Asthma: A manageable burden

Josephine Chinele, CNS Correspondent, Malawi
Every day, Talimba (name changed), cooks using firewood which produces lots of smoke. She does not have any affordable alternative source of energy. 20 year old Talimba dropped out of school to take up the responsibility of looking after her household, including her siblings, after the death of their parents. “I live in the rural area where there is no electricity at all. I even use paraffin lamp for lighting at night. That’s what we can afford,” says Talimba.

She is exposed to the firewood smoke daily even though it makes her very sick as she is living with asthma. World Health Organisation (WHO) describes asthma as a chronic disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person. Symptoms may occur several times in a day or week in affected individuals and, for some people, become worse during physical activity or at night. During an asthma attack, the lining of the bronchial tubes swells, causing the airways to narrow and reducing the flow of air into and out of the lungs. Asthma can cause sleeplessness, daytime fatigue, reduced activity levels and school and work absenteeism, notes the WHO.

“Some extended family and friends have given me lots of native medicine to cure this disease but none have proved very effective. One native doctor said I am failing to get well because this is not asthma, rather I was bewitched,” Talimba tells. She rarely goes to the nearest health facility to collect medication as there is always shortage of the drugs. “I am forced to use native medicine, which helps me slightly to feel better when I have an attack. I don’t know what they are made of.” There are wide spread misconceptions about asthma in most parts of Malawi and very few are mindful of the triggers, such as firewood smoke, which people living with asthma like Talimba  are exposed to on a daily basis. A Ministry of Health spokesperson Adrian Chikumbe says asthma is a serious public health problem in Malawi and it leads to absenteeism from school or work. “People are dying of asthma but we cannot quantify it as some deaths are not recorded in the hospitals. We feel there is a need to do a study on the same in the country,” he admits.

Chikumbe says that his Ministry took a huge step in terms of public awareness and management and last year it launched a project to train health workers on how to manage asthma and other Non-Communicable Diseases (NCDs), adding that, “We have also empowered Health Surveillance Assistants (HSAs) who are responsible for community awareness.” He However agrees that the Ministry’s health facilities sometimes run out of drugs. Chikumbe also blames patients for perpetuating the problem as they report late to a health facility. “There is also an inability by health workers to manage the condition. This is the Ministry’s major challenge, and that is why we are training them on management of the disease,” he confesses. Doctor Jeremia Chakaya Muhwa of Forum of international Respiratory Societies and a member of Board of Directors at the International Union against Tuberculosis and Lung Disease (The Union) calls asthma a chronic, persistent and incurable disease, which is under diagnosed and under treated.

“Even though asthma does not kill so much as many other NCDs, it is not an illness that can be ignored. It has social and psychological effects— I have seen marriages break up because of this. One may also not be able to participate in physical activities. It is an economic burden too, as one lives with it for the rest of their lives,” he said in his presentation during a recent webinar organised by Citizen News Service (CNS) and the Union. Dr Muhwa highlighted that the disease is a ‘double tragedy for the poor’ and its adverse effects are magnified in the poor and vulnerable populations. The strongest risk factors for developing asthma are a combination of genetic predisposition of a person with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways, such as indoor allergens (bio-mass smoke, house dust mites in bedding, carpets and stuffed furniture, pollution and pet dander), outdoor allergens (such as pollens and moulds), tobacco smoke, chemical irritants in the workplace and air pollution.

Priya Kanayson of NCD Alliance points out that air pollution is a leading factor for asthma and other non communicable diseases (NCDs), and that current energy use of fossil fuels contributes to asthma. “Rapid urbanization is also linked to rising asthma rates,” she says, recommending the use of clean cook stoves, reduction of fossil fuels and transition to renewable energy as the solution. The Sustainable Development Goals 2030 (SDGs), which were launched in 2015, target to reduce by 2030, premature mortality from NCDs   by one third through prevention and treatment and by promoting well-being. If this is achieved, millions of impoverished people, like Talimba, will have better health care and medication.

Facts about Asthma

  • An estimated over 300 million people currently suffer from asthma
  • Asthma is the most common NCD disease among children
  • Asthma occurs in all countries regardless of the level of development
  • Asthma cannot be cured, but with proper management, people living with it can lead a normal life
  • Asthma is under-diagnosed and under-treated. It creates substantial burden to individuals and families and often restricts individuals’ activities for a lifetime

Josephine Chinele, Citizen News Service - CNS
May 4, 2016