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Rates of asthma exacerbations and mortality and associated factors in Uganda: a 2-year prospective cohort study
  1. Bruce J Kirenga1,2,
  2. Corina de Jong3,4,
  3. Levicatus Mugenyi1,5,
  4. Winceslaus Katagira2,
  5. Abdallah Muhofa2,
  6. Moses R Kamya1,
  7. H Marike Boezen6,
  8. Thys van der Molen3,4
  1. 1Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
  2. 2Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
  3. 3GRIAC-Primary Care, Department of General Practice and Elderly Care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
  4. 4Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
  5. 5Center for Statistics, Interuniversity Institute for Biostatistics, and Statistical Bioinformatics, Hasselt University (UHasselt), Groningen, The Netherlands
  6. 6Department of Epidemiology, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Bruce J Kirenga, Makerere University Lung Institute, Mulago Hospital, Kampala 7072, Uganda; brucekirenga{at}yahoo.co.uk

Abstract

Data on asthma treatment outcomes in Africa are limited. 449 patients with asthma (age 5–93 years) in Uganda were followed up for 2 years to determine rates of exacerbations and mortality and associated factors. During follow-up the median number of exacerbations per patient was 1 (IQR 0–5) and 17 patients died (3.7%, 27.3 deaths per 1000 person years). Considering only the first year of follow-up, 59.6% of the patients experienced at least one exacerbation, 32.4% experienced three or more exacerbations. A multivariable model showed that the likelihood of experiencing at least one exacerbation in the first year of follow-up was lower with better baseline asthma control (higher asthma control test (ACT) score), with OR 0.87 (95% CI: 0.82 to 0.93, P=0.000), and was higher with more exacerbations in the year prior to enrolment (OR for log number of exacerbations 1.28, 95% CI: 1.04 to 1.57, P=0.018). Better asthma control (OR 0.93, 95% CI: 0.88 to 0.99, P=0.021) and number of baseline exacerbations (OR 1.35,95% CI: 1.11 to 1.66, P=0.005) were also the only factors that were independently associated with experiencing three or more exacerbations during the first year of follow-up. The only factor found to be associated with all-cause mortality was FEV1, with higher recent FEV1 associated with lower all-cause mortality (OR 0.30, 95% CI: 0.14 to 0.65; P=0.002). Rates of asthma exacerbations and mortality are high in Uganda and are associated with poor asthma control. Health systems should be strengthened to care for asthma patients.

  • asthma
  • asthma epidemiology

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Footnotes

  • Contributors BJK conceived the idea of the project and wrote the initial proposal. TvdM, MRK and HMB critically advised the writing of the proposal. CdJ and LM supported data analysis. WK and AM performed patients' clinical reviews. All authors critically reviewed and contributed to manuscript writing.

  • Funding This study was funded by the GSK’s Trust In Science Africa Project.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Mulago Hospital Research and Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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