Improving asthma case detection among children and adolescents through clinic-based screening in primary care health facilities in Uganda: a cluster randomised trial

Introduction Underdiagnosis of asthma in children and adolescents is a major challenge, particularly in low-resource settings. We aim to assess the clinical and cost-effectiveness of screening for asthma symptoms among children and adolescents with respiratory symptoms presenting at primary care health facilities in Uganda. The feasibility and acceptability of routine screening will also be explored. Methods and analysis A cluster-randomised trial, using screening for asthma symptoms as the intervention, will be conducted in health centres in Jinja region, Eastern Uganda. We hypothesise that screening for asthma symptoms at clinical care points will lead to an increase in the proportion of children diagnosed with asthma. The health centres will be randomised into intervention and control arms. In the intervention sites, 1050 children aged 2 months to 17 years with respiratory symptoms will be screened for asthma symptoms using the International Study on Asthma and Allergies in Children verbal questionnaire. History and physical examination will be conducted among the screen positives to identify those with asthma. Data on asthma diagnoses 12 months before the intervention and during the intervention will be collected from both the control and intervention health centres. Data on direct and indirect costs of screening will be collected prospectively. Focus group discussions (FGDs) will be conducted among health workers and key informant interviews (KII) among facility in-charges at the intervention sites to assess the feasibility and acceptability of the intervention. The primary outcome will be the proportion of asthma diagnoses. A random-effects logistic regression model, adjusting for baseline data while accounting for facility level clustering, will be used to assess the effectiveness of screening. Cost-effectiveness will be assessed by computing the incremental cost-effectiveness ratio. Framework analysis will be used to analyse data from the FGDs and KIIs. Ethics and dissemination Ethics approval was obtained from Makerere University School of Public Health Research and Ethics Committee (SPH-2024-552), Uganda National Council for Science and Technology (HS4136ES) and the Queen Mary University of London Research Ethics Committee in the UK (QME24.0514). All participants will provide written informed consent. Children aged 8 years and above will provide assent, in addition to consent by their parents/caregivers. The study results will be disseminated through publications in peer reviewed journals, conferences, participant feedback meetings and Makerere University Lung Institute website. Policy briefs will be shared with key stakeholders including the Ministry of Health and Jinja District/City administrators. Trial registration number ISRCTN16018011 .