Noncommunicable Lung Disease in Sub-Saharan Africa. A Community-based Cross-Sectional Study of Adults in Urban Malawi

Article, Other literature type English OPEN
Meghji, Jamilah ; Nadeau, Gilbert ; Davis, Kourtney J. ; Wang, Duolao ; Nyirenda, Moffat J. ; Gordon, Stephen B. ; Mortimer, Kevin (2016)

Rationale\ud Non-communicable diseases (NCD) are major causes of morbidity and mortality in sub-Saharan Africa (sSA). Valid burden of disease estimates are lacking for non-communicable lung disease in sSA.\ud Objectives\ud We performed a community-based survey to determine the prevalence of chronic lung disease amongst adults ≥18 years in Malawi, using ATS standard spirometry, internationally validated respiratory symptom and exposure questionnaires, and including assessment of HIV-status.\ud Methods\ud An age and gender stratified random sample of 2000 adults was taken from the population of Chilomoni district of Blantyre, Malawi. Fieldworkers collected questionnaire data, conducted HIV-testing and performed pre/post bronchodilator spirometry on eligible\ud participants. Survey-weighted population prevalence estimates of respiratory symptoms and spirometric abnormalities were computed, and bivariate and multivariable regression were used to identify associated variables.\ud Results\ud Questionnaire data, HIV status and BOLD standard spirometry were obtained from 1059, 937 and 749 participants respectively. Current respiratory symptoms, exposure to biomass and ever smoking were reported by 11.8%, 85.2% and 10.4% respectively. HIV prevalence\ud was 24.2%. Moderate-severe airway obstruction was seen in 3.6%. The prevalence of spirometric restriction was 38.6% using NHANES reference ranges and 9.0% using local reference ranges. Age was positively associated with obstruction while low BMI was associated with restriction.\ud Conclusions\ud Over 40% of the Malawian adults in our urban population-representative sample had abnormal lung function (mostly restrictive) in the context of widespread exposure to biomass smoke and high HIV prevalence. These findings have potentially major pubic health implications for Malawi and the broader sSA region.
  • References (20)
    20 references, page 1 of 2

    1. World Health Organisation. Global Status Report on noncommunicable diseases, 2014. Geneva, Switzerland: World Health Organisation; 2014.

    2. World Health Organisation. Global Action Plan for the prevention and control of non-communicable diseases, 2013-2020. Geneva, Switzerland: World Health Organisation; 2013.

    3. GBD 2013 Mortality and Cause of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385: 117-171.

    4. Beran D, Zar HJ, Perrin C, Menezes AM, Burney P. Burden of asthma and chronic obstructive pulmonary disease and access to essential medicines in lowincome and middle-income countries. Lancet Respir Med 2015; 3: 159-170.

    5. Finney LJ, Feary JR, Leonardi-Bee J, Gordon SB, Mortimer K. Chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review. Int J Tuberc Lung Dis 2013; 17: 583-589.

    6. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, Menezes AMB, Sullivan SD, Lee TA, Weiss KB, Jensen RL, Marks GB, Gulsvik A, Nizankowska-Mogilnicka E. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet 2007; 370: 741-750.

    7. Stocks J, Hislop A, Sonnappa S. Early lung development: lifelong effect on respiratory health and disease. Lancet Respir Med 2013; 1: 728-742.

    8. Salvi SS, Barnes PJ. Chronic obstructive pulmonary disease in non-smokers. Lancet 2009; 374:733-743.

    9. World Health Organisation. Global tuberculosis report 2014. Geneva, Switzerland: World Health Organisation.

    10. Ehrlich RI, Adams S, Baatjies R, Jeebhay MF. Chronic airflow obstruction and respiratory symptoms following tuberculosis: a review of South African studies. Int J Tuberc Lung Dis 2011; 15: 886-891.

  • Metrics
    No metrics available
Share - Bookmark