Niger J Paediatr 2017; 44 (2):68 – 75
How much do school teachers
know about childhood asthma in
Accepted: 10th March 2017
the teachers had university
hood asthma is affected by events
education while only 7 (5.3%) had
Kuti BP (
and conditions of the school envi-
post graduate degree. The mean
Omole KO, Oso BO
ronment. Teachers as de-facto
(SD) score of the 40 item ques-
caregivers of children with asthma
tions was 21.5 (7.2) and majority
Department of Paediatrics,
have a major role to play in ensur-
(51.5%) had poor asthma knowl-
Wesley Guild Hospital, Ilesa,
ing good asthma control in school.
edge (score < 22). Poorer knowl-
This study set out to determine the
edge was observed in questions
level of knowledge of school
related to the nature and manage-
teacher about childhood asthma
ment of childhood asthma than
triggers and manifestations. No
Department of Paediatrics and
significant correlation was found
Child Health Obafemi Awolowo
between knowledge and age,
University, Ile-Ife, Nigeria
(two private and two public) in
teaching experience and qualifica-
Ilesa, South West Nigeria were
tions (p > 0.05). However, teachers
selected by multistage sampling
with previous training about child-
Department of Paediatrics,
method. All the teachers in these
hood asthma had relatively good
schools were required to fill a self
knowledge about the condition. (p
-administered questionnaire incor-
porating a validated
asthma knowledge questions. Fac-
edge about childhood asthma
tors associated with the level of
among school teachers in Ilesa is
knowledge were determined ap-
poor particularly as regards to na-
ture and management of the dis-
ease. We advocate for training of
(M: F = 1:2) participated in the
school teachers about common
study with 85 (64.4%) from pri-
childhood conditions including
vate school. The mean (SD) age
asthma to ensure optimal symp-
the teachers was 38.0 (9.1)
toms control in school.
years and median (IQR) years in
teaching service was 7.0 (5.0 to
15.0) years. Majority (56.1%) of
Knowledge, School teachers
School children are required to take part in physical ac-
tivities and exercise at school either formally as part of
Asthma is a chronic inflammatory airway disorder char-
physical and health education or informally as leisure
and peer activities. These physical activities are often
acterised by recurrent episodic airway narrowing mani-
festing as intermittent or persistent wheeze, chest tight-
potent triggers of acute exacerbations of asthma in chil-
dren. Poorly controlled childhood asthma is a leading
ness, breathlessness and cough. These symptoms may
resolve spontaneously or with medications. Asthma af-
cause of school absenteeism which may lead to poor
fects all age groups including school aged children. The
academic performance and ultimately to poor quality of
prevalence of childhood asthma has been reported to be
increasing worldwide. Childhood asthma is believed to
events and occurrences in schools as well as the
school environment greatly affect the asthmatic child.
affect 5-10% of school aged children in Nigeria with
another 3-5% probably unrecognized. Falade
et al in
Excessive bully by peers and teachers can cause school
2004, using ISAAC questionnaire, reported a prevalence
phobia and emotional distress which can lead to acute
7.6% among school age children in Ibadan, Nigeria.
asthmatic exacerbations and make symptoms control
Likewise the presence of triggering
Sample size estimation
factors in the school environment such as dust, fumes,
pollens, unfavourable weather conditions, certain food
The minimum sample size for this study was estimated
using open Epi sample size software.
and dust mites which the child with asthma may be per-
Based on the
sistently exposed to may also make symptoms control
assumption that 38% of teachers would have limited
Conversely, excessive protection of
knowledge of childhood asthma (from the study of Gov-
ender and Gray) and a 10% level of precision in a
children with asthma and exempting them from partici-
pating in school sports and recreational activities can
cluster of 24 schools in the local government and an
make the child feel isolated and ostracized often leading
estimated 95% respondent rate, a minimum sample size
depression and low self-esteem.
130 was obtained.
School teachers are the primary caregivers and custodi-
ans of the children under their care during the school
hours and they are often called upon to help children
with acute asthmatic exacerbations.
They are also re-
permission of the local educational authority and
quired to assist children with the use of their medica-
institutional ethical approval from the Institute of Public
tions and provide care and first aid treatment together
Health, Obafemi Awolowo University, Ile-Ife, Nigeria
with the school health workers for the children with
obtained to carry out this study. The permission and
asthma child before their parents and or health care pro-
approval of the principals and head teachers of the par-
fessionals are contacted. It is therefore very important
ticipating schools were also obtained. Consent from all
the school teachers to know about childhood asthma
teachers in the selected schools was obtained and
indeed common childhood health conditions to be
were sensitized about the nature and reasons for the
to be of meaningful assistance to the children under
The study participants were then required to fill a self-
Consequently lots of studies had been carried out to de-
administered questionnaire to capture their age, sex,
termine the level of knowledge of school teachers about
highest educational qualifications and number of years
reports of variable levels of
teaching service. Also of interest was whether the
knowledge and obvious gaps in knowledge about differ-
study participants had previous information about child-
aspects of the disease.
majority of these
asthma and the sources of the information. Per-
studies were from developed countries of Europe and
sonal and/or family history of asthma was obtained as
paucity of data
as history of previous experience with students with
from sub-Saharan Africa including Nigeria.
asthma. Also the teachers were asked if they had wit-
levels of knowledge about childhood diseases includ-
nessed or assisted any child with acute asthmatic exacer-
ing asthma may be affected by localperceptions and ex-
bations in the past. The disposition of the teachers as
periences, myths and beliefs which may differ from one
regards having a child with asthma in their classroom
place to another. It is important to assess the levels of
was also ascertained.
awareness and knowledge about childhood asthma
among school teachers in this locality. This study there-
School teachers’ Asthma knowledge assessment
fore sets out to determine the level of knowledge of
school teacher about different aspects of childhood
The level of knowledge of the school teachers about
asthma and factors influencing these levels of knowl-
childhood asthma was assessed using the Asthma
edge among school teachers in Ilesa, Nigeria.
Knowledge Questionnaire (AKQ). This was a 40-item
questions derived from previous validated questionnaire
(Govender and Gray) The questionnaire was pre-tested
a pilot study among teachers in a school different
from those selected for the study for content and face
validity of the questions.
This was a cross sectional study
Study location: The study was carried in four secondary
The AKQ has four parts thus: Part one with 11 questions
schools in Ilesa East Local Government Area, State of
assess general knowledge about childhood asthma; part
Osun, Nigeria. Ilesais the largest town in Ijesaland,
two with eight questions assess knowledge about signs
located about 200 kilometres north-east of Lagos.
and symptoms of childhood asthma; part three with 11
questions assess knowledge about common triggers of
childhood asthma, while part four with 10 questions
assessed knowledge about asthma medications and man-
The local government has 24 secondary schools, 11 pub-
agement. The study participants were required to pick
lic (middle school) and 13 Private.
of three options for each question - a “true”, “false”
were selected by multistage sampling – all the
“don’t know”. The “don’t know” option was included
schools in Ilesa East LGA were divided into two i.e.
discourage the study participants from guessing and
public and private, (the sampling frame) the two schools
only pick the options they are sure of. A score of one
were then selected each from the pools of public and
allocated for every correct answer and ‘0” for a
private schools by simple randomization method.
wrong and “don’t know” response. For the purpose of
this study, score less than 22 was considered poor or
Table 1: Socio-demographic
suboptimal knowledge of childhood asthma.
mation of the school teachers
This was done using the Statistical Programme for So-
cial Sciences (SPSS) software version 17.0 (SPSS Inc.,
Chicago 2008, IL, USA) and WinPEPI®.
variables such as sex, age categories and highest educa-
tional qualifications of the teachers were summarized
using proportions and percentages, while continuous
variables such as scores of study participants from the
Type of school
and length of time in teaching service were sum-
marized using mean and standard deviations (SDs) for
normally distributed variables and median and interquar-
tile ranges (IQR) for non-normally distributed ones. Dif-
ferences between continuous variables were analyzed
using Student’s t -test, while categorical variables were
Level of education of the teachers
analyzed using Pearson’s Chi - square test and Fisher’s
National Certificate of Education
exact test as appropriate. Pearson or Spearman rho was
Ordinary National Diploma
used to assess the correlations between school teachers’
scores in the AKQ and their ages, length of service in
the teaching profession. The level of significance at 95%
Years in teaching service
confidence interval was taken at P < 0.05.
Experience with asthma
the 150 questionnaire distributed to the schools, 132
(88.0%) were adequately filled and form the basis of
Previous information about asthma
further analysis. One hundred and thirty-two teachers
a student with asthma in class
participated in the study, 85 (64.4%) teach in private
Comfortable having an asthmatic
schools and there was female preponderance with a male
child in class
female ratio of 1: 2.
Seen/assisted a child with acute asth-
formal lecture/training about
Socio-demographic characteristics of the study partici-
Experience with childhood asthma
These are highlighted in Table 1.
Eighty-six (65.2%) of the teachers were aware or had
Age of the study participants:
of the school
previous knowledge about childhood asthma and the
teachers ranged from 20 to 60 years with a mean (SD) of
sources of their information are highlighted in figure 1.
(9.2) years. About one-half of the teachers were in
About one-third (46) of the teachers however had no
the age range of 30 to 39 years.
previous knowledge about childhood asthma.
Thirty-eight (28.8%) of the teachers gave a history of
Yoruba ethnicity which was the predominant ethnic
having had a student with asthma in their class either
group in the study location; the other tribes represented
presently or in the past, 50 (37.9%) had seen or assisted
were Igbos (9.1%); Ebiras and Edos. (Table 1)
child with acute asthmatic exacerbation, 43 (32.6%)
Level of education :
had received a talk, lecture or training about childhood
ers had university or Polytechnics education up to BSC/
asthma, but only 17 (12.9%) of the teachers are comfort-
or Higher National Diploma (HND). The distribu-
able having an asthmatic child in their classroom.
tion of the highest level of educational qualifications of
the teachers is presented in table 1.
Fig 1: source
Teaching experience :
ing profession of the teachers ranged from one to 35
years with median (IQR) of 7.0 (5.0 – 15.0) years. The
majority (56.1%) had less than 10-year teaching experi-
ence, only three (2.3%) of the teachers had spent 30
years 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 with
Level of knowledge of the teachers about childhood
Table 3: The
asthma using the 40-item AKQ: The AKQ
questions relating to signs/symptoms and triggers of exacerba-
the teachers ranged from 3 (7.5% of the obtainable
tion of childhood asthma
score) to 34 (85.0% of the obtainable score). The mean
Questions related to signs
(SD) score was 21.5 (7.2) and 68 (51.5%) of the teachers
were considered to have poor knowledge about child-
hood asthma (AKQ score < 22 of the 40 item questions).
Symptoms of asthma
difficulty in breathing,
Domains of knowledge: The
cough and wheezing?
four domains of knowledge tested by the AKQ are high-
Asthmatic attacks are
lighted in tables 2 to 5. The teachers demonstrated rela-
more usually occur in day
tively higher level of knowledge about triggers of child-
time as compare to night?
3.Asthma attack can cause
hood acute exacerbation and clinical manifestations of
childhood asthma than general knowledge about the
4.Asthma can be com-
disease. The poorest level of knowledge was demon-
strated in question regarding management of the disease.
Inhalers are used to treat
Only 6.8% of the study participants knew that asthma is
Asthma can affect stu-
not due to dilatation of the bronchi, while majority
(>80.0%) knew that breathlessness, cough and wheeze
Asthmatic children have
features of childhood asthma and that house dust
Peak flow meters are
mites can trigger acute asthmatic exacerbations. (Tables
used to determine the
severity of asthma?
Significantly there were higher scores in question related
Mean (SD) score 81.8
clinical features of childhood asthma compared to
Questions related to trig-
general knowledge about the disease [81.8 (37.1) vs.
of acute exacerbation
64.7 (3.3); t =5.27; p <0.001]. Likewise the teachers
demonstrated significantly more knowledge about the
Every patient has his
triggers 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
House dust mites
general questions about childhood asthma
Certain food and drugs
Fur of animals
General knowledge about asthma:
Asthma is a lung disease?
Mean (SD) 84.4 (21.3)
Asthma is a communicable dis-
ease;it spread from one person to
Table 4: The
Asthma is a hereditary disease?
questions about childhood asthma medications and
Asthma is a primary emotional
disorder that needs psychological
Sometimes asthma can be caused
an infection due to microorgan-
Antibiotics are used to relieve an
Asthma is a chronic disease
which needs treatment for long
Aspirin is used to relieve an
Asthma predominantly effect
used to relieve an
Asthma occurs in specific age
Oxygen therapy is required in
very severe asthma attacks?
Asthma attack occurs due to
cause a rapid
dilatation of the bronchi?
pulse rate, palpitations and trem-
Asthma attack occurs due to
inflammation of the bronchiduring
Asthmatic children should avoid
exercise and sports?
The bronchi are blocked with
Preventative medication can be
phlegm during attack
taken by the asthmatic childbefore
exercise and sports?
Mean (SD) score 64.7 (3.3)
Swimming is a good sport for
With appropriate treatment most
children should lead a normal life
with no restrictions on activity?
Self-medication should be
discouraged in the management of
asthma in children?
Mean (SD) score 47.2 (31.4)
Level of knowledge as related to experience with
childhood asthma among the teachers:
Level of knowledge as related to socio-demographic
lights the association between experience of the teachers
characteristics of the teachers:
about asthma as related to good and poor knowledge of
Table 5 highlights the association between socio-
demographic characteristics of the school teachers as
Teachers who have had previous lectures/training about
related to their having good or poor knowledge about
childhood asthma had significantly better knowledge
about the disease compared to those without previous
significant association between the level of knowl-
lecturers/training. (x = 9.210; p = 0.02). Likewise teach-
(poor or good knowledge) of the teachers and the
whose source of information about childhood asthma
sex, type of school, and ethnicity of the teachers.
formal seminar/talks had better knowledge about the
disease compared to those who acquired their informa-
Correlation between knowledge level and age, teach-
tion from other sources including from health care work-
ing experience and qualifications of the teachers:
ers. (Table 6). Also significantly related to having good
There was a weakly negative correlation between the
knowledge about childhood asthma among the teachers
level of knowledge of the teachers about childhood and
was having had an encounter with student with asthma
their age (Pearson Correlation -0.102; p = 0.242) as well
either having had an asthmatic child in class or assisted
the length of service in the teaching profession
child with acute asthmatic exacerbation. However per-
(Pearson Correlation -0.127; p = 0.145) though not sta-
sonal history of asthma or history of asthma in a close
tistically significant. However teachers with NCE have
relative of the teachers was not significantly associated
significantly poor knowledge about childhood asthma
with higher level of knowledge among the teachers.
than those with higher qualifications. (Table 5) The level
childhood asthma knowledge correlated positively
with the level of education of the teachers, though not
Table 6: Awareness
statistically significant (Pearson Correlation 0.126; p
teachers and as related to their knowledge about childhood
Table 5: Socio-demographic
mation of the school teachers and as related to their knowledge
about childhood asthma
Experience with asthma
edge n = 68
tion about asthma
Sources of information
Seminars and talks
Health care workers
Family and friends
a student with
asthma in class
Type of school
child with acute
Level of education of the teachers
Years in teaching service
The present study reveals limited knowledge about
childhood 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 in
*National certificate of Education; # Fischer’s Exact applied;
keeping with report by Govender and Gray from South
Africa and Talieha et
al from Pakistan. Other workers
^Yate’s Correction applied
developed and developing countries also reported
limited or suboptimal knowledge about childhood
asthma among school teachers.
Riyadh Saudi Arabia where the provi-
About one-third of the teachers had no previous experi-
sion of Information, Education and Communication
ence or awareness of childhood asthma. This was also
(IEC) materials to school teachers significantly im-
proved their level of knowledge about asthma. The
reported by other workers from developing countries.
However high awareness or experience about child-
need for specific training and provisions of information
hood asthma among school teachers in the United King-
about childhood health issues to teachers and caregivers
dom was reported by Bevis and Taylor. This relatively
children cannot be overemphasized.
poor awareness about childhood asthma in developing
countries may be related to the fact that childhood health
Lots of misconceptions about childhood asthma were
issues including asthma are often missing in the curricu-
observed among the study participants. For instance,
lum of teachers coupled with the non-existence of ba-
over 75.0 percent of the teachers believed childhood
sic school health education and health services in most
asthma can be completely cured. This misconception
was also reported by workers from other countries.
schools in developing countries compare to what is ob-
tainable in developed countries.
Teachers and caregivers often misconstrue well con-
trolled asthmatic symptoms as “complete cure”.
Worthy of note from the present study is that more pro-
may be a dangerous notion as it may lead to relaxation
portion of the teachers got information about childhood
about management, adherence to medications, avoidance
asthma from mass media than from health care workers.
triggers and possible unexpected fatal conse-
This finding was similarly reported by Talieha
implies that children and their parents/
from Pakistan and Jiwane and Wadhva from India.
caregivers should be repeatedly educated on the need to
This may be related to poor school health programmes
continue to adhere strictly to asthma treatment plans
majority of schools in developing countries and the
even when asthma symptoms are well controlled.
fact that health care providers may not have enough time
Also of note is the poor knowledge and misconceptions
and patience to give comprehensive health education
the school teachers about the management of asthma
including asthma education to their clients both in the
children. More than 70 percent of the study partici-
busy specialist clinics and in the school environment.
pants did not know that aspirin is not used to relieve an
These corroborate the findings in this study that even the
asthmatic attack. This is similarly reported by Govender
Gray in South Africa. Aspirin may in fact precipi-
teachers with personal history of asthma or those who
a child or close relative with asthma did not signifi-
or worsen asthma exacerbation and is best avoided
cantly have better knowledge about asthma than others.
in the treatment of fever in children with asthma
those with viral illness.
underscores the need for health care providers and
most of the teach-
health educators to provide more comprehensive infor-
did not know that antibiotics may not be useful to
mation about childhood health issues including asthma
relieve asthma attack and appropriately used bronchodi-
their clients and caregivers.
lators are needed. This misconception about use of anti-
biotics in relieving asthma symptoms was observed
among teachers in South Africa, Asian Countries
the present study, the school teachers had better
even in developed countries.
knowledge of triggers and clinical manifestations of
This may not
childhood asthma than knowledge about management of
only lead to poorly treated symptoms of asthma but also
the disease. This finding has been reported by other
may contribute to antibiotic misuse with consequent
development of antibiotic resistance.
workers assessing asthma knowledge among school
The need for
and among parents/caregivers.
enlightenment, awareness creation and strengthening of
related to the domain health workers or health educa-
the school health instruction services to educate the en-
tors lay more emphasis on during counseling sessions on
tire school personnel is of paramount importance.
childhood asthma. Also triggers and clinical signs/
symptoms are easier to conceptualise and understand by
Concerning childhood asthma and physical activities,
teachers and parents/caregivers alike than more confus-
two-third of the respondents in this study believed that
ing explanations of the pathogenesis and management of
asthmatic children should avoid exercise and sports alto-
gether. This was similarly reported by workers from
Pakistan, India and South Africa . This misconcep-
Worthy of note from this study is that the level of
tion often arises because sizeable proportion of children
knowledge of the teachers is not related to age, length of
with asthma may have exercise-induced bronchospasm
years in teaching services and level of education of the
during, and often shortly after engaging in physical ac-
teachers. These findings were also noted by Govender
This fact however should not prevent chil-
and Gray in South Africa and by Jiwane
et al in In-
dren with asthma from engaging in guided exercises,
dia. This may be because specific asthma education
physical activities and school sports necessary for their
optimal growth and development. Use of short-acting
been reported to be grossly inadequate and/or absent
most teachers’ training curricula. Furthermore, edu-
bronchodilator, before and after engaging in these activi-
cational or academic qualifications do not always trans-
ties and pre-exercise warm-up activities among others
late to health literacy.
have been recommended as being effective to eliminate,
reduce and/or treat exercise-induced bronchospasms.
Teachers with previous training about childhood asthma
the present study had better knowledge about the con-
appreciate the fact that the present study assessed
dition. This was corroborated by Abdel Gawwad and
only the knowledge of the teachers about childhood
asthma and practice of these teachers which may be dif-
also be worthwhile.
ferent from knowledge was not assessed. Nonetheless,
the use of self-administered validated tool to assess the
level of knowledge which also indirectly assessed their
Kuti BP: Conceptualised the study, collected and ana-
practice constitutes great strength of the study.
lysed the data and wrote the manuscript
conclusion, this study has highlighted suboptimal
Kuti DK: Participated in data collection and analysis.
knowledge and lots of misconceptions about childhood
Also revised the manuscript
asthma among schoolteachers in Ilesa, Nigeria. These
Omole KO, OSO BO, Mohammed LO, Minna YA par-
gaps in knowledge are not related to the teachers’ age,
ticipated in data collection and critical review of the
length in teaching service and level of education. How-
ever, teachers who have had formal training about
All the authors approved the final version of the manu-
asthma or had previous contact or experience about
childhood asthma exacerbations had better knowledge
Conflicts of interest :
about the condition.
hereby recommend routine training and provision of
comprehensive information about childhood health is-
including asthma to school teachers and other
school personnel to ensure more school-friendly asthma
authors acknowledge the Proprietress, Principals
environment. This will make the school environment a
Head Teachers of the selected schools for giving
safer place for children with asthma. Inclusion of com-
their kind permission for the conduct of the study. They
prehensive training about childhood asthma and other
acknowledge the teachers who kindly accepted to
health related issues in the curriculum of teachers will
participate in the study.
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