Authors : Dr. Deepak Raj Paudel; Dr. Ram Hari Chapagain; Dr. Anil Kumar Shrestha; Dr. Dipak Kumar Gupta; Dr. Amrita Ghimire; Dr. Dinesh Kumar Lamsal; Gita Devi Ghimire

Volume/Issue : Volume 9 - 2024, Issue 9 - September

Google Scholar : https://tinyurl.com/2zrh76zz

Scribd : https://tinyurl.com/mr3h3kmv

DOI : https://doi.org/10.38124/ijisrt/IJISRT24SEP802

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Introduction: Effective pediatric asthma management relies on the proper utilization of Metered Dose Inhalers (MDIs), yet multiple barriers can hinder this. This study aims to identify and assess the key barriers to MDI utilization in pediatric asthma management in both urban and rural settings of Gandaki Province, Nepal.  Methods: A cross-sectional study was conducted with 171 pediatric asthma patients. Data were collected through structured questionnaires, examining educational, economic, healthcare infrastructure, cultural, social, and technical barriers. The association between residence (urban vs. rural) and these barriers was analyzed using Chi-square tests.  Results: The study sample consisted of 53% children aged 1- 5 years, 64.9% males, and 59.6% from urban areas. Educational barriers were prevalent, with 27.5% of participants lacking knowledge of MDI use and 28.1% having no formal education on childhood asthma and MDIs. Economic barriers, particularly limited health insurance coverage (28.1%) and high costs of inhalers (24.0%), were prominent in both settings. Rural areas faced greater challenges with healthcare infrastructure, including lack of availability of MDIs (22.8%), long distances to healthcare facilities (18.7%), and limited access to specialized care (18.7%). Cultural factors, such as preference for traditional medicine (16.4%), were also more significant in rural areas. Chi-square analysis revealed significant differences between urban and rural areas for several barriers, including inadequate knowledge of MDI use (p=0.024), difficulty affording regular usage (p=0.038), lack of availability of MDIs (p=0.001), long distances to healthcare (p=0.0006), and preference for traditional medicine (p=0.009).  Conclusions: Rural populations face more pronounced barriers to MDI utilization, particularly regarding healthcare access and cultural preferences. Tailored interventions addressing both economic and infrastructural issues in rural areas, along with educational programs in both urban and rural settings, are necessary to improve pediatric asthma management.

Keywords : Pediatric Asthma, Barriers, Rural Healthcare, Urban Healthcare, Healthcare Infrastructure, Cultural Factors, Economic Barriers.

References :

1. Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. 2023.
2. World Health Organization (WHO). Asthma. Fact Sheet. 2021.
3. Sharma AK, Thapa SB, Basnet S. Prevalence of Asthma, Eczema and Allergic Rhinitis Symptoms in School Children of Kathmandu Valley: Results of a Questionnaire Survey. J Nepal Paediatr Soc 2018;38(3):163-9.
4. Mortimer K, Reddel HK, Pitrez PM, et al. Asthma management in low and middle income countries: case for change. Eur Respir J 2022; 60: 2103179 [DOI: 10.1183/13993003.03179-2021].
5. GBD 2019 Diseases and Injuries Collaborators. Global Burden of Disease Study 2019. Lancet. 2020.
6. Bhattarai S, Bhattarai S, Gaurav K, et al. Prevalence of Asthma and Associated Factors in Nepal. J Nepal Health Res Counc. 2021.
7. Koirala GP, et al. Asthma Management in Gandaki Province. Respir Med. 2022.
8. Vanker A, Barnett W, et al. Environmental and Socioeconomic Factors Associated with Childhood Asthma in LMICs. Pediatr Pulmonol. 2021.
9. Asher MI, Rutter CE, Bissell K, et al. Worldwide trends in the burden of asthma symptoms in school-aged children: Global Asthma Network Phase I cross-sectional study. Lancet 2021; 398: 1569–1580
10. Singh D, et al. Pediatric Asthma: Challenges in Low-Resource Settings. Asian Pac J Allergy Immunol. 2019.
11. Kandel P, et al. Utilization of MDIs in Pediatric Asthma in Nepal. J Respir Med. 2022.
12. Mehta RS, et al. Technical Challenges in MDI Use in Pediatric Asthma. J Clin Pediatr. 2019.
13. Shrestha S, et al. Factors Influencing Asthma Control in Nepali Children. Pediatr Allergy Immunol. 2020.
14. Vyas M, et al. Economic Impact of Childhood Asthma in South Asia. Health Econ Policy Law. 2021.
15. Tackett AP, Farrow M, Kopel SJ, Coutinho MT, Koinis-Mitchell D, McQuaid EL. Racial/ethnic differences in pediatric asthma management: the importance of asthma knowledge, symptom assessment, and family-provider collaboration. J. Asthma. 2021; 58(10), 1395-1406
16. Soto-Martínez ME, Soto-Quiros ME, Custovic A. Childhood asthma: low and middle-income countries perspective. Acta Med Acad 2020; 49: 181–190.
17. Lakhanpaul M, Bird D, Manikam L, et al. A systematic review of explanatory factors of barriers and facilitators to improving asthma management in South Asian children. BMC Public Health 2014; 14: 403.
18. Gupta P, et al. Cultural Perceptions of Asthma in South Asia. South Asian J Med. 2020.
19. Khatri D, et al. Financial Barriers to Asthma Treatment in Nepal. Health Policy. 2020.
20. Joshi A, et al. Healthcare Barriers in Rural Nepal: A Study on Asthma Care. Nepal J Health Sci. 2019.
21. Tiwari D, et al. Healthcare Access in Nepal and Its Impact on Asthma Management. J Trop Med. 2021.
22. Pradhan B, et al. Economic Burden of Asthma in Nepal. Health Econ Rev. 2020.
23. Jha R, et al. Asthma Education in Nepal: Current Gaps and Future Directions. J Nepal Med Assoc. 2021.
24. Lee JH, et al. Barriers to Effective Asthma Management in Low-Income Countries. BMC Pulm Med. 2020.
25. World Bank. Health Insurance in Nepal: Current Challenges. 2021.
26. Devkota B, et al. Accessibility of Respiratory Medications in Nepal. J Pharm Pract. 2021.
27. Nepal Ministry of Health. National Guidelines for Asthma Management. 2020.
28. McDonald K, et al. Educational Interventions to Improve Asthma Outcomes in LMICs. Cochrane Database Syst Rev. 2019.