Influence of caregiver knowledge of home asthma management on health outcomes of children in low- and middle-income countries: A systematic review

Emily M Nyaga; Sweccha Guntamukkala; Mackenzie Noell; Shawn S Fan; Janet Jelal; Arielle Warren; Justus Simba; Julie A Zuniga; O'Brien M Kyololo

doi:10.1016/j.pedn.2025.06.019

Influence of caregiver knowledge of home asthma management on health outcomes of children in low- and middle-income countries: A systematic review

J Pediatr Nurs. 2025 Jun 13:84:217-225. doi: 10.1016/j.pedn.2025.06.019. Online ahead of print.

Authors

Emily M Nyaga¹, Sweccha Guntamukkala², Mackenzie Noell², Shawn S Fan², Janet Jelal³, Arielle Warren², Justus Simba⁴, Julie A Zuniga², O'Brien M Kyololo⁵

Affiliations

¹ Moi University, Eldoret, Kenya. Electronic address: nyaga.emily@mu.ac.ke.
² The University of Texas at Austin, Austin, TX, USA.
³ Moi University, Eldoret, Kenya.
⁴ Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
⁵ Moi University, Eldoret, Kenya; Aga Khan University, Nairobi, Kenya.

PMID: 40516291
DOI: 10.1016/j.pedn.2025.06.019

Abstract

Background: Low- and Middle-income Countries (LMICs) bear the highest burden of childhood asthma globally. More than 90 % of asthma-related deaths and 84 % of disability-adjusted life-years associated with childhood asthma occur in LMICs. To reduce the overall burden of childhood asthma in LMICs, concerted efforts have focused on enhancing caregiver knowledge regarding symptom management, adherence to medications, and addressing misconceptions about the disease. The overall impact of these efforts at improving the outcomes in children with asthma in LMICs is mainly unknown.

Research question: How does caregivers' knowledge of home asthma management influence the health outcomes of children in LMICs?

Methods: PRISMA guided this systematic review. PubMed, Web of Science, and CINAHL databases were searched for original studies published between January 2014 and May 2025. Retrieved articles were imported into Covidence (https://www.covidence.org) for management. At least two researchers independently screened articles during each phase of the review. Study quality assessment tools were used to assess the quality of studies.

Results: The search yielded 1425 articles, of which 24 met the inclusion criteria. Caregivers' knowledge of asthma was associated with favorable childhood asthma outcomes. More specifically, caregivers with better knowledge about the disease reported better symptom management, adherence to medication instructions, correct inhaler use technique, reduced hospital visits, and fewer rehospitalizations.

Conclusion: Good caregiver knowledge results in improved outcomes in children with asthma in LMICs.

Practice implications: Developing strategies that enhance caregivers' knowledge has the potential to reduce the burden of childhood asthma in resource-limited settings.

Keywords: Asthma; Caregivers; Children; Health outcomes; Home management; Knowledge; Low- and middle-income countries.

Publication types

Review