Nigeria
Poverty, inadequate resources, weak health systems, and poor infrastructure hamper asthma management.
Challenges in the management of bronchial asthma in Nigeria include poverty, inadequate resources, weak health systems, and poor infrastructure. In the last few decades, different therapeutic regimens and approaches have been employed in treating Nigerian people with asthma.
Guideline
To streamline various treatment plans among healthcare practitioners, the Nigerian Thoracic Society launched the National Guideline for Asthma Management in Nigeria on 2 May 2017 (Figure). The guideline serves as a reference document for healthcare providers and other stakeholders. There is a plan to systematically evaluate the adoption of the guideline among healthcare practitioners in Nigeria, and determine its impact on reducing asthma morbidity and mortality.
Access to medicines
The challenges which some centres in Nigeria face with access to medicines:
- The cost of asthma medicines, particularly inhaled corticosteroid (ICS), is prohibitive because up to 70.2% of Nigerians live on less than US$1.00 per day and they have to pay for their healthcare, as they have no insurance coverage.
- ICS, either in the form of pressurised metered dose inhalers or nebules for delivery through a nebuliser, are not commonly available. The consequence is that all patients needing ICS are given combination drugs (ICS with longacting β2-agonists (LABA)), when some could be effectively managed with ICS alone.
- In under-5 children the combination ICS/LABA inhaled medicine is not considered safe, yet ICS is largely unavailable in Nigeria. Therefore in those who would otherwise be prescribed ICS alone, leukotriene modifiers are employed. However, a proportion of them report side effects necessitating discontinuation.
- Ipratropium bromide has not been available in the last several months.
Priorities
Asthma diagnostic facilities are essential at all levels of care in Nigeria, and the government should provide them. It is urgently desirable to subsidise asthma medicines in Nigeria, as only a few Nigerians are enrolled in the National Health Insurance Scheme. More importantly, Nigeria urgently needs to improve the availability of ICS for asthma patients.
