Knowledge of asthma and its management in newly qualified doctors in Accra, Ghana
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Date
1994-03
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Respiratory Medicine
Abstract
This study assessed first-year doctors’ (House Officers) knowledge of asthma at the Korle-Bu Teaching
Hospital. Seventy-two out of 80 doctors answered 32 questions on various aspects of asthma. Many of these
doctors managed between one to three asthmatics per week. Few, however, did so by acceptable standards. In
assessing the severity of asthma, 88% looked for cyanosis, 69% looked for pulsus paradoxicus and 63% looked
for a fast pulse rate. Only 63% considered the measurement of peak expiratory flow useful. Ninety-four per
cent used intravenous aminophylline, 82% intravenous hydrocortisone and 14% oxygen as the drug of choice
for acute severe asthma. In moderate forms of acute asthma, 54% used salbutamol inhaler or intravenous
aminophylline, 28% oxygen, 15% steroid inhaler and 14% oral prednisolone. Nebulized bronchodilators are
not well known for use in either severe or moderate asthma and only 19-21% of doctors had prescribed their
use. In chronic asthma, 55565% of respondents prescribed bronchodilators compared to 19-35% who gave
anti-inflammatory drugs. These results reveal insufficient knowledge of the pathophysiology of asthma, the use
of standard drugs in asthma therapy and international guidelines for the management of asthma. The results
also show that the pragmatic constraints which exist in developing countries preclude the adoption of
international guidelines without local modification.Introduction
Asthma is now recognized to be due to chronic
inflammation of the airways. There is evidence of
inflammation even in patients with mild forms of the
disease (1). This current view of the pathophysiology
of the disease has altered the traditional methods
of management. Internationally, the rationale of
management is primarily to reduce inflammation.
Anti-inflammatory drugs are generally preferred to
bronchodilators in modern practice (2).
The disease still has a significant morbidity and
mortality which may increase worldwide despite the
availability of potent drugs. Among the major factors
which contribute to the morbidity and mortality of
asthma are under-diagnosis and under-treatment by
medical personnel and patients (3-5). Factors related
to the availability of health care are also major
contributors (6,7). In Third World countries where
hospital facilities are inadequate and where current
information about management may not be readily
available, morbidity and mortality are expected to be
even higher. Lack of knowledge of the pathophysiology
of asthma has also contributed to the morbidity
and mortality of the disease. To reduce mortality andparticular,
education of health personnel and even of
patients on principles of the management of asthma
is essential (8). This need has, indeed, been emphasized
in the international guidelines for assessment
and treatment of asthma (2).
In Ghana, bronchial asthma is well known and
commonly encountered in clinical practice. However,
very little systematic work has been done to establish
its prevalence and the level of mortality. It is also
important to determine the level of knowledge of
practising doctors in Ghana of the disease and its
management. The present study focuses on recently
qualified doctors who, presumably, have current
knowledge of the management of asthma from recent
medical school training. A reason for choosing this
group is that House Officers are first-in-line for the
management of emergencies including asthma. Management
problems are more likely to be associated
with this group.
Methods
Seventy-two out of 80 House Officers (aged 25-32
years) at the Korle-Bu Teaching Hospital (KBTH) in
Accra participated in this study. KBTH is the primary
referral centre in Ghana. It has a bed capacityof 1700, and is the main hospital for training students
from the University of Ghana Medical School.
House Officers involved in this study had worked in
the KBTH for up to 12 months after graduation from
medical school. They included doctors trained at the
University of Ghana Medical School, the School of
Medical Sciences, Kumasi and a number from
schools outside Ghana.Each respondent answered 32 questions on various
aspects of asthma, including its management. Some
of the questions demanded multiple responses to
determine degree of knowledge.
Description
Keywords
Knowledge of asthma, Management, Qualified Doctors, 88% looked for cyanosis