Adherence to National Guidelines by Healthcare Practitioners in the Management of Acute Asthma among Children at a Nairobi County Facility, Kenya

Vincent Munene; Justus Simba; Patrick Mburugu; Elizabeth Jowi; Michuki Maina; Penina Kanario; Catherine Munyendo

doi:10.37284/eajhs.8.1.2831

Vincent Munene Jomo Kenyatta University of Agriculture and Technology
Justus Simba Jomo Kenyatta University of Agriculture and Technology
Patrick Mburugu Jomo Kenyatta University of Agriculture and Technology
Elizabeth Jowi Mbagathi County Hospital
Michuki Maina Kenya Medical Research Institute
Penina Kanario Kenyatta University Teaching, Referral and Research Hospital
Catherine Munyendo Gatundu Level Five County Hospital

DOI: https://doi.org/10.37284/eajhs.8.1.2831

Keywords: Asthma, Adherence, Asthma Guidelines, Acute Asthma, Healthcare Practitioners, Length of Hospital Stay (LOS), Children, Kenya

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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 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 (MLKH), Kenya and identified barriers to their implementation. A mixed-methods study conducted included a retrospective design that quantitatively reviewed the medical records of 135 children aged 3-18 years where data on initial assessment, severity classification, treatment adherence, and outcomes while qualitative methods of data collection included (Key Informant Interviews (KIIs) from twenty-six healthcare workers and three focused discussions groups (FDGs) that highlighted insights on the challenges to implementation of guidelines. 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 (11.2%), while 60.7% received oxygen, 82.2% antibiotics, and 77% systemic corticosteroids. Nebulisationation was used in 86.7 %, but only 0.7% received an inhaler with a spacer and mask. Follow-up at the Pediatric 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). 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 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.

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