Quality of Asthma Care: Western Cape Province, South Africa (Original Articles) (Clinical Report‪)‬

Asthma is the eighth leading contributor to the burden of disease in South Africa and is the second most important chronic disease after HIV/AIDS. (1) Asthma is often not considered particularly serious, but it causes significant morbidity in young and working-age adults that adds to the number of disability-adjusted life years (DALYs) in relation to other chronic diseases. The prevalence of recent wheeze in adults is reported as 14.4% in males and 17.6% in females, with a self-reported prevalence of asthma of 3.7% and 3.8% respectively. (2) In the Western Cape the prevalence of asthma among children aged 13-14 years was 14.4%, slightly above the global average of 13.7%. (3,4) The prevalence of asthma in children is rising in sub-Saharan Africa. (3) Access to essential drugs for asthma, including inhaled steroids, is better in South Africa than in other sub-Saharan countries. Because of the overwhelming HIV/AIDS epidemic and the primary health care services focus on acute episodic conditions, chronic asthma has not received priority attention. The South African Thoracic Society published new guidelines for chronic asthma in adults and adolescents (5) and funded a multifaceted dissemination and implementation strategy in the Western Cape. (6) The Asthma Guidelines Implementation Project (AGIP) developed an audit tool to assist primary care facilities with quality assessment and improvement. It aimed to elicit reflection on the quality of care and to plan improvements at facility level. As the first evaluation of the quality of asthma care at provincial level in South Africa it sets a benchmark for future audits and gives valuable insights into asthma care. As the Western Cape is better resourced than other provinces its quality of asthma care is likely to be better than elsewhere.