Study of Kazakhstan inpatient childhood asthma: assessment of prevalence and factors influencing treatment adherence

Background: Up to date, the assessment of adherence to the treatment of children with asthma in Kazakhstan has not been carried out yet. Objective: The study aimed to evaluate the level of therapeutic adherence of paediatric patients with asthma in urban and rural areas of Kazakhstan. In addition, the validity and reliability of a structured scale for assessing adherence in patients with asthma was also scrutinized. Methods: A prospective study of verified cases of bronchial asthma of 518 children in the dispensary control in the Children's City Clinical Hospital N2 (Almaty, Kazakhstan) was conducted in the period from 2018 to 2020. Children with asthma were sub-divided into 2 groups: urban and rural residents. The demographic and clinical characteristics, external and social factors of the patients were analysed. Patient adherence to treatment was assessed using the Lebanese Medication Adherence Scale-14(LMAS-14). The reliability was tested using the measure of internal consistency (Cronbach's alpha). Data were collected after the discharge from the hospital (T1) and after 6 months (T2). Results: Urban and rural patients made up 81.3% vs. 18.7% respectively. Children aged 5-12 years accounted for 70.6%. Male gender was predominant in all groups (p=0.73). Better financial situation, education were noted by 90.5% and 95.5% of urban parents (p=0.001). The influence of external factors (dampness, coal heating and possession of pets) was higher in rural areas (p=0.001).The results of study based on the LMAS-14 questionnaire (T1 period) showed no significant differences. However, in the T2 period, the adherence of urban children was higher than rural ones (p=0.001). The Cronbach's alpha was 0.606 for the total score. According to the results of a survey after 18 months, a significant relationship was found between the levels of adherence and the frequency of asthma attacks (p=0.001). Conclusion: In 2018-2020, a low therapeutic adherence of children with asthma, especially in a rural area, was detected in the territory of the Republic of Kazakhstan. Our findings indicate the necessity to develop effective measures to regulate and increase adherence to treatment of patients, especially those living in rural areas.