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Effect of School-Based Asthma Screening on Asthma Detection among Secondary School Students in Nigeria

Abstract

Asthma remains an important chronic respiratory health concern among secondary school students in Nigeria and may affect students' physical activity, school attendance, academic participation, sleep, and overall quality of life. Asthma symptoms may include recurrent wheezing, coughing, chest tightness, and shortness of breath, but some students may experience mild or intermittent symptoms that remain unrecognized or may be mistaken for other respiratory conditions. Undetected asthma may result in delayed treatment, recurrent symptoms, avoidable school absenteeism, emergency healthcare utilization, and limitations in daily activities. Secondary school students may also encounter environmental triggers such as dust, smoke, air pollution, allergens, poor indoor air quality, and other respiratory irritants. School-based asthma screening provides an opportunity to identify students with symptoms suggestive of asthma through systematic assessment conducted within schools, followed by appropriate clinical evaluation and referral. Early detection may facilitate timely diagnosis, asthma education, trigger avoidance, appropriate treatment, and development of individualized asthma management plans where clinically indicated. However, inadequate school health programmes, limited access to trained healthcare personnel, insufficient diagnostic resources, low awareness among students, teachers, and parents, and weak referral and follow-up systems may limit the effectiveness of school-based asthma screening in Nigeria. Against this background, this study investigates the effect of school-based asthma screening on asthma detection among secondary school students in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how students' and parents' perceptions of susceptibility to asthma, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in school-based asthma screening. The Social Ecological Model emphasizes the influence of individual, family, school, community, and environmental factors on respiratory health, asthma-related behaviours, healthcare utilization, and access to health services. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective school-based respiratory screening and management programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how school-based asthma screening may influence asthma detection among secondary school students in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise students enrolled in selected public and private secondary schools across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, schools, classes, and eligible students. School-based asthma screening will be measured using indicators such as availability of asthma screening programmes, screening coverage, frequency of screening activities, assessment of asthma-related symptoms, respiratory health questionnaires, peak expiratory flow assessment where appropriate, assessment of asthma risk factors and environmental triggers, availability of trained healthcare personnel, screening equipment, asthma health education, and referral arrangements. Asthma detection will be assessed using indicators such as recurrent wheezing, chronic or recurrent cough, shortness of breath, chest tightness, exercise-related respiratory symptoms, suspected asthma cases, newly identified students with symptoms suggestive of asthma, referrals for clinical assessment, diagnostic confirmation following appropriate medical evaluation, and linkage to asthma management services. Data will be collected using structured questionnaires, school screening registers, respiratory assessment forms, peak flow records where applicable, school health records, healthcare facility records, referral registers, and relevant school health programme documents. Descriptive statistics will be used to summarize students' characteristics, respiratory symptoms, screening coverage, and patterns of asthma detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of school-based asthma screening on asthma detection. Where appropriate, asthma detection rates before and after implementation of school-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that school-based asthma screening has a significant positive effect on asthma detection among secondary school students in Nigeria. Students who participate in school-based asthma screening are expected to have a higher likelihood of having previously unrecognized asthma or asthma-related respiratory symptoms identified than students without access to such screening. Systematic screening may facilitate early recognition of recurrent respiratory symptoms and provide opportunities for appropriate clinical assessment and diagnostic evaluation. Early detection may support timely asthma management, health education, identification and avoidance of triggers, appropriate medication use, and monitoring of respiratory symptoms. Conducting screening within schools may reduce geographical, financial, and time-related barriers while reaching students who may not routinely access healthcare services. School-based asthma education may also improve students', teachers', and parents' awareness of asthma symptoms, triggers, first-aid responses, and the importance of appropriate medical care. Conversely, inadequate screening coverage, limited diagnostic facilities, shortage of trained healthcare personnel, low student participation, inadequate parental involvement, and weak referral and follow-up systems may reduce the effectiveness of school-based asthma screening. The study therefore expects accessible and well-organized school-based asthma screening to contribute significantly to improved detection and early management of asthma among secondary school students in Nigeria. The study is expected to contribute to the literature on school-based asthma screening, asthma detection, adolescent respiratory health, chronic respiratory disease prevention, school health services, respiratory health education, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, Federal Ministry of Education, National Primary Health Care Development Agency, state ministries of health and education, secondary schools, healthcare providers, respiratory physicians, paediatricians, school health coordinators, parents, development partners, and policymakers regarding strategies for improving asthma detection and management among students. The study will also provide evidence-based recommendations for expanding school-based asthma screening programmes, strengthening respiratory health education, improving access to appropriate diagnostic assessment, increasing availability of trained healthcare personnel and screening equipment, improving environmental health within schools, strengthening referral and follow-up systems, increasing student and parental awareness of asthma symptoms and triggers, and integrating asthma screening into comprehensive school health programmes across Nigeria.

Keywords: School-based asthma screening, asthma detection, secondary school students, adolescent respiratory health, asthma, respiratory screening, chronic respiratory disease, school health services, preventive healthcare, health education, Nigeria, public health.