Factors contributing to prevalence of bronchial asthma in old age people living in Wadajir district- Mogadishu –Somalia

 

BY

Abdirahman Moalim Hassan Ibrahim

(Reg No: HKMHSM 00713)

(Bsc. In General Nursing, MU)

 

PROPOSAL PRESENTED TO THE GRADUATE SCHOOL IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR AWARD OF THE MASTERS DEGREE OF HEALTH SERVICE MANAGEMENT.

 

 

KAMPALA UNIVERSITY

 

 

 

 

July, 2015

 

Chapter One:  Introduction

1.0 Background

Asthma is a chronic inflammatory disease characterized by hyper-responsiveness of airways to various stimuli. This complex disease affects patients of all ages.

The prevalence of asthma in adults age 65 and older is estimated at 4 to 8 percent. Although asthma has an equal incidence across all age groups, asthma in the elderly is often under diagnosed and undertreated. Over the past 40 years, the incidence rate of asthma has increased across all age groups. The incidence rate of asthma in adults older than 65 years is similar to that found in other age groups.

Asthma is common in adults over age 65; it substantially reduces both psychological and physical quality of life among older adults. Some experts distinguish two categories of asthma in older adults. The first category comprises older patients whose typical symptoms of asthma developed in childhood or early adulthood and persisted through later life. Normal lung function is usually interspersed with intermittent periods of airflow obstruction, although chronic airway remodeling may lead to airflow limitation that does not fully reverse. The second category, which is less common, comprises patients who first develop new symptoms of asthma as older adults. The diagnosis in the first category is usually reasonably clear. The diagnosis in the second category may be challenging due to the higher incidence of COPD and the longer list of differential diagnoses.

 

1.1 Background of the subject

Bronchial asthma is a condition of the lungs characterized by widespread narrowing of the airways due to spasm of the smooth muscle, oedema of the mucosa, and the presence of mucus in the lumen of the bronchi and bronchioles. It is caused by the local release of spasmogensvasoactive substances in the course of an allergic reaction.

Causes Asthma can be classified into three types according to causative factors. Allergic or atopic asthma (sometimes called extrinsic asthma) is due to an allergy to antigens; usually the offending allergens are suspended in the air in the form of pollen, dust, smoke, automobile exhaust, or animal dander.

Symptoms. Typically, an attack of asthma is characterized by dyspnea and a wheezing type of respiration. The patient usually assumes a classic sitting position, leaning forward so as to use all the accessory muscles of respiration.

1.2 Problem statement and justification of the study

• First The major problem that compelled me to make research about the prevalence of precipitating factor of bronchial asthma in  old age people live in wadajir  district is to educate the people and enhance awareness of its complication among the community living in wadajir district especially old age , second Since Somalia has lost it central government in 1991 and the country went into choose and low less by then the health system infrastructure resulted into severe distraction and missed all the basic health care and the public health sector and the private sectors failed to recap the basic needs of the community about Bronchial asthma and its consequences so I decided to write such a topic in order to explain Factors contributing to prevalence of bronchial asthma in old age people living in Wadajir district- Mogadishu –Somalia. Bronchial asthma are one of the most common problems in adult especially old age  who are lack  of health facility specially in wadajir district because they don’t have enough hospital and where the central health care far away. The situation is worse in Somalia because of the lack of government and provision of any quality community health care.There is lack of control of health and awareness of the community that live in Mogadishu specially wadajir district, Many people have bronchial asthma disease due to lack of education.

1.3 Objectives of the study  

1.3.0 General objective

The main objective of this research is to identify the knowledge of precipitating factor of bronchial asthma among the people live in wadajir district.

 1.3.1 Specific objective

• To Explain prevalence precipitating factor of bronchial asthma in old age
• To determine the sign and symptoms of bronchial asthma in old age
• To identify the risk factor of bronchial asthma in old age
• To discuss diagnose and manage the best possible way of bronchial asthma. in old age

1.4 Research questions  and hypothesis of the study

• What are the socio-demographic characteristics of bronchial asthma of old age people living in wadajir District of Mogadishu Somalia?
• What is the rate of exposure of bronchial asthma of old age people living in wadajir .District of Mogadishu?
• What are control measures can be used to prevent occurrence of bronchial asthma of old age people living in wadajir District of Mogadishu

1.6 significance of the study

The result of this study will contribute the generation of knowledge and awareness of precipitating factor of bronchial asthma. as well as this topic will be very important in our population who has no complete health system, health education, good screenings and palliative care  about prevalence of  precipitating factors of bronchial asthma in old age people live in wadajir district This research will identify the simplest way to manage the precipitating factor of bronchial asthma and easiest way to prevent early of precipitating factor of bronchial asthma This study will provide and support the people have an allergic  in giving good consultant and health care which could necessarily extend benefits in the bronchial asthma people. They should give advices and health promotion. For the people to be more aware of the effects of bronchial asthma towards their health.

The research will be used by other researchers who interested this study by using as a reference especially the fresh students who wants to make other research about prevalence of precipitating factor of bronchial asthma in old age live in wadajir district.

The research was also done in partial fulfilment of the award of Master of Health Service Management (MHSM) in HU and KU University Post-graduate partnership.

 

 

 

 

Chapter: Two

2.0 Literature review

2:1 Introduction

As of 2011, 235–330 million people worldwide are affected by asthma, and approximately 250,000–345,000 people die per year from the disease. Rates vary between countries with prevalence between 1 and 18%.It is more common in developed than developing countries. One thus sees lower rates in Asia, Eastern Europe and Africa. Within developed countries it is more common in those who are economically disadvantaged while in contrast in developing countries it is more common in the affluent. The reason for these differences is not well known. Low and middle income countries make up more than 80% of the mortality.

While asthma is twice as common in boys as girls, severe asthma occurs at equal rates. In contrast adult women have a higher rate of asthma than men and it is more common in the young than the old.

Global rates of asthma have increased significantly between the 1960s and 2008 with it being recognized as a major public health problem since the 1970s. Rates of asthma have plateaued in the developed world since the mid-1990s with recent increases primarily in the developing world. Asthma affects approximately 7% of the population of the United States and 5% of people in the United Kingdom. Canada, Australia and New Zealand have rates of about 14–15%.

The clinical characteristics of Asthma such as narrowing of airways came to be realized by modern medicine folks only during the seventeenth century. Asthma attacks then came to be known as epilepsy of the lungs due to unpredictable behaviour of their occurrence.

It was not until the late 20th century that the researchers discovered that asthma was an inflammatory disease by nature where the immune system becomes extra sensitive to the trigger factors. This discovery has led to better drug development because now the drugs catered to not just the airway narrowing but the underlying inflammation as well.

Despite the rich and lengthy background history of asthma the complete cure of asthma has proven to be elusive. At the threshold of the 21st Century many landmark medical advances have taken place, one of them being the completion of the human genome project.

Asthma being has a genetic correlation; we hope that the genetic research in future will result in complete cure of asthma through development of better personalized asthma drugs for all asthmatics to lead normal healthy lives.

CHAPTER THREE: METHODOLOGY

3.0: INTRODUCTION

To explore Factors contributing to the prevalence of bronchial asthma in old age people living in WADAJIR district in Mogadishu, this chapter will discuss the Methodology of the study. The chapter consists of eight sections. First section, the study presents research design follow by research population including sample size and sampling procedure. To verify the technique, the third section provides research with instrument follow by data gathering procedures.

To analyze the data, section five presents data analysis follow by the ethical consideration of the study, while final section presents the limitations/suffers of the study.

3.1 RESEARCH DESIGN

This study was conducted through survey research design. Survey “is used to present oriented methodology used to investigate population by selecting samples to analyze and discover occurrences” (Oso&Onen, 2008, p.70). The main purpose of survey is to depict and delineate events as they are, as they were or as they will be (Oso&Onen, 2008). Therefore, questionnaire techniques will be utilize in collecting primary data process.

3.2 RESEARCH POPULATION

This study was conducted in selected district WADAJIR; in this area the study population were comprised of old age since all other ages may be comprised. Saunders et al., (2009) defined population as the full set of cases from which a sample is taken. Target population refers to the total number of subjects of the total environment of interest to the researcher (Oso&Onoen, 2008).

3.2.1 Sample size

A sample is defines as “part of the target population (or accessible) population that has been procedurally select to represent it” (Oso and Onen, 2008, p.75).

Roscoe (1975) suggested that the appropriate and suitable sample sizes for most research to be greater than 30 and less than 500 (as cited in Jusoh et al., 2004). As well as, Saunders et al. (2009) followed him with that suggestion. Therefore, the research team was developed sample size of 222 through literature by adopting above theories.

In the study, sample size of 222 is developed using rule of Solven’s formula as showed below:

Researcher used Slovene’s formula which is:

Where n = sample size (222)

N= target population (500)

a = 0.05 coefficient of validity

222

 

 

 Sample size

No,	Healthy facilities	Target population	Sample size
1	BANADIR Hospital	100	34
2	MADINA MCH	150	54
3	BULO HUBEY MCH	50	18
4	KORSAN Health Centre	100	58
5	Medina  hospital	100	58
Total		500	222

3.2.2 Sampling procedure

This study was employed non-probability sampling because the population of this study is un known, also the study was being utilized purposive or judgmental sampling to meet research objectives of the study.

Non- probability sampling (or non-random sampling) consists of convenience, purposive, quota and snowball sampling techniques. On- probability sampling “provides a range of alternative techniques to select samples based on your objective judgment”. Also, defines purposive or judgmental sampling is selected cases that the best enable that researcher to answer his or her questions and objectives.

A list of five different health facilities at wadajir district, which utilizes for people for receiving medical care, these facilities are: Banadir hospital, Madina MCH, Korsan health center,Madiina hospital and Bulohubey MCH.

3.3: Inclusion and exclusion criteria of the study:

3.3.1    Inclusion criteria

• Only old age people with bronchial asthma have allowed participating in the study.
• Only old age people living in Wadajir District will be included in the study.
• Old age people who might have been admitted at the health facilities like hospitals, MCH and health centers within Wadajir District and had records will be included in the study.

3.3.2    Exclusion criteria

• Children and young adults will not be included in the study
• All people who are not the actual residents of the district or who are visiting the district at the time of the study will not be included in the study sample.

3.4: RESEARCH INSTRUMENT

The study was utilized by questionnaire adapted from Zakariaet al., (2006) as the main tool for collecting data. Questionnaire is “a technique of data collection in which each person is asked to respond to the same set of questions in a predetermined order” (sounders et al., 2009, 360).

The instrument used has the advantage of having its external validity tested and verified in many countries of the world Fadzly and Ahmad (2004). Questionnaire techniques have been adapted in collecting primary data process as it provides an efficient way of collecting responses from a large sample size.

3.5: DATA COLLECTING PROCEDURE

The first step when collecting data is requesting from student affairs and registration office a letter enlightening that I am conducting academic research. For the purposes of this study, data will gathered by means of a self-administer questionnaire as a measuring instrument. Self-administer questionnaires allow respondents time to think and use resources (Nolinske, 2008, p.10).The questionnaire was collect through (SPSS Version 16.0).

3.6: DATA ANALYSIS

As previously talk about, the quantitative data analysis was used in this study. The analysis was carried out with the aid of the Statistical Package for Social Sciences, (SPSS Version 16.0). Descriptive statistics have been used to describe the variables in this study. Descriptive statistics is the use of measure of central tendency such as mean, mood and median (sounders et al., 2009). In addition, it measures the central tendency generally and describes how close a measure or a variable (oso&onnen, 2008

 

 

 

 

 

 

3.8 WORK PLAN

 

 

 

 

 

 

 

 

 

	June	July		August
1.     Assigned for the topic	4th Week				Abdirahman Moalim Hassan
2.     proposal written and submission		1st wk-2nd  wk			Abdirahman Moalim Hassan
3.     Communicating to the local Authorities, sitting with community figures.		3th week			4persons Assigned these tasks
4.     Training to the volunteers and participants		4th week			Abdirahman Moalim Hassan
5.     Data collection				1st wk	All the team including the appraiser
6.     Data analysis and interpretation			2nd -4th       wk		Abdirahman Moalim Hassan

 

3.7 ETHICAL CONSIDERATION

In generally, ethics is defined as “the systematic study of behavior based on moral principles, philosophical choices and values of right and wrong conduct” (Shaikh and Talha, 2003, p.159). In this study, the research team has been in mind about the ethical issues throughout research project, and was kept the privacy and confidentiality of the respondents. To consider ethical issue, the research team was requested the Health Facility to permit the distribution of the questionnaire to the Caretakers. Also, the information of the respondents has been used only for academic purpose. Secrecy, privacy and confidentiality of the undisclosed information were the main concern of this study.

3.9 BUDGET

No	Item (Stationary)	Quantity	Price per each	Total Amount
1	Transportation	12days	$ 9	$ 108
2	A4 sized papers Pens Binding material	2 reams 10pcs 3sets	5$ 0.25$ 5$	10$ 2.5$ 15$
3	Printer facilities Photocopies	1 Toner 300	30$ 0.2$	30$ 60$
4	Internet & telephone calls	2months	40$	$80
5	Antivirus for computer	1PC	18 $	18$
Total				$323.5

 

 

 

3.10 Appendix 1Reference

• World Health Organization,Global Surveillance, Prevention and Control of Chronic Respiratory Diseases: A Comprehensive Approach, WHO Press, Geneva, Switzerland, 2007.
• A. Hardie, W. M. Vollmer, A. S. Buist, P. Bakke, and O. Morkve, “Respiratory symptoms and obstructive pulmonary disease in a population aged over 70 years,”Respiratory Medicine, vol. 99, no. 2, pp. 186–195, 2005. View at Publisher · View at Google Scholar · View at Scopus
• Murtagh, L. Heaney, J. Gingles, et al., “The prevalence of obstructive lung disease in a general population sample: the NICECOPD study,”European Journal of Epidemiology, vol. 20, no. 5, pp. 443–453, 2005. View at Publisher · View at Google Scholar · View at Scopus
• “Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA),” 2009,http://www.ginasthma.org/.
• National Asthma Education and Prevention Program (NAEPP), “Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma,” Full Report 2007,http://www.nhlbi.nih.gov/.
• Partridge MR; Asthma: 1987-2007. What have we achieved and what are the persisting challenges? Prim Care Respire J. 2007 Jun; 16(3):145-8.
• Fireman P; Understanding asthma path physiology. Allergy Asthma Proc. 2003 Mar-Apr;24(2):79-83
• Quality and Outcomes Framework (QOF), NICE 2011
• Key facts and statistics; Asthma UK
• Anderson HR, Gupta R, Strachan DP, et al; 50 years of asthma: UK trends from 1955 to 2004. Thorax. 2007 Jan; 62(1):85-90.