ORIGINALNiger J Paediatr 2017; 44 (2):68 – 75

Kuti BPKuti DKOmole KOOso BOMohammed LOMinna YA

How much do school teachersknow about childhood asthma inIlesa, Nigeria?

Accepted: 10th March 2017

Kuti BPOmole KO, Oso BOMohammed LODepartment of Paediatrics,Wesley Guild Hospital, Ilesa,NigeriaEmail: kutitherapy@yahoo.com

Kuti DKDepartment of Paediatrics andChild Health Obafemi AwolowoUniversity, Ile-Ife, Nigeria

Minna YADepartment of Paediatrics,National HospitalGarki, Abuja,Nigeria

( )

DOI:http://dx.doi.org/10.4314/njp.v44i2.5

Abstract: Background: Child-hood asthma is affected by eventsand conditions of the school envi-ronment. Teachers as de-factocaregivers of children with asthmahave a major role to play in ensur-ing good asthma control in school.This study set out to determine thelevel of knowledge of schoolteacher about childhood asthmaand factors influencing thisknowledge.Methods: Four secondary schools(two private and two public) inIlesa, South West Nigeria wereselected by multistage samplingmethod. All the teachers in theseschools were required to fill a self-administered questionnaire incor-porating a validated 40-itemasthma knowledge questions. Fac-tors associated with the level ofknowledge were determined ap-propriately.Results: A total of 132 teacher(M: F = 1:2) participated in thestudy with 85 (64.4%) from pri-vate school. The mean (SD) ageof the teachers was 38.0 (9.1)years and median (IQR) years inteaching service was 7.0 (5.0 to15.0) years. Majority (56.1%) of

the teachers had universityeducation while only 7 (5.3%) hada post graduate degree. The mean(SD) score of the 40 item ques-tions was 21.5 (7.2) and majority(51.5%) had poor asthma knowl-edge (score < 22). Poorer knowl-edge was observed in questionsrelated to the nature and manage-ment of childhood asthma thantriggers and manifestations. Nosignificant correlation was foundbetween knowledge and age,teaching experience and qualifica-tions (p > 0.05). However, teacherswith previous training about child-hood asthma had relatively goodknowledge about the condition. (p<0.05)Conclusion: The level of knowl-edge about childhood asthmaamong school teachers in Ilesa ispoor particularly as regards to na-ture and management of the dis-ease. We advocate for training ofschool teachers about commonchildhood conditions includingasthma to ensure optimal symp-toms control in school.

Keywords: Childhood asthma,Knowledge, School teachers

Introduction

Asthma is a chronic inflammatory airway disorder char-acterised by recurrent episodic airway narrowing mani-festing as intermittent or persistent wheeze, chest tight-ness, breathlessness and cough. These symptoms mayresolve spontaneously or with medications.1Asthma af-fects all age groups including school aged children.1 Theprevalence of childhood asthma has been reported to beincreasing worldwide.2 Childhood asthma is believed toaffect 5-10% of school aged children in Nigeria withanother 3-5% probably unrecognized.3 Falade et al4 in2004, using ISAAC questionnaire, reported a prevalenceof 7.6% among school age children in Ibadan, Nigeria.

School children are required to take part in physical ac-tivities and exercise at school either formally as part ofphysical and health education or informally as leisureand peer activities.5 These physical activities are oftenpotent triggers of acute exacerbations of asthma in chil-dren.6 Poorly controlled childhood asthma is a leadingcause of school absenteeism which may lead to pooracademic performance and ultimately to poor quality oflife.7

The events and occurrences in schools as well as theschool environment greatly affect the asthmatic child.8

Excessive bully by peers and teachers can cause schoolphobia and emotional distress which can lead to acuteasthmatic exacerbations and make symptoms control

very difficult.8-9 Likewise the presence of triggeringfactors in the school environment such as dust, fumes,pollens, unfavourable weather conditions, certain foodand dust mites which the child with asthma may be per-sistently exposed to may also make symptoms controlequally difficult.8-9 Conversely, excessive protection ofchildren with asthma and exempting them from partici-pating in school sports and recreational activities canmake the child feel isolated and ostracized often leadingto depression and low self-esteem.10

School teachers are the primary caregivers and custodi-ans of the children under their care during the schoolhours and they are often called upon to help childrenwith acute asthmatic exacerbations.11 They are also re-quired to assist children with the use of their medica-tions and provide care and first aid treatment togetherwith the school health workers for the children withasthma child before their parents and or health care pro-fessionals are contacted.12 It is therefore very importantfor the school teachers to know about childhood asthmaand indeed common childhood health conditions to beable to be of meaningful assistance to the children undertheir care.

Consequently lots of studies had been carried out to de-termine the level of knowledge of school teachers aboutchildhood asthma13-19 with reports of variable levels ofknowledge and obvious gaps in knowledge about differ-ent aspects of the disease.13-19 The majority of thesestudies were from developed countries of Europe15 andNorth America12, 17, 19 and Asia14, 18 with paucity of datafrom sub-Saharan Africa including Nigeria.As levels of knowledge about childhood diseases includ-ing asthma may be affected by localperceptions and ex-periences, myths and beliefs which may differ from oneplace to another. It is important to assess the levels ofawareness and knowledge about childhood asthmaamong school teachers in this locality. This study there-fore sets out to determine the level of knowledge ofschool teacher about different aspects of childhoodasthma and factors influencing these levels of knowl-edge among school teachers in Ilesa, Nigeria.

MethodsStudy design

This was a cross sectional studyStudy location: The study was carried in four secondaryschools in Ilesa East Local Government Area, State ofOsun, Nigeria. Ilesais the largest town in Ijesaland,located about 200 kilometres north-east of Lagos.20

Sample selection

The local government has 24 secondary schools, 11 pub-lic (middle school) and 13 Private.21 The participatingschools were selected by multistage sampling – all theschools in Ilesa East LGA were divided into two i.e.public and private, (the sampling frame) the two schoolswere then selected each from the pools of public andprivate schools by simple randomization method.

Sample size estimation

The minimum sample size for this study was estimatedusing open Epi sample size software.(R) 22 Based on theassumption that 38% of teachers would have limitedknowledge of childhood asthma (from the study of Gov-ender and Gray) 13 and a 10% level of precision in acluster of 24 schools in the local government and anestimated 95% respondent rate, a minimum sample sizeof 130 was obtained.

Study procedure

The permission of the local educational authority andinstitutional ethical approval from the Institute of PublicHealth, Obafemi Awolowo University, Ile-Ife, Nigeriawas obtained to carry out this study. The permission andapproval of the principals and head teachers of the par-ticipating schools were also obtained. Consent from allthe teachers in the selected schools was obtained andthey were sensitized about the nature and reasons for thestudy.

The study participants were then required to fill a self-administered questionnaire to capture their age, sex,highest educational qualifications and number of yearsin teaching service. Also of interest was whether thestudy participants had previous information about child-hood asthma and the sources of the information. Per-sonal and/or family history of asthma was obtained aswell as history of previous experience with students withasthma. Also the teachers were asked if they had wit-nessed or assisted any child with acute asthmatic exacer-bations in the past. The disposition of the teachers asregards having a child with asthma in their classroomwas also ascertained.

School teachers’ Asthma knowledge assessment

The level of knowledge of the school teachers aboutchildhood asthma was assessed using the AsthmaKnowledge Questionnaire (AKQ). This was a 40-itemquestions derived from previous validated questionnaire(Govender and Gray)13 The questionnaire was pre-testedin a pilot study among teachers in a school differentfrom those selected for the study for content and facevalidity of the questions.

The AKQ has four parts thus: Part one with 11 questionsassess general knowledge about childhood asthma; parttwo with eight questions assess knowledge about signsand symptoms of childhood asthma; part three with 11questions assess knowledge about common triggers ofchildhood asthma, while part four with 10 questionsassessed knowledge about asthma medications and man-agement. The study participants were required to pickone of three options for each question - a “true”, “false”or “don’t know”. The “don’t know” option was includedto discourage the study participants from guessing andonly pick the options they are sure of. A score of onewas allocated for every correct answer and ‘0” for awrong and “don’t know” response. For the purpose of

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this study, score less than 22 was considered poor orsuboptimal knowledge of childhood asthma.

Data analysis

This was done using the Statistical Programme for So-cial Sciences (SPSS) software version 17.0 (SPSS Inc.,Chicago 2008, IL, USA) and WinPEPI®.23 Categoricalvariables such as sex, age categories and highest educa-tional qualifications of the teachers were summarizedusing proportions and percentages, while continuousvariables such as scores of study participants from theAKQ and length of time in teaching service were sum-marized using mean and standard deviations (SDs) fornormally distributed variables and median and interquar-tile ranges (IQR) for non-normally distributed ones. Dif-ferences between continuous variables were analyzedusing Student’s t-test, while categorical variables wereanalyzed using Pearson’s Chi-square test and Fisher’sexact test as appropriate. Pearson or Spearman rho wasused to assess the correlations between school teachers’scores in the AKQ and their ages, length of service inthe teaching profession. The level of significance at 95%confidence interval was taken at P < 0.05.

Results

Of the 150 questionnaire distributed to the schools, 132(88.0%) were adequately filled and form the basis offurther analysis. One hundred and thirty-two teachersparticipated in the study, 85 (64.4%) teach in privateschools and there was female preponderance with a maleto female ratio of 1: 2.

Socio-demographic characteristics of the study partici-pants:

These are highlighted in Table 1.Age of the study participants: The ages of the schoolteachers ranged from 20 to 60 years with a mean (SD) of38 (9.2) years. About one-half of the teachers were inthe age range of 30 to 39 years.Ethnicity: The majority (89.3%) of the teachers belongsto Yoruba ethnicity which was the predominant ethnicgroup in the study location; the other tribes representedwere Igbos (9.1%); Ebiras and Edos. (Table 1)Level of education: Seventy four (56.1%) of the teach-ers had university or Polytechnics education up to BSC/BA or Higher National Diploma (HND). The distribu-tion of the highest level of educational qualifications ofthe teachers is presented in table 1.Teaching experience: The length of years in the teach-ing profession of the teachers ranged from one to 35years with median (IQR) of 7.0 (5.0 – 15.0) years. Themajority (56.1%) had less than 10-year teaching experi-ence, only three (2.3%) of the teachers had spent 30years or more in the teaching profession.Personal or family history of asthma in the teachers:Nine (6.8%) of the teachers gave history of being asth-matic and 25 (18.9%) had a child or close relative withasthma.

Table 1: Socio-demographic characteristics and general infor-mation of the school teachers

Experience with childhood asthmaEighty-six (65.2%) of the teachers were aware or hadprevious knowledge about childhood asthma and thesources of their information are highlighted in figure 1.About one-third (46) of the teachers however had noprevious knowledge about childhood asthma.Thirty-eight (28.8%) of the teachers gave a history ofhaving had a student with asthma in their class eitherpresently or in the past, 50 (37.9%) had seen or assisteda child with acute asthmatic exacerbation, 43 (32.6%)had received a talk, lecture or training about childhoodasthma, but only 17 (12.9%) of the teachers are comfort-able having an asthmatic child in their classroom.

Fig 1: source of information about childhood asthma

Socio-demographic characteristics Frequency(n = 132)

Percentage(%)

Sex 32.6Male 43 32.6Female 89 67.4Age20-29 21 15.930-39 65 49.240-50 26 19.750-60 20 15.2Type of schoolPublic 47 35.6Private 85 64.4EthnicityYoruba 118 89.4Igbo 12 9.1Others 2 1.5Level of education of the teachersNational Certificate of Education 44 33.3Ordinary National Diploma 7 5.3Degree/Higher National Diploma 74 56.1Post graduate 7 5.3Years in teaching service< 10 74 56.110 -19 32 24.220 -29 23 17.4≥30 3 2.3Experience with asthmaPersonal history 9 6.8Close relative 25 18.9Previous information about asthma 86 65.2Had a student with asthma in class 38 28.8Comfortable having an asthmaticchild in class

17 12.9

Seen/assisted a child with acute asth-matic exacerbation

50 37.8

Had formal lecture/training aboutasthma

43 32.6

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Level of knowledge of the teachers about childhoodasthma using the 40-item AKQ: The AKQ scores ofthe teachers ranged from 3 (7.5% of the obtainablescore) to 34 (85.0% of the obtainable score). The mean(SD) score was 21.5 (7.2) and 68 (51.5%) of the teacherswere considered to have poor knowledge about child-hood asthma (AKQ score < 22 of the 40 item questions).Domains of knowledge: The Mean (SD) scores in thefour domains of knowledge tested by the AKQ are high-lighted in tables 2 to 5. The teachers demonstrated rela-tively higher level of knowledge about triggers of child-hood acute exacerbation and clinical manifestations ofchildhood asthma than general knowledge about thedisease. The poorest level of knowledge was demon-strated in question regarding management of the disease.Only 6.8% of the study participants knew that asthma isnot due to dilatation of the bronchi, while majority(>80.0%) knew that breathlessness, cough and wheezeare features of childhood asthma and that house dustmites can trigger acute asthmatic exacerbations. (Tables2- 4)Significantly there were higher scores in question relatedto clinical features of childhood asthma compared togeneral knowledge about the disease [81.8 (37.1) vs.64.7 (3.3); t =5.27; p <0.001]. Likewise the teachersdemonstrated significantly more knowledge about thetriggers of childhood asthma exacerbation than the man-agement of the condition [84.4 (21.3 vs. 47.2 (31.4); t =11.3; p <0.001].

Table 2: The rate of correct responses of school teachers togeneral questions about childhood asthma

Mean (SD) score 64.7 (3.3)

Table 3: The rate of correct responses of school teachers toquestions relating to signs/symptoms and triggers of exacerba-tion of childhood asthma

Table 4: The rate of correct responses of school teachers toquestions about childhood asthma medications andmanagement

Questions Answers Correctanswersn = 132

Percent-age (%)

General knowledge about asthma:1. Asthma is a lung disease? True 102 77.32. Asthma is a communicable dis-ease;it spread from one person toanother?

False 95 72.0

3. Asthma is a hereditary disease? True 96 72.74. Asthma is a primary emotionaldisorder that needs psychologicalcounseling?

False 29 22.0

5. Sometimes asthma can be causedby an infection due to microorgan-ism?

False 31 23.5

6. Asthma is a chronic diseasewhich needs treatment for longtime?

True 109 82.6

7. Asthma predominantly effectfemale children

False 56 42.4

8. Asthma occurs in specific ageamong children?

False 50 37.9

9. Asthma attack occurs due todilatation of the bronchi?

False 9 6.8

10. Asthma attack occurs due toinflammation of the bronchiduringasthma attack?

True 62 47.0

11. The bronchi are blocked withphlegm during attack

True 73 55.3

Questions related to signsand symptoms

Answers Correctanswersn = 132

Percentage(%)

1. Symptoms of asthmaare difficulty in breathing,cough and wheezing?

True 113 85.6

2. Asthmatic attacks aremore usually occur in daytime as compare to night?

False 32 24.2

3.Asthma attack can causedeath?

True 117 85.6

4.Asthma can be com-pletely cured?

False 30 22.7

5. Inhalers are used to treatasthmatic attack?

True 119 90.2

6. Asthma can affect stu-dent’s studies?

True 105 79.5

7. Asthmatic children havelow IQs?

False 65 49.2

8. Peak flow meters areused to determine theseverity of asthma?

True 73 55.3

Mean (SD) score 81.8(37.1)Questions related to trig-gers of acute exacerbation

Answers Correctanswersn =132

Percentage(%)

1. Every patient has hisown asthma triggers?

True 73 55.3

2. Viral infection True 38 28.83. Smoking True 105 79.54. Pollen grains True 58 43.95. Perfumes True 95 72.06. House dust mites True 107 81.17. Emotional stress True 88 66.78. Strenuous exercise True 100 75.89. Certain food and drugs True 80 60.610. Fur of animals True 84 63.611. Chalk dust True 100 75.8Mean (SD) 84.4 (21.3)

Questions Answers Correctanswersn = 132

Percentage(%)

1. Antibiotics are used to relieve anasthma attack?

False 24 18.2

2. Aspirin is used to relieve anasthma attack?

False 32 26.5

3. Ventolin(R) are used to relieve anasthma attack?

True 34 25.8

4. Oxygen therapy is required invery severe asthma attacks?

True 100 75.8

5.Ventolin(R) can cause a rapidpulse rate, palpitations and trem-ors?

True 34 25.8

6. Asthmatic children should avoidexercise and sports?

False 33 25.0

7. Preventative medication can betaken by the asthmatic childbeforeexercise and sports?

True 84 63.6

8. Swimming is a good sport forasthmatics?

True 22 16.7

9. With appropriate treatment mostchildren should lead a normal lifewith no restrictions on activity?

True 91 68.9

10. Self-medication should bediscouraged in the management ofasthma in children?

False 18 13.6

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Mean (SD) score 47.2 (31.4)

Level of knowledge as related to socio-demographiccharacteristics of the teachers:Table 5 highlights the association between socio-demographic characteristics of the school teachers asrelated to their having good or poor knowledge aboutchildhood asthma.No significant association between the level of knowl-edge (poor or good knowledge) of the teachers and theage, sex, type of school, and ethnicity of the teachers.(Table 5)Correlation between knowledge level and age, teach-ing experience and qualifications of the teachers:There was a weakly negative correlation between thelevel of knowledge of the teachers about childhood andtheir age (Pearson Correlation -0.102; p = 0.242) as wellas the length of service in the teaching profession(Pearson Correlation -0.127; p = 0.145) though not sta-tistically significant. However teachers with NCE havesignificantly poor knowledge about childhood asthmathan those with higher qualifications. (Table 5) The levelof childhood asthma knowledge correlated positivelywith the level of education of the teachers, though notstatistically significant (Pearson Correlation 0.126; p=0.151).

Table 5: Socio-demographic characteristics and general infor-mation of the school teachers and as related to their knowledgeabout childhood asthma

*National certificate of Education; # Fischer’s Exact applied;^Yate’s Correction applied

Level of knowledge as related to experience withchildhood asthma among the teachers: Table VI high-lights the association between experience of the teachersabout asthma as related to good and poor knowledge ofthe condition.Teachers who have had previous lectures/training aboutchildhood asthma had significantly better knowledgeabout the disease compared to those without previouslecturers/training. (x2= 9.210; p = 0.02). Likewise teach-ers whose source of information about childhood asthmais formal seminar/talks had better knowledge about thedisease compared to those who acquired their informa-tion from other sources including from health care work-ers. (Table 6). Also significantly related to having goodknowledge about childhood asthma among the teacherswas having had an encounter with student with asthmaeither having had an asthmatic child in class or assisteda child with acute asthmatic exacerbation. However per-sonal history of asthma or history of asthma in a closerelative of the teachers was not significantly associatedwith higher level of knowledge among the teachers.(table 6)

Table 6: Awareness and previous experience of the schoolteachers and as related to their knowledge about childhoodasthma

Discussion

The present study reveals limited knowledge aboutchildhood asthma among school teachers in Ilesa, Nige-ria as only about one-half of the teachers scored 50 per-cent or more of the total (AKQ) questions. This is inkeeping with report by Govender and Gray from SouthAfrica13and Talieha et al14 from Pakistan. Other workersin developed and developing countries also reportedlimited or suboptimal knowledge about childhood

Socio-demographiccharacteristics

Poor childhoodasthma knowl-edge n = 68(%)

Good child-hood asthmaknowledge n= 64 (%)

p -value

SexMale 21 (30.9) 22 (34.4) 0.669Female 47 (69.1) 42 (65.6)Age20-29 12 (17.6) 9 (14.1) 0.57430-39 29 (42.6) 36 (56.3) 0.11840-50 15 (22.1) 11 (17.2) 0.48250-60 12 (17.6) 8 (12.7) 0.410

Public 20 (29.4) 27 (42.2) 0.126Private 48 (70.6) 37 (57.8)EthnicityYoruba 63 (92.6) 55 (85.9) 0.211Igbo 3 (4.4) 9 (14.1) 0.104#Others 2 (2.9) 0 (0.0) 0.503^Level of education of the teachersNCE 30 (44.1) 14 (21.9) 0.007Diploma 1 (1.4) 6 (9.4) 0.102Degree 34 (50.0) 40 (62.5) 0.206Post graduate 3(4.4) 4 (6.3) 0.698Years in teaching service< 10 34 (50.0) 40 (62.5) 0.14810 -19 18 (26.5) 14 (21.9) 0.53820 -29 13 (19.1) 10 (15.6) 0.062≥30 3 (4.4) 0 (0.0) 0.243^

Type of school

Variables Poor child-hood asthmaknowledge n= 68 (%)

Good child-hood asthmaknowledge n= 64 (%)

p -value

Personal history 3 (4.4) 6 (9.4) 0.432Close relative 10 (14.7) 15 (23.4) 0.201Previous informa-tion about asthma

36 (52.9) 50 (78.1) 0.002

Sources of informationMass media 14 (20.6) 8 (12.5) 0.213Textbooks 3 (4.4) 2 (3.1) 0.698Seminars and talks 8 (11.8) 19 (29.7) 0.011Health care workers 6 (8.8) 13 (20.3) 0.060Family and friends 6 (8.8) 10 (15.6) 0.231Had a student withasthma in class

12 (17.6) 26 (40.6) 0.004

Comfortable havingan asthmatic childin class

8 (11.8) 9 (14.1) 0.694

Seen/assisted achild with acuteasthmatic exacerba-tion

16 (23.5) 34 (53.1) 0.001

Had formal lecture/training aboutasthma

11 (16.2) 32 (50.0) 0.001

Experience with asthma

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asthma among school teachers.17-19

About one-third of the teachers had no previous experi-ence or awareness of childhood asthma. This was alsoreported by other workers from developing countries.13-

14 However high awareness or experience about child-hood asthma among school teachers in the United King-dom was reported by Bevis and Taylor.15 This relativelypoor awareness about childhood asthma in developingcountries may be related to the fact that childhood healthissues including asthma are often missing in the curricu-lum of teachers11 coupled with the non-existence of ba-sic school health education and health services in mostschools in developing countries compare to what is ob-tainable in developed countries.24

Worthy of note from the present study is that more pro-portion of the teachers got information about childhoodasthma from mass media than from health care workers.This finding was similarly reported by Talieha et al14

from Pakistan and Jiwane and Wadhva from India.18

This may be related to poor school health programmesin majority of schools in developing countries24 and thefact that health care providers may not have enough timeand patience to give comprehensive health educationincluding asthma education to their clients both in thebusy specialist clinics and in the school environment.25

These corroborate the findings in this study that even theteachers with personal history of asthma or those whohad a child or close relative with asthma did not signifi-cantly have better knowledge about asthma than others.This underscores the need for health care providers andhealth educators to provide more comprehensive infor-mation about childhood health issues including asthmato their clients and caregivers.

In the present study, the school teachers had betterknowledge of triggers and clinical manifestations ofchildhood asthma than knowledge about management ofthe disease. This finding has been reported by otherworkers assessing asthma knowledge among schoolteachers13-15 and among parents/caregivers.26 This maybe related to the domain health workers or health educa-tors lay more emphasis on during counseling sessions onchildhood asthma. Also triggers and clinical signs/symptoms are easier to conceptualise and understand byteachers and parents/caregivers alike than more confus-ing explanations of the pathogenesis and management ofchildhood asthma.

Worthy of note from this study is that the level ofknowledge of the teachers is not related to age, length ofyears in teaching services and level of education of theteachers. These findings were also noted by Govenderand Gray in South Africa13 and by Jiwane et al in In-dia.18 This may be because specific asthma educationhas been reported to be grossly inadequate and/or absentin most teachers’ training curricula.11 Furthermore, edu-cational or academic qualifications do not always trans-late to health literacy.Teachers with previous training about childhood asthmain the present study had better knowledge about the con-dition. This was corroborated by Abdel Gawwad and

El-Herishi 16 in Riyadh Saudi Arabia where the provi-sion of Information, Education and Communication(IEC) materials to school teachers significantly im-proved their level of knowledge about asthma.16 Theneed for specific training and provisions of informationabout childhood health issues to teachers and caregiversof children cannot be overemphasized.

Lots of misconceptions about childhood asthma wereobserved among the study participants. For instance,over 75.0 percent of the teachers believed childhoodasthma can be completely cured. This misconceptionwas also reported by workers from other countries.15-19

Teachers and caregivers often misconstrue well con-trolled asthmatic symptoms as “complete cure”.28 Thismay be a dangerous notion as it may lead to relaxationabout management, adherence to medications, avoidanceof triggers and possible unexpected fatal conse-quences.28-29 The implies that children and their parents/caregivers should be repeatedly educated on the need tocontinue to adhere strictly to asthma treatment planseven when asthma symptoms are well controlled.Also of note is the poor knowledge and misconceptionsof the school teachers about the management of asthmain children. More than 70 percent of the study partici-pants did not know that aspirin is not used to relieve anasthmatic attack. This is similarly reported by Govenderand Gray in South Africa.13 Aspirin may in fact precipi-tate or worsen asthma exacerbation and is best avoidedeven in the treatment of fever in children with asthmaand those with viral illness.30-31 Also most of the teach-ers did not know that antibiotics may not be useful torelieve asthma attack and appropriately used bronchodi-lators are needed. This misconception about use of anti-biotics in relieving asthma symptoms was observedamong teachers in South Africa,13 Asian Countries14,16,18

and even in developed countries.12,15,19 This may notonly lead to poorly treated symptoms of asthma but alsomay contribute to antibiotic misuse with consequentdevelopment of antibiotic resistance.32 The need forenlightenment, awareness creation and strengthening ofthe school health instruction services to educate the en-tire school personnel is of paramount importance.

Concerning childhood asthma and physical activities,two-third of the respondents in this study believed thatasthmatic children should avoid exercise and sports alto-gether. This was similarly reported by workers fromPakistan,14 India18 and South Africa13. This misconcep-tion often arises because sizeable proportion of childrenwith asthma may have exercise-induced bronchospasmduring, and often shortly after engaging in physical ac-tivities.33-34 This fact however should not prevent chil-dren with asthma from engaging in guided exercises,physical activities and school sports necessary for theiroptimal growth and development.34 Use of short-actingbronchodilator, before and after engaging in these activi-ties and pre-exercise warm-up activities among othershave been recommended as being effective to eliminate,reduce and/or treat exercise-induced bronchospasms.34

We appreciate the fact that the present study assessedonly the knowledge of the teachers about childhood

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asthma and practice of these teachers which may be dif-ferent from knowledge was not assessed. Nonetheless,the use of self-administered validated tool to assess thelevel of knowledge which also indirectly assessed theirpractice constitutes great strength of the study.In conclusion, this study has highlighted suboptimalknowledge and lots of misconceptions about childhoodasthma among schoolteachers in Ilesa, Nigeria. Thesegaps in knowledge are not related to the teachers’ age,length in teaching service and level of education. How-ever, teachers who have had formal training aboutasthma or had previous contact or experience aboutchildhood asthma exacerbations had better knowledgeabout the condition.

We hereby recommend routine training and provision ofcomprehensive information about childhood health is-sues including asthma to school teachers and otherschool personnel to ensure more school-friendly asthmaenvironment.35 This will make the school environment asafer place for children with asthma. Inclusion of com-prehensive training about childhood asthma and otherhealth related issues in the curriculum of teachers will

also be worthwhile.

Author’s contributionsKuti BP: Conceptualised the study, collected and ana-lysed the data and wrote the manuscriptKuti DK: Participated in data collection and analysis.Also revised the manuscriptOmole KO, OSO BO, Mohammed LO, Minna YA par-ticipated in data collection and critical review of themanuscript.All the authors approved the final version of the manu-script.Conflicts of interest: NoneFunding: None

Acknowledgement

The authors acknowledge the Proprietress, Principalsand Head Teachers of the selected schools for givingtheir kind permission for the conduct of the study. Theyalso acknowledge the teachers who kindly accepted toparticipate in the study.

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