Knowledge on Asthma and Use of Metered-Dose Inhalers among Healthcare Professionals at Health Centres and Regional Referral Hospitals in Dar Es Salaam

Abstract

Background: The metered-dose inhalers (MDIs) are the most commonly used devices to deliver asthma inhalational drugs. Inhaler use technique is very challenging especially when no proper training is given to patients. Healthcare professionals are tasked with educating the patients on correct use and their knowledge on asthma and inhaler technique is of paramount importance. Objective: To assess knowledge on asthma and use of metered-dose inhaler among healthcare professionals in health centers and regional referral hospitals in Dar es Salaam. Methodology: This was a cross-sectional multi-centers, hospital-based study conducted at regional referral hospitals of Amana, Mwananyamala, Temeke and health centers of Sinza and Kigamboni. Participants included healthcare providers (HCPs) in the departments of internal medicine, pediatrics, emergency medicine and pharmacy. Questionnaires were used to collect participant’s demographic data and to assess for knowledge on asthma and its management. For asthma knowledge, an 18 questions HCP asthma knowledge questionnaire (HQ) was used. Each correct answer was awarded one point while a zero point was given to wrongly answered or unattempted question. Knowledge was considered adequate if the score was 13/18 or higher as per HQ otherwise it was considered inadequate. HCPs technique in using MDIs was assessed using placebo inhalers against a 12 step published checklist. Correct technique participants had to get all the steps correctly, otherwise it was poor technique. Data analysis was done using SPSS version 23.0. Chi-square was used to compare categorical data and one way ANOVA for comparison of mean scores for asthma knowledge and inhaler technique across HCPs cadres. A p-value less than 0.05 was considered significant. Results: A total of 114 participants were enrolled in the study. Among the participants, 57% were medical officers, 59.6% had work experience of less than 5 years and 53.5% had no training on inhaler technique. Placebo inhalers for demonstration to patients were not available at work place in any of the facilities involved in the study. Among the HCPS, 75.4%had inadequate knowledge on asthma. Medical specialists had the highest mean score (14.5) for asthma knowledge. Factors associated with good asthma knowledge included age more than 40 years (p=0.039) and being a medical specialist (p=0.002). . Only 4.4% of the participants did all the steps of inhaler technique correctly. The highest mean score on inhaler technique was seen among medical specialists (6) while the lowest was among nurses (3). Conclusion: Knowledge on asthma and inhaler technique is generally poor among healthcare providers in Dar es Salaam. None of the health facilities had placebo inhalers for patients’ training on inhaler technique. Recommendation: Training on asthma and inhaler demonstration should be offered to all cadres and should be continued at work places. Availability of placebo inhalers should be ensured for demonstration to patients