Clinical profiles, healthcare given and hospital outcomes of children hospitalised for acute asthma at a tertiary hospital in Harare, Zimbabwe: a 2010-2020 chart review

Background: Acute asthma is among the commonest medical emergencies that cause repeated presentation to the emergency department and hospitalisation. Several guidelines exist on the management of acute asthma in children. Despite this, evidence from high income countries suggests that practice deviates from standard of care. In low-income countries including most African countries there is paucity of data on the clinical profiles, healthcare given and hospital outcomes of children hospitalised for acute asthma. 
Objectives: This retrospective chart review reports on the clinical profiles, health care given and hospital outcomes of children presenting with acute asthma at a tertiary hospital. 
Materials and Methods: A retrospective chart review was done on consecutive case files of patients hospitalised for acute asthma in the period January 2010 to December 2020. A standardized electronic data collection tool (REDCap) was used for data abstraction. The data was uploaded onto a REDCap server then onto an excel spreadsheet.  Statistical Package for Social Sciences version 16 (SPSS 16.0) was used for descriptive statistics and to test for association between clinical profiles and length of hospital stay. This review was approved by the Medical Research Council of Zimbabwe and Institutional Joint Research Ethical Committee. 
Results:  A total of 214 case files were reviewed. The ages of the study participants ranged from2months to 17 years, the median was 3years (Q1=1, Q3=6) and 69% were below 5 years. Of the study population, 15% had their asthma diagnosis made before one year of age and 94% by 6 years. Newly diagnosed asthmatics accounted for 101(47%) of the study population while111(52%) were known asthmatics. Cough, fast breathing, and wheeze were universal presenting symptoms.  Severe acute asthma was present in 81% of those who had their asthma severity assessed.  Up to 73% of the study population had comorbidities. All patients received nebulised Short Acting B2 Agonist (SABA) in the emergency department and in hospital. Oxygen therapy was given to all the patients who had SpO2 measurement less than 92%. However, assessment of asthma severity was done in only 42%, looking for triggers in only 9%, health education was given to 52%, asthma action plan was given to only 5% and review dates were given to 77% of the study population.  The median hospital stay was 3 days (Q1=2,Q3=4) and 2 patients died during the period under review. Having newly diagnosed asthma, younger age, low oxygen saturation at presentation and presence of comorbid conditions was significantly associated with severe acute asthma. Patients with severe acute asthma had longer hospital stay. 
Discussion:  This review has revealed that most children with asthma present by 6 years, most have severe acute asthma, co-morbidities, and recurrent hospitalizations due to acute asthma. The care given to children with acute asthma fell short of the standard of care. 
Conclusions:  The chart review acts as the basis for corrective interventions including; development of clinical decision-making algorithms, education of health workers, capacitation of health facilities and guidance of future research.