Malawi struggles with asthma

Sam Banda Jnr, Malawi
(First published in The Daily Times, Malawi on 14th May 2013): The world on May 7 joined hands to commemorate the World Asthma Day, a disease that has suffered little attention despite millions of people in almost every region being affected. It is an issue of international concern and this is why an annual event is organised by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world.The theme for this year's commemoration was "You Can Control Your Asthma." However, this year GINA also introduced a sub-theme, "It's Time to Control Asthma."

World Health Organisation (WHO) estimates that around 15 million disability adjusted life years (DALYs) are lost annually through this disease and that children with untreated asthma can miss much of their primary school education, which affects their future opportunities. The body further notes that asthma also impacts the productivity of the parents and relatives who must stay home to care for them, contributing to a cycle of poverty in families and communities. "Asthma can also be fatal and causes an estimated 250,000 deaths annually – one in 250 deaths worldwide," says the United Nations Organisation.

What has been done to fight Asthma?

The International Study of Asthma and Allergies in Childhood (Isaac) in collaboration with the International Union Against Tuberculosis and Lung Health, has released a Global Asthma report 2011 that aims at helping countries including Malawi identify and address the problem.

Designed for stakeholders from government ministers and policy-makers to health workers and people with asthma, the report provides an overview of what is known about the causes of the disease, the global incidence, the progress being made and the significant challenges today and for the future.

According to Executive Director of International Union Against Tuberculosis and Lung Health, Nils Billo, the report demonstrates that the suffering and waste of resources caused by not managing asthma effectively are much greater than the cost of effective action."Asthma is a public health problem that can – and should- be solved now," says Billo in the report.

The disease

Isaac describes asthma as a disease of the bronchial tubes (the airwaves) that typically presents with wheezing, a high pitched whistling sound heard during breathing especially when breathing out.

However, wheezing does not always occur, and asthma can also involve shortness of breath or coughing particularly in children. The disease is the most common chronic among children and also affects millions of adults.

"Some 235 million people worldwide suffer from this non communicable disease," says Isaac. The report however, has not highlighted the number of cases in Malawi. The disease most commonly develops in early childhood and more than three quarters of children who develop asthma symptoms before the age of seven no longer have symptoms by the age of 16.

While some people have given up on asthma having its medication and others have only attached it to hereditary, the report says the causes of asthma are not well understood, but effective medicines are available that can treat it, thus largely avoiding the diminished lives, disabilities and death it can bring.

A wide variety of factors are known to affect asthma but the report says no one specific cause, either biological or environmental, has been identified. The disease runs in families and identical twins are likely to be both asthmatic hence making a contribution to genetic. Other factors that trigger the disease include respiratory tract infections including common colds and by exercise. Environmental factors include inhaled allergens and inhaled irritants (cigarette smoke, fumes from cooking, heating or cosmetics).

The burden of asthma has been growing over the past 30 years, particularly in the low and middle income countries least able to absorb its impact. According to a survey conducted on availability of surveyed inhalers by country, type of health facility and national essential medicines list in the world, shows that Malawi has a lot to do, as some drugs were not available in the private pharmacy, national procurement centre and public hospital pharmacy.

Some of the surveyed drugs include beclometasone which was available in some instances alongside salbutamol in private and public hospitals alongside procurement centre however; budesonide was not available in all the three.

And Ministry of Health spokesperson Henry Chimbali admits that the country has in the past years not put much attention on Non-Communicable Diseases (NCD's) and that at times they have experienced drug stock-outs. He also added that estimates for NCD's have not been that consistent and that they have since realized its extent.

"The monitoring for NCD's has not been that consistent for the past years but the current system is now looking into all that. We have a specific programme on NCD where we are collecting data among others to form decisions. We have released the extent of NCD's and so more money will be allocated," said Chimbali recently.

Many people in Malawi opt for traditional medicines having been ignorantly convinced that there is no conventional medicine for the affliction.

The way forward

Christophe Perrin, Pharmacist and Coordinator, Asthma Drug Facility (ADF), International Union Against Tuberculosis and Lung Health says the percentage of adults which are reported with asthma over the past years has been increasing significantly. "It is very much linked to the fact that they were not aware of these asthmatic conditions," says Perrin.

He adds that over the years ADF mechanism has managed to bring down the price of one year treatment of severe asthma by 60 percent. "The inhalers have the ingredient which when taken by the patient are in form of little drops, that reach the lungs. The turbo halers contain a powder and the size of the powder particles plays a very significant role in turbohalers," he explains.

He adds that this is complex technology that matters in the asthma medicines and that there is a need to master the manufacturing of these devices and then scale up.

Perrin says the Union believes that it is very important in countries to have guidelines which they call as the national guidelines for standard management of asthma.

"It needs to have standard case management for asthma so that a standardized approach is set. Proper medicine procurement system needs to be functional. Proper prescription of medicines is important so that people know of what to use.

"The Union is really trying to push forward in as many countries as possible and also through ADF are inhaled corticosteroids. Inhaled corticosteroids are the medicines which would help in healing of lungs of asthma patients because asthma is about in¬flammation of the lungs," he says.

Perrin further says that the inhaled corticosteroids are the key medicines to cure these inflammation and that Inhaled corticosteroids were not available as desired in many countries such as India, Nigeria, Kenya, Malawi or Zimbabwe in a study they conducted.

"We need to ensure availability and accessibility of affordable and quality assured medicines for all people with asthma," he says.

Sam Banda Jnr, Malawi
Citizen News Service - CNS
(First published in The Daily Times, Malawi on 14th May 2013)