Improving access to asthma care for children and adolescents in Uganda
Asthma
The unit of randomization will be health facilities in the study area. The method is simple randomization. The primary care facilities of interest have 2 levels; 5 Health Centre IV (HC IV) and 12 Health Centre III (HC III) based on the range of services provided. 4 HC IVs and 4 HC IIIs will be randomly selected to participate in the study. The 4 HC IVs will be randomly allocated to the intervention and control groups in a ratio of 1:1. The same process will be followed for HC IIIs. The total number of study sites will be 8 (4 intervention and 4 control). It is a single-centre study. The intervention for the first research question (What is the feasibility, acceptability, and effectiveness of routine screening for asthma symptoms among children and adolescents with respiratory illnesses in improving identification of patients with undiagnosed asthma?) is routine screening for asthma symptoms among all children with respiratory symptoms attending the intervention facilities for clinical care. A standard screening tool will be used. In the control arm, children and adolescents with respiratory symptoms will be assessed as usual and no screening tool will be used. To assess if routine screening for asthma symptoms can identify children with undiagnosed asthma, the researchers shall collect baseline data on asthma diagnoses in both the control and intervention health facilities. The baseline data will be asthma diagnoses in the 12 months prior to starting the intervention. The researchers shall also prospectively collect data on asthma diagnoses per month during the study period. They shall then compare the asthma diagnoses between the control and intervention facilities to estimate the difference in asthma diagnoses attributable to routine screening. They shall use a random-effects logistic regression model to adjust for baseline data while accounting for facility-level clustering. Intention-to-treat analysis will be used. The intervention for the second research qu
1. Children aged 2 months up to 17 years 2. Respiratory symptoms at the time of attending the study health facilities 3. Diagnosis of asthma at enrolment (for CRT on asthma education) 4. Ability to attend follow-up visits at months 1, 3 and 6 (for the CRT on asthma education)
1. Children attending the health study health facilities for other services including disease prevention and health promotion services like immunization, growth monitoring and reproductive health 2. Children who will be unaccompanied and without any contact information for reaching their parents/guardians 3. Patients who will present after 5:00 p.m. and in the night will be excluded due to the difficulties of having the research team on site during this time