Asthma in African children and adolescents: Burden, barriers, and management strategies
Article Sidebar
Main Article Content
Abstract
Background. Asthma is the leading chronic disease in African children and adolescents, yet remains underdiagnosed and poorly managed. Asthma in Africa has been associated with higher mortality rates compared with high-income countries. Barriers to asthma control in African children and adolescents are lack of accurate diagnosis, limited access to inhaled therapy, lack of knowledge about asthma, and poor air quality.
Objectives. To review the asthma burden, risk factors, barriers to care and management strategies in an African setting.
Methods. A narrative review of peer-reviewed literature from 1990 to 2024 was conducted using PubMed, global asthma guidelines, Global Initiative for Asthma, Scopus, Google Scholar and African Journals Online.
Results. The prevalence of asthma is rising, with urban-rural disparities and multifactorial risk profiles. Barriers to control include poor access to diagnostics, underutilisation of inhaled corticosteroids, and limited education.
Conclusion. A multisectoral approach is needed to improve asthma care, including adaptation, education, and access to essential medicines.
Downloads
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors retain copyright and grant the journal right of first publication.
How to Cite
References
1. Global Initiative for Asthma. 2023 GINA Report, Global Strategy for Asthma Management and Prevention. https://ginasthma.org/2023-gina-main-report/ (accessed 27 February 2026).
2. Faniyi AA, Okesanya OJ, Nukpezah RN, et al. Addressing the asthma crisis in Africa: Challenges, strategies, and recommendations for improved management. Egypt J Intern Med 2024;36:76. https://doi.org/10.1186/s43162-024-00340-6
3. Mphahlele RE, Kitchin O, Masekela R. Barriers and determinants of asthma control in children and adolescents in Africa: A systematic review. BMJ Open 2021;11(10):e053100. https://doi.org/10.1136/bmjopen-2021-053100
4. Mash B, Rhode H, Pather M, et al. Quality of asthma care: Western Cape province, South Africa. S Afr Med J 2009;99(12):892-896.
5. DusserD,MontaniD,ChanezP,etal.Mildasthma:Anexpertreviewonepidemiology, clinical characteristics and treatment recommendations. Allergy 2007;62(6):591-604. https://doi.org/10.1111/j.1398-9995.2007.01394.x
6. Abrams EM, Becker AB, Szefler SJ. Paradigm shift in asthma therapy for adolescents: Should it apply to younger children as well? JAMA Pediatr 2020;174(3):227-228. https://doi.org/10.1001/jamapediatrics.2019.5214
7. ChungKF,WenzelSE,BrozekJL,etal.InternationalERS/ATSguidelinesondefinition, evaluation and treatment of severe asthma. Eur Respir J 2014;43(2):343-373. https:// doi.org/10.1183/09031936.00202013
8. Lai CK, Beasley R, Crane J, et al.; International Study of Asthma and Allergies in Childhood Phase Three Study Group. Global variation in the prevalence and severity of asthma symptoms: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax 2009;64(6):476-483. https://doi.org/10.1136/ thx.2008.106609
9. Adeloye D, Chan KY, Rudan I, Campbell H. An estimate of asthma prevalence in Africa: A systematic analysis. Croat Med J 2013;54(6):519-531. https://doi. org/10.3325/cmj.2013.54.519
10. Refiloe M, Kevin M, Rebecca N, et al. Asthma care in sub-Saharan Africa: Mind the gap! J Pan Afr Thorac Soc 2022;3(2):59-62. https://doi.org/10.25259/JPATS_12_2022
11. 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(10311):1569-1580. https://doi.org/10.1016/S0140- 6736(21)01450-1
12. Ahmed R, Robinson R, Mortimer K. The epidemiology of noncommunicable respiratory disease in sub-Saharan Africa, the Middle East, and North Africa. Malawi Med J 2017;29(2):203-211. https://doi.org/10.4314/mmj.v29i2.24
13. Alansari D, Mirza TA. Assessment of asthma control among asthmatic patients at primary healthcare centers in Makkah, Saudi Arabia. Cureus 2020;12(10):e11103. https://doi.org/10.7759/cureus.11103
14. Mallol J, Crane J, von Mutius E, et al. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: A global synthesis. Allergol Immunopathol (Madr) 2013;41(2):73-85. https://doi.org/10.1016/j.aller.2012.03.001
15. Zeitouni MO, Al-Moamary MS, Coussa ML, et al. Challenges and recommendations for the management of asthma in the Middle East and Africa. Ann Thorac Med 2022;17(2):71-80. https://doi.org/10.4103/atm.atm_469_21
16. Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/ European Respiratory Society statement: Asthma control and exacerbations: Standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009;180(1):59-99. https://doi.org/10.1164/rccm.200801-060ST
17. Soto-Martínez ME, Soto-Quiros ME, Custovic A. Childhood asthma: Low and middle-income countries perspective. Acta Med Acad 2020;49(2):181-190. https:// doi.org/10.5644/ama2006-124.296
18. Masekela R, Gray CL, Green RJ, et al. The increasing burden of asthma in South African children: A call to action. S Afr Med J 2018;108(7):537-539. https://doi. org/10.7196/SAMJ.2018.v108i7.13162
19. Weinberg EG. Urbanisation and childhood asthma: An African perspective. J Allergy Clin Immunol 2000;105(2 Pt 1):224-231. https://doi.org/10.1016/s0091- 6749(00)90069-1Rodriguez A, Brickley E, Rodrigues L, et al. Urbanisation and asthma in low-income and middle-income countries: A systematic review of the urban- rural differences in asthma prevalence. Thorax 2019;74(11):1020-1030. https://doi. org/10.1136/thoraxjnl-2018-211793
20. Baard CB, Franckling-Smith Z, Munro J, Workman L, Zar HJ. Asthma in South African adolescents: A time trend and risk factor analysis over two decades. ERJ Open Res 2021;7(2):00576-2020. https://doi.org/10.1183/23120541.00576-2020
21. Calvert J, Burney P. Effect of body mass on exercise-induced bronchospasm and atopy in African children. J Allergy Clin Immunol 2005;116(4):773-779. https://doi. org/10.1016/j.jaci.2005.05.025
22. DesaluOO,AdeotiAO,OjuawoOB,etal.Urban-ruraldifferencesintheepidemiology of asthma and allergies in Nigeria: A population-based study. J Asthma Allergy 2021;14:1389-1397. https://doi.org/10.2147/JAA.S333133
23. Keeley DJ, Neill P, Gallivan S. Comparison of the prevalence of reversible airways obstruction in rural and urban Zimbabwean children. Thorax 1991;46(8):549-553. https://doi.org/10.1136/thx.46.8.549
24. Mphahlele R, Lesosky M, Masekela R. Prevalence, severity and risk factors for asthma in school-going adolescents in KwaZulu Natal, South Africa. BMJ Open Respir Res 2023;10(1):e001498. https://doi.org/10.1136/bmjresp-2022-001498
25. Mpairwe H, Namutebi M, Nkurunungi G, et al. Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda. eLife 2019;8:e49496. https://doi.org/10.7554/eLife.49496
26. Nantanda R, Ostergaard MS, Ndeezi G, Tumwine JK Factors associated with asthma among under-fives in Mulago hospital, Kampala Uganda: A cross-sectional study. BMC Pediatr 2013;13:141. https://doi.org/10.1186/1471-2431-13-141
27. Cruz ÁA, Stelmach R, Ponte EV. Asthma prevalence and severity in low-resource communities. Curr Opin Allergy Clin Immunol 2017;17(3):188-193. https://doi. org/10.1097/ACI.0000000000000360
28. Addo-Yobo EOD, Custovic A, Taggart SCO, Craven M, Bonnie B, Woodcock A. Risk factors for asthma in urban Ghana. J Allergy Clin Immunol 2001;108(3):363-168. https://doi.org/10.1067/mai.2001.117464
29. Lim S, Said B, Zurba L, et al. Characterising sources of PM2·5 exposure for school children with asthma: A personal exposure study across six cities in sub-Saharan Africa. Lancet Child Adolesc Health 2024;8(1):17-27. https://doi.org/10.1016/S2352- 4642(23)00261-4
30. OlandAA,BoosterGD,BenderBG.Psychologicalandlifestyleriskfactorsforasthma exacerbations and morbidity in children. World Allergy Organ J 2017;10(1):35. https://doi.org/10.1186/s40413-017-0169-9
31. Kumar RK, Hitchins MP, Foster PS. Epigenetic changes in childhood asthma. Dis Model Mech 2009;2(11-12):549-553. https://doi.org/10.1242/dmm.001719
32. Thomsen SF. Genetics of asthma: An introduction for the clinician. Eur Clin Respir J 2015;2. https://doi.org/10.3402/ecrj.v2.24643
33. Iraqi B, Mahraoui C. Evaluation of asthma control among children in the Maghreb and sub-Saharan Africa. Eur Respir J 2016;48(Suppl 60):PA4382. https://doi. org/10.1183/13993003.congress-2016.PA4382
34. Asthma Control Test. https://www.asthmacontroltest.com/en-gb/welcome/ (accessed 27 February 2026).
35. Asthma Control Questionnaire. chrome-extension:// efaidnbmnnnibpcajpcglclefindmkaj/ https://media.mycme.com/documents/171/ w16-11_asthma_q_42563.pdf (accessed 26 June 2025).
36. Tarraf H, Al-Jahdali H, Al Qaseer AH, et al. Asthma control in adults in the Middle East and North Africa: Results from the ESMAA study. Respir Med 2018;138:64-73. https://doi.org/10.1016/j.rmed.2018.03.024
37. The Global Asthma Report 2018. https://www.globalasthmareport.org/2018/index. html (accessed 28 April 2025).
38. Oyenuga VO, Mosler G, Addo-Yobo E, et al. Asthma symptoms, severity, and control with and without a clinical diagnosis of asthma in early adolescence in sub-Saharan Africa: A multi-country, school-based, cross-sectional study. Lancet Child Adolesc Health 2024;8(12):859-871. https://doi.org/10.1016/S2352-4642(24)00232-3
39. Akinso O, Adhikari A, Yin J, Chopak-Foss J, Shah G. Childhood asthma-management practices in rural Nigeria: Exploring the knowledge, attitude, and practice of caregivers in Oyo State. Children (Basel) 2023;10(6):1043. https://doi.org/10.3390/ children10061043
40. Taiwo I. Asthma in African children: Causes, symptoms and care. DatelineHealthAfrica, 2024. https://www.datelinehealthafrica.org/asthma-in-african-children-causes- symptoms-and-care (accessed 31 August 2025).
41. Jayasooriya S, Stolbrink M, Khoo EM, et al. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis 2023;27(9):658-667. https://doi.org/10.5588/ijtld.23.0203
42. Ojo OT, Ajibare AO, Odeyemi A, Fapohunda T, Adeyeye OO. Clinical utility of peak flow meter in asthma diagnosis and monitoring in low- and middle-income countries: A narrative review. Int J Med Health Dev 2023;28(2):87-92. https://doi.org/10.4103/ ijmh.IJMH_4_23
43. Masekela R, Zurba L, Gray D. Dealing with access to spirometry in Africa: A commentary on challenges and solutions. Int J Environ Res Public Health 2018;16(1):62. https://doi.org/10.3390/ijerph16010062
44. Vanjare N, Chhowala S, Madas S, et al. Use of spirometry among chest physicians and primary care physicians in India. NPJ Prim Care Respir Med 2016;26:16036. https:// doi.org/10.1038/npjpcrm.2016.36
45. Levy ML. Is spirometry essential in diagnosing asthma? No. Br J Gen Pract 2016;66(650):485. https://doi.org/10.3399/bjgp16X686965
46. Yang CL, Simons E, Foty RG, Subbarao P, To T, Dell SD. Misdiagnosis of asthma in schoolchildren. Pediatr Pulmonol 2017;52(3):293-302. https://doi.org/10.1002/ ppul.23541
47. Looijmans-van den Akker I, van Luijn K, Verheij T. Overdiagnosis of asthma in children in primary care: A retrospective analysis. Br J Gen Pract 2016;66(644):e152-e157. https://doi.org/10.3399/bjgp16X683965
48. Masekela R, Risenga SM, Kitchin OP, et al. The diagnosis of asthma in children: An evidence-based approach to a common clinical dilemma. S Afr Med J 2018;108(7):540-545. https://doi.org/10.7196/SAMJ.2018.v108i7.13165
49. Nantanda R, Tumwine JK, Ndeezi G, Ostergaard MS. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda: Evidence of under-diagnosis of asthma. PLoS ONE 2013;8(11):e81562. https://doi.org/10.1371/journal.pone.0081562
50. Olaniyan T, Dalvie MA, Röösli M, et al. Asthma-related outcomes associated with indoor air pollutants among schoolchildren from four informal settlements in two municipalities in the Western Cape Province of South Africa. Indoor Air 2019;29(1):89-100. https://doi.org/10.1111/ina.12511
51. Zar HJ, Levin ME. Challenges in treating pediatric asthma in developing countries. Paediatr Drugs 2012;14(6):353-359. https://doi.org/10.2165/11597420-000000000-00000
52. Oluwole O, Rennie DC, Senthilselvan A, et al. Asthma diagnosis among children along an urban-rural gradient. J Asthma 2018;55(11):1242-1252. https://doi.org/10
.1080/02770903.2017.1407335
53. Masekela R. Paediatric asthma in South Africa: A case of hunger in times of plenty. S Afr Med J 2018;108(7):536. https://doi.org/10.7196/SAMJ.2018.v108i7.13387
54. Salvi S, Madas S, Ghorpade D, Gadhave S, Barne M. Is underuse of inhaled corticosteroids for asthma in India contributing to 42% of global asthma deaths? Lung India 2022;39(4):331-336. https://doi.org/10.4103/lungindia.lungindia_600_21
55. Magwenzi P, Rusakaniko S, Sibanda EN, Gumbo FZ. Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub-Saharan Africa. Respir Res 2022;23(1):254. https://doi.org/10.1186/s12931- 022-02170-y
56. Naidoo KL, Dladla S, Mphahlele RE, et al. Barriers to childhood asthma care in sub- Saharan Africa: A multicountry qualitative study with children and their caregivers. BMJ Open 2023;13(9):e070784. https://doi.org/10.1136/bmjopen-2022-070784
57. Naidoo KL, Dladla S, Mphahlele RE, et al. A cross-country qualitative analysis of teachers’ perceptions of asthma care in sub-Saharan Africa. NPJ Prim Care Respir Med 2023;33(1):31. https://doi.org/10.1038/s41533-023-00354-7
58. Stolbrink M, Thomson H, Hadfield RM, et al. The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: A systematic review. Lancet Glob Health 2022;10(10):e1423-e1442. https:// doi.org/10.1016/S2214-109X(22)00330-8
59. Tadesse S, Beyene Z. Contributing factors for underutilisation of inhaled corticosteroids among asthmatic patients attending at Adama Hospital Medical College, Adama, Ethiopia. J Asthma Allergy 2020;13:333-341. https://doi.org/10.2147/ JAA.S264119k
60. Forum of International Respiratory Societies. https://firsnet.org/ (accessed 25 June 2025).
61. Meghji J, Mortimer K, Agusti A, et al. Improving lung health in low-income and middle-income countries: From challenges to solutions. Lancet 2021;397(10277):928- 940. https://doi.org/10.1016/S0140-6736(21)00458-X
62. World Health Organization. Regional framework for integrating essential noncommunicable disease services in primary health care. Report of the Secretariat, Regional Committee for Africa. 14 June 2017. https://www.afro.who.int/sites/default/ files/2017-08/AFR-RC67-12%20Regional%20framework%20to%20integrate%20 NCDs%20in%20PHC.pdf (accessed 17 September 2025).
63. Mosler G, Oyenuga V, Addo-Yobo E, et al. Achieving control of asthma in children in Africa (ACACIA): Protocol of an observational study of children’s lung health in six sub-Saharan African countries. BMJ Open 2020;10(3):e035885. https://doi. org/10.1136/bmjopen-2019-035885
64. Stolbrink M, Chinouya MJ, Jayasooriya S, et al. Improving access to affordable quality- assured inhaled medicines in low- and middle-income countries. Int J Tuberc Lung Dis 2022;26(11):1023-1032. https://doi.org/10.5588/ijtld.22.0270
65. Rylance S, Masekela R, Banda NPK, Mortimer K. Determinants of lung health across the life course in sub-Saharan Africa. Int J Tuberc Lung Dis 2020;24(9):892-901. https://doi.org/10.5588/ijtld.20.0083