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BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed.
OBJE
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CTIVES. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.
METHODS. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.
CONCLUSIONS. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. The aim of this journal is to provide an eviden
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ce-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.
For that, the South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.
The final conclusions are that it is important to ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.
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Myth: It’s better to ‘tough it out’ without taking asthma medication. The lungs do not get stronger or become better able to deal with asthma if a person tries to work through an attack without medication. In fact, the lung inflammation that goes along with an attack (see what is asthma)
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can cause permanent damage to the lungs. Always use medication according to the Asthma Action Plan. If you have questions, talk with your health care provider.
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When someone is having an asthma attack, their airways go into spasm which causes tightness of the chest; the linings of the airways become inflamed and phlegm is produced further obstructing the airways and leading to severe difficulty in breathing (Fig. 1). Asthma does lead to fatalities and shoul
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d always be taken seriously.
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The diagnosis of asthma in young children is limited by the inability to perform objective lung function testing in this group of patients and the wi
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de variety of conditions that can phenotypically present with asthma-like symptoms.
This article provides an evidence-based approach for clinicians to accurately diagnose asthma in young children and to assess the level of control to guide therapeutic decisions.
The South African Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The asthma diagnosis and control task groups reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system, providing recommendations based on current evidence.
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This video is meant to train the public on how to use some of the devices for delivery of asthma medications.
Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the tee
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nage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. The Paediatric Asthma Project Plan has been initiated to strengthen diagnosis and management of asthma. This encompasses a vision for the next 10–15 years, building on the knowledge and experience from previous educational projects. It will take into account the educational needs of patients, carers and healthcare professionals as well as the accessibility and affordability of medication, particularly in low and middle-income countries where the prevalence of asthma is rising more rapidly. This overview presents a first step for those involved in the diagnosis and management of childhood asthma to strengthen care for children globally.
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Healthy Settings, a key component of Malawi’s Health Sector Strategic Plan (HSSP) 2011–2016, is the World Health Organization’s (WHO) holistic community-led approach to achieving health improvement by addressing social determinants of health, an approach which is central to the current WHO fra
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mework on integrated people-centred health services. Healthy Settings projects by their construct have many different components which vary from one group and community to another depending on their priorities: from housing, hospital improvements and waste management to “softer” interventions like leadership skills training and health promotion. It can be challenging to find relevant indicators to monitor and assess the impact of such a complex holistic project, this paper explores if social capital data can provide useful impact assessment indicators at the start of such a project.
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As our world changes, so too does the burden of disease. Globalisation, evolving trade and consumption patterns, and increased access to life-saving medical care are just some of the factors that have transformed the global health landscape.
Adapted from: Standard Treatment Guidelines and Essential Medicine List PHC. The syndromic approach to Sexually Transmitted Infections (STIs) diagnosis
and management is to treat the signs or symptoms (syndrome) of a group of
diseases rather than treating a specific disease. This allows for the tr
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eatment
of one or more conditions that often occur at the same time and has been
accepted as the management of choice.
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The Ministry of Education, Arts and Culture (MoEAC) has been implementing the Integrated School Health Programme in various forms since before the country attained political independence in 1990. School health goes beyond the physical health of the learner, in that it includes the holistic wellbeing
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of the individual learner, meaning that the school environment should be safe and conducive to learning. The National Safe Schools Framework (NSSF) is an exciting dimension of the Integrated School Health Programme. The Programme focuses on promoting the health, safety and wellbeing of learners and other school stakeholders in Namibia, and the NSSF was developed to provide practical guidance to the schools and school stakeholders on how to systematically improve the standards of school safety, and how to develop a culture of care in any school.
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Outubro/2018 Nº 397
This document sets out key messages to support malaria prevention and control efforts, for teachers, pupils and the wider community. It is designed to facilitate health education in schools by encouraging teachers to guide pupils through the core messages about malaria and emphasise the most importa
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nt points. Pupils are expected to actively engage by taking notes and applying what they learn. Ultimately, the goal is to equip children with the practical knowledge to influence behavioural change at both the individual and community levels.
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This malaria education poster by Children for Health uses clear, child-friendly language to raise awareness of malaria and promote its prevention. Using simple language and engaging visuals, it informs children and caregivers about key facts, symptoms and protective behaviours, such as using insecti
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cide-treated nets and seeking timely treatment. Designed for use in schools and communities, the poster supports health education initiatives aimed at reducing the impact of malaria in endemic regions by encouraging children to play an active role in preventing the disease.
Accessed on 20/06/2025.
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The purpose of this guide is to provide updated clinical guidance on TB/HIV, with an emphasis on diagnostic aspects—including new techniques—as well as current treatment, while maintaining a public health approach. By compiling and consolidating the latest World Health Organization recommendatio
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ns on the subject into a single guide, the aim is to create a reference and consultation document that is frequently used, and that unifies and standardizes the comprehensive management of TB/HIV co-infection in healthcare facilities based on the principle of “two diseases, one patient.” It also seeks to support the updating of national standards and guidelines on co-infection and to complement the coordinated work that must exist between TB and HIV prevention and control programs at all levels, within the framework of the twelve internationally recommended TB/HIV collaborative activities.
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The presentation titled "Malaria Capacity Building Initiative" outlines efforts led by the WHO and partner organizations to strengthen the skills and systems needed to fight malaria globally. It highlights the need for a coordinated, long-term strategy to build human resource capacity in malaria-end
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emic countries—especially among national malaria control programs, frontline health workers, NGOs, and WHO staff. The document reviews past and current training activities, such as workshops on case management, entomology, vector control, epidemiology, and planning. It emphasizes the development of standardized training materials and competency frameworks, the role of national and regional training centers, and the use of blended learning methods (e.g., e-learning and in-person sessions). The goal is not just to deliver training, but to build sustainable capacity through partnerships, continuous improvement, quality assurance, and integration into health systems. It also calls for better coordination, tracking of trained personnel, and engagement of ministries of finance to ensure long-term support.
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This educational video provides an overview of malaria, including its causes, symptoms and how it is transmitted. It focuses on the most vulnerable groups: children under five, pregnant women, people living with HIV/AIDS, and travellers or migrants. Using engaging visuals and background music, the v
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ideo emphasises the importance of prevention strategies such as insecticide-treated bed nets, antimalarial medication and raising public awareness.
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Malaria and HIV, two of the world’s most deadly diseases, are widespread, but their distribution overlaps greatly in sub-Saharan Africa. Consequently, malaria and HIV coinfection (MHC) is common in the region. In this paper, pertinent publications on the prevalence, impact, and treatment strategie
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s of MHC obtained by searching major electronic databases (PubMed, PubMed Central, Google Scholar, ScienceDirect, and Scopus) were reviewed, and it was found that the prevalence of MHC in SSA was 0.7%–47.5% overall. Prevalence was 0.7%–47.5% in nonpregnant adults, 1.2%–27.8% in children, and 0.94%–37% in pregnant women. MHC was associated with an increased frequency of clinical parasitemia and severe malaria, increased parasite and viral load, and impaired immunity to malaria in nonpregnant adults, children, and pregnant women, increased in placental malaria and related outcomes in pregnant women, and impaired antimalarial drug efficacy in nonpregnant adults and pregnant women. Although a few cases of adverse events have been reported in coinfected patients receiving antimalarial and antiretroviral drugs concurrently, available data are very limited and have not prompted major revision in treatment guidelines for both diseases. Artemisinin-based combination therapy and cotrimoxazole are currently the recommended drugs for treatment and prevention of malaria in HIV-infected children and adults. However, concurrent administration of cotrimoxazole and sulfadoxine–pyrimethamine in HIV-infected pregnant women is not recommended, because of high risk of sulfonamide toxicity. Further research is needed to enhance our understanding of the impact of malaria on HIV, drug–drug interactions in patients receiving antimalarials and antiretroviral drugs concomitantly, and the development of newer, safer, and more cost-effective drugs and vaccines to prevent malaria in HIV-infected pregnant women.
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The document provides a standardized protocol for evaluating the Early Warning Alert and Response Network (EWARN), a surveillance system used during humanitarian emergencies when regular national health surveillance may be disrupted. The purpose of EWARN is to detect outbreaks of communicable diseas
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es early and enable rapid public health response. The guidance explains how the system should be assessed in terms of its structure, implementation, effectiveness, and usefulness. It outlines the key steps of evaluation: preparation, system description, data collection, and post-evaluation reporting. The protocol highlights common challenges observed in previous EWARN implementations, such as delays in establishing the system, limited data quality, weak outbreak response, and lack of clear transition plans back to routine surveillance systems. It emphasizes the need to evaluate both weekly disease reporting and alert verification processes, and to review attributes such as simplicity, data quality, timeliness, sensitivity, and stability. The document also provides templates for interviews, data review forms, and laboratory assessment, as well as guidance on conducting remote evaluations when access is limited. The overall goal of the protocol is to ensure that EWARN functions effectively to detect and respond to outbreaks and that practical recommendations are developed to improve the system’s performance and sustainability in emergency settings.
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Continuum of HIV services refers to a comprehensive package of HIV prevention, diagnostic, treatment, care and support services provided for people at risk of infection or living with HIV and their families. This revised edition of the guidelines for use of ARV and opportunistic infection
(OI) dru
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gs in adults, adolescents and children is based on recent national and
global evidences and experiences. The Federal Ministry of Health believes that
these guidelines, along with other national guidelines and training manuals, will be
instrumental in maintaining the standard of care and ensuring quality of HIV service
delivery.
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