NIHR GRP: Calling time on avoidable morbidity from asthma in African children The NIHR Global Research Professorship (GRP) scheme is open to all professions and all Higher Education Institutions (HEI), based in UK and low-and-middle-income-country (LMIC), to nominate health researchers and methodologists with an outstanding research record of clinical and applied health research and its effective translation for improved health. Global Research Professors are required to have existing strong collaborations or links with collaborators or partners in institutions in countries on the OECD DAC list and the award should plan to strengthen these/support training and capacity development/mentorship in these partners.

Vision: All children and adolescents with asthma in Africa having equitable access to affordable and effective care.

Aims: My overall aim is to improve access to effective and affordable care for children and adolescents with asthma in Africa.

Around 1 in 10 children and adolescents have asthma and mortality from asthma in some African countries is 100 times that in the UK. Medications to reduce suffering and death have been available for over half a century, but these have largely been unavailable in Africa. Quality data on prevalence and cost of care are largely unavailable resulting in low prioritisation by policymakers. These inequities warrant urgent intervention. A recent change in asthma management recommends against use of asthma relievers (reliefs airways obstruction) inhaler therapy alone based on disproportionately high deaths associated with their excessive use. Combination inhalers which include both a controller (treatment to prevent airway swelling) medication usually corticosteroids and fast-acting relievers (β2-agonist) are now widely accepted and endorsed as the first step in the treatment ladder, but are inaccessible in Africa.
 
Design and methods:
Individually randomised controlled trial of the clinical-and cost-effectiveness of a pragmatic single inhaler-based approach to asthma management in poor rural South African setting.
Population: Children and adolescents 6-18 years, who have had ≥1 asthma attack in the last 12 months. A total of 2028 will be included with equal numbers in the intervention and the control group.

Intervention: An easy to use strategy of  an inhaled corticosteroid/ fast-onset β2-agonist (ICS/LABA) inhaler for symptom relief (reliever) as well as for maintenance (controller) therapy. 

Control: Local standard asthma care 

Primary outcome: Severe asthma attack defined as any asthma attack that requires medication with oral or intravenous corticosteroids.

Time: 12 months’ follow-up.
I will conduct a multi-country cross-sectional study to determine the prevalence and risk factors for asthma in children and adolescents in three African countries, with a view to create an African Asthma Observatory.
I will collect data with standardised tools Global Asthma Network (GAN) methodology with a self-administered written and video questionnaire on symptoms of asthma, allergic rhinitis, eczema and environmental questions. In addition, a list of questions on risk factors tailored for the African setting will be included.

Patient Public Involvement:
Pilot work from focus groups with patients and carers of the NIHR Global Group Achieving Control of Asthma in Children in Africa (ACACIA) informed the research. Half of the asthmatics experienced severe symptoms which affected participation in sport, school and leisure activities. Asthmatics also expressed a need for effective, easy to use inhalers.  A pilot on the prevalence of asthma in the uMkhanyakude community with the Vukuzazi health camp by Africa Health Research Institute where I propose to perform the clinical trial found than only 55% of adolescents with asthma symptoms had a diagnosis. I will adapt the NIHR INVOLVE information for participation in clinical trials to isiZulu to ensure equitable participation. Community stakeholders and service-users will be engaged throughout the project. 1. To determine the clinical and cost effectiveness of ICS/LABA compared to standard asthma care
2. The determine the prevalence and risk factors for asthma in adolescents in Africa
3. To create an observatory for asthma for Africa
4. To establish opportunities for early career researcher in Africa to strengthen research capacity
5. To advocate for access and effective medications for asthma for African children and adolescents.