Spectrum of Factors

The asthma epidemic among children in Matara has three roots:  the disease prevalence is under-recognized, asthma education is poor, and asthma is not being properly treated in the outpatient or inpatient settings. 

Pre-Hospital Factors -  general lack of understanding and recognition of the disease

Environment

1. Industrialization and development in the Matara region, a growing economic hub
2. Improved insulation of living conditions (traps mice dust)

Culture / Education

1. Community awareness of asthma is poor
2. “Wheezing” an early sign of asthma is not recognized by parents and therefore the disease is not identified early
3. Cultural stigma on use of inhalers – as a result, children, who have been identified with asthma, do not use them

 Access

1. Medications - Inhalers are available, however, they are not used properly
2. Rural clinics are not adequately outfitted to treat minor, outpatient symptoms of asthma

Hospital Factors - poorly trained personnel and insufficient resources to effectively manage asthma

Layout

1. Overcrowded, unsanitary conditions
2. Open, disorganized general units (no disease-specific units) without haphazard arrangement of supplies and equipment
3. No isolation units for patients with infectious diseases

Services

1. No dedicated pediatric intensive care unit (PICU) to treat severe asthma exacerbations requiring ventilator support

 Medical Training

1. Nursing and respiratory staff are not adequately trained to obtain arterial blood gases, a necessary tool in the armamentarium to manage asthma and respiratory diseases

• Clinical Pathways:
• Physicians do not follow evidence-proven protocols in managing asthma leading to inconsistent and suboptimal outcomes