Prevalence and determinants of uncontrolled asthma among secondary school-going adolescents in Kampala City, Uganda: findings from a cross-sectional study

The Uganda Ministry of Health Sector Performance Report 2022 highlights a salient increase in non-communicable, genetic and environmentally engineered diseases such as asthma among Ugandans, mostly the children. Much of the effort towards controlling asthma is geared towards early and middle childhood when asthma is more frequent. Adolescents in school, face a high risk of poor asthma control due to limited health care access, inadequate school support, and low adherence to treatment. However, uncontrolled asthma among adolescents aged 12–19 years in Kampala is under studied. This study investigated the prevalence and determinants of uncontrolled asthma among adolescents in selected secondary schools in Kampala City, Uganda. This cross-sectional study involved 263 secondary school adolescents who had a documented history of asthma in Kampala city, Uganda. The participants provided written informed consent or assent with parental/legal guardian consent. Multistage sampling was done to select the participating secondary schools and adolescents with asthma. Data were collected using self-administered questionnaires based on the International Study of Asthma and Allergies in Childhood (ISAAC) and the Asthma Control Test (ACT). Asthma control was categorized as well controlled (ACT ≥ 20) or not well controlled (“Uncontrolled”, ACT ≤ 19). Descriptive statistics and bivariate analyses were performed, followed by multivariate mixed-effects logistic regression models to account for clustering of participants within schools and identify determinants of uncontrolled asthma. The study found poor asthma control in 81.8% of the enrolled adolescents. The environmental determinants influenced asthma control; adolescents exposed to moulds were four times more likely to have uncontrolled asthma (AOR = 3.84, 95% CI: 1.02, 14.46; p = 0.047), and reliance on public transport significantly increased the odds of having uncontrolled asthma (AOR = 5.75, 95% CI: 1.38, 24.05; p = 0.016). Self-reported uncontrolled asthma was observed among secondary school adolescents with a documented history of asthma in Kampala. Environmental factors, such as reliance on public transport and household mould exposure, significantly contributed to poor asthma control. To address these, efforts should focus on reducing exposure through improved home ventilation and mould control, promoting safer and less polluted commuting options for students, and enhancing school-based asthma management. We recommend regular asthma screening, teacher training, and better access to care in schools to enhance its early detection and control.