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Neglected asthma burden

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Despite being asthmatic, Talimba, cooks using firewood which produces a lot of smoke everyday.

She does not have any affordable alternative source of energy.

“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 I can afford,” says Talimba who is looking after her two siblings.

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The 20-year old dropped out of school to assume the responsibility of looking after the household. The daily exposure to the firewood smoke triggers her asthma.

World Health Organisation (WHO) describes asthma as a chronic disease characterised 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, it becomes worse during physical activity or at night, says the WHO.

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“Some extended family and friends have given me lots of native medicine to cure this disease but none has worked. One native doctor said I’m failing to get well because this is not asthma but I was bewitched,” Talimba tells.

She rarely goes to the nearest health facility to collect medication as there is short of the drugs, “I’m forced to use native medicine, which helps me to feel better. I don’t know what they are made of but they make me feel better each time I have an attack.”

This is a wide spread perception of asthma in most parts of Malawi as very few people care of the triggers such as firewood smoke which people living with asthma like Talimba are exposed to on daily basis.

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 as a country as some deaths are not recorded in the hospitals. We feel there is need to do a study on the same in the country,” he admits.

Chikumbe however says the ministry has taken a huge step in terms of public awareness and management as it last year launched a project to train health workers on how to manage asthma and other Non-Communicable Diseases (NCDs), adding: “We have also empowered Health Surveillance Assistants (HSAs) who are responsible for community awareness.”

He agrees with Talimba that the ministry’s health facilities sometimes run out of drugs.

Chikumbe also blames patients for perpetuating the problem as they report late to the facilities.

“There is also inability by health workers to manage the condition. This is the ministry’s major challenge that’s why we are training them on management of the disease,” he confesses.

Kenyan based Doctor Jeremia Muhwa of Forum of international Respiratory Societies and a member of Directors, International Union against Tuberculosis and Lung Disease (The Union) says asthma is a chronic persistent incurable disease which is under diagnosed and under treated.

“Asthma doesn’t kill as many other NCDs. It’s not a minor illness as it is ignored. It has social effects; I have seen marriages break up because of this.

“It has psychological effects, one may not be able to participate in physical activities and economic burden as one lives with it for the rest of their lives,” he said in his presentation document titled: Bronchial Asthma: A Public Health Problem Needs a Public Health Response.

Dr Muhwa highlighted that the disease is magnified in the poor vulnerable populations describing it as “a double tragedy for the poor”.

He stressed that the disease is easy to diagnose and equally easy to treat as the under diagnosis and treatment are largely due to “neglect”.

WHO explains that during an asthma attack, the lining of the bronchial tubes swell, causing the airways to narrow and reducing the flow of air into and out of the lungs.

Recurrent asthma symptoms frequently cause sleeplessness, daytime fatigue, reduced activity levels, school and work absenteeism, notes the WHO.

According to the WHO the fundamental causes of asthma are not completely understood.

The strongest risk factors for developing asthma are a combination of genetic predisposition with environmental exposure to inhaled substances and particles that may provoke allergic reactions or irritate the airways, such as indoor allergens (for example, 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 NCDs saying the current energy use of fossil fuels contributes to Asthma.

“Rapid urbanisation is also linked to rising asthma rates,” she says recommending the use of clean cook stoves, reduction on fossil fuels and transition of renewable energy as the solution.

The Sustainable Development Goals (SDGs) (which were launched in September 2015) target to reduce by one third of premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being by 2030.

If this is achieved impoverished and vulnerable people like Talimba will have better health care and medication. Every Tuesday of May is World Asthma day and last Tuesday, Malawi silently joined the rest of the world to commemorate this day.

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