited patient-empowerment and understanding of asthma. Our recent randomized controlled trial (RCT), found that treatment-initiation and education delivered by non-medical professionals can improve asthma control in children, and reduce school absence.1 2 We shared this local evidence among different stakeholders, to raise awareness and improve asthma care in Blantyre, Malawi.INTERVENTIONCommunity dissemination of the RCT resultsNurse-led training and workplace mentoring in all government health centres in urban Blantyre.Formation of a non-governmental advocacy organization (the Asthma Association of Malawi)LESSONS LEARNEDOver six months, the nurse-lead for the initial study delivered asthma awareness and sensitization meetings to 700 stakeholders including; community chiefs, teachers, religious leaders, and local politicians. This focused on the recognition of asthma, triggers, management, and beliefs and misconceptions about asthma care (see figure 1).Supported by the District Health Office, nurse-led workshops in health centres (n=13, see figure 2) had more medical focus, with specific information on emergency management, and manufacture and use of bottle-spacers. Inhaled salbutamol and corticosteroids were available in 10/12 and 4/12 government health facilities, respectively. Interactions with patients and their parents in the nurse-led outpatient clinic inspired families to advocate for better asthma care, and reduced pressure on clinics. Motivated individuals have formed the Asthma Association of Malawi, and been supervised to develop skills in peer-education. MESSAGES FOR OTHERSLocal relevant research can inspire improved health literacyHigh quality support reduces clinic workloads through decentralizationPoor access to inhalers is a major concernOngoing work includes wider training, and structured engagement with the Ministry of Health to address access to essential medicines for patients with asthma. REFERENCES Rylance S, Chinoko B, Mnesa B, et al. An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial. Thorax 2021 doi: 10.1136/thoraxjnl-2020-216065 Nkhalamba L, Rylance S, Muula AS, et al. Task-shifting to improve asthma education for Malawian children: a qualitative analysis. Hum Resour Health 2021;19(1):28. doi: 10.1186/s12960-021-00576-1 Declaration of Interest This dissemination work is funded by the Medical Research Foundation Changing Policy and Practice Award (MRF-145-0007-DG-MORT-C0861). References and Clinical Trial Registry Information