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Al-Ahmad M, Al Zaabi A, Madkour A, Alqaraghuli HA, Al Hayaan H, Mobayed H, Idrees M, Al Busaidi N, Zeineldine S. Expert consensus on oral corticosteroids stewardship for the treatment of severe asthma in the Middle East and Africa. Respir Med 2024; 228:107674. [PMID: 38782138 DOI: 10.1016/j.rmed.2024.107674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 05/25/2024]
Abstract
In the Middle East and Africa (MEA) region, overuse of oral corticosteroids (OCS) for asthma management, both as burst and maintenance therapy, poses a significant challenge. Gaps in knowledge regarding the need to taper OCS in patients with severe asthma and the use of OCS in comorbid conditions have been noted. OCS stewardship can help attain optimal and effective OCS tapering along with reducing OCS overuse and over-reliance. In this paper, we discuss current practices regarding the use of OCS in asthma, globally and in the MEA region. Expert recommendations for achieving OCS stewardship in the MEA region have also been presented. Regional experts recommend increasing awareness among patients about the consequences of OCS overuse, engaging community pharmacists, and educating primary healthcare professionals about the benefits of prompt appropriate referral. Innovative local referral tools like ReferID can be utilized to refer patients with asthma to specialist care. The experts also endorse a multidisciplinary team approach and accelerating access to newer medicines like biologics to implement OCS stewardship and optimize asthma care in the MEA region.
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Affiliation(s)
- Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait.
| | | | | | | | | | | | - Majdy Idrees
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Kokori E, Olatunji G, Mustapha MJ, Fawehinmi P, Onyia A, Omoworare O, Akinmeji O, Solomon S, Olafimihan A, Ologbe D, Aderinto N. The potential of smart inhaler for asthma management in Sub-Saharan Africa. Ann Med Surg (Lond) 2024; 86:2408-2410. [PMID: 38694290 PMCID: PMC11060201 DOI: 10.1097/ms9.0000000000002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 05/04/2024] Open
Affiliation(s)
- Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | | | | | | | - Adrian Onyia
- College of Medicine, University of Nigeria, Nsukka
| | - Oluwatobi Omoworare
- Department of Medicine and Surgery, Lagos State University College of Medicine, Lagos
| | - Olufemi Akinmeji
- Department of Medicine and Surgery, Olabisi Onabanjo University Teaching Hospital, Ogun
| | - Samuel Solomon
- Department of Medicine and Surgery, University of Ilorin, Ilorin
| | | | - Damilola Ologbe
- William Harvey Hospital, Kennington Rd, Willesborough, Ashford, Kent, UK
| | - Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University Teaching Hospital, Ogbomoso, Nigeria
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Lu MY, Shobnam N, Livinski AA, Saksena S, Salters D, Biete M, Myles IA. Examining allergy related diseases in Africa: A scoping review protocol. PLoS One 2024; 19:e0297949. [PMID: 38377144 PMCID: PMC10878524 DOI: 10.1371/journal.pone.0297949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024] Open
Abstract
During recent decades, allergy related diseases have emerged as a growing area of concern in developing regions of the world, including Africa. Worldwide prevalence of allergic diseases has grown to an estimated 262 million for asthma, 400 million for allergic rhinitis (or hay fever), 171 million with atopic dermatitis (or eczema), and over 200 million for food allergy. In Africa, considerable variability exists in the data surrounding prevalence at the continent-wide, regional, and study site levels. Furthermore, research conducted in many rural areas and underdeveloped countries in Africa remains limited, and presently, little has been done to characterize and map the extremely heterogeneous body of literature which confounds research efforts. This scoping review will seek to identify studies examining the prevalence, management strategies, outcomes, and associated risk factors for allergy related diseases in Africa. The Joanna Briggs Institute's scoping review methods will be followed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) was used for writing the protocol. Four databases (Embase, Global Health, PubMed, African Journals Online) will be searched for literature published from 2003 to 2023 in any language. Title and abstract screening and full-text screening will be completed by two independent reviewers using Covidence; conflicts resolved by a third reviewer. Data will be extracted using Covidence by two reviewers independently. To report the results, we will follow the PRISMA-ScR checklist and report descriptive statistics and a narrative summary.
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Affiliation(s)
- Max Yang Lu
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Nadia Shobnam
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alicia A. Livinski
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sarini Saksena
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Dylan Salters
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michelle Biete
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Ian A. Myles
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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Mebrahtom G, Hailay A, Mariye T, Haile TG, Girmay G, Zereabruk K, Aberhe W, Tadesse DB. Chronic obstructive pulmonary disease in East Africa: a systematic review and meta-analysis. Int Health 2024:ihae011. [PMID: 38324403 DOI: 10.1093/inthealth/ihae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/22/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a common lung disease that causes restricted airflow and breathing problems. Globally, COPD is the third leading cause of death and low- and middle-income countries account for the majority of these deaths. There is limited information on COPD's prevalence in East Africa. Thus the purpose of this systematic review and meta-analysis is to estimate the pooled prevalence of COPD in East Africa.A computerized systematic search using multiple databases was performed in search of relevant English articles from the inception of the databases to August 2023. All the authors independently extracted the data. R and RStudio software were used for statistical analysis. Forest plots and tables were used to represent the data. The statistical heterogeneity was evaluated using I2 statistics. There was heterogeneity between the included articles. Therefore, a meta-analysis of random effects models was used to estimate the overall pooled prevalence of COPD in East Africa. A funnel plot test was used to examine possible publication bias.The database search produced 512 papers. After checking for inclusion and exclusion criteria, 43 full-text observational studies with 68 553 total participants were found suitable for the review. The overall pooled prevalence of COPD in East Africa was 13.322%. The subgroup analysis found the COPD pooled prevalence in the different countries was 18.994%, 7%, 15.745%, 9.032%, 15.026% and 11.266% in Ethiopia, Uganda, Tanzania, Malawi, Sudan, and Kenya, respectively. Additionally, the subgroup analysis of COPD by study setting among community-based studies was 12.132% and 13.575% for hospital-based studies.According to the study's findings, approximately one of every seven individuals in East Africa has COPD, indicating a notably high prevalence of the disease. Thus governments and other stakeholders working on non-communicable disease control should place an emphasis on preventive measures to minimize the burden of COPD.
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Affiliation(s)
- Guesh Mebrahtom
- Department of Adult Health Nursing, College of Health Science, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Abrha Hailay
- Department of Adult Health Nursing, College of Health Science, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Teklewoini Mariye
- Department of Adult Health Nursing, College of Health Science, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Teklehaimanot Gereziher Haile
- Department of Maternity and Neonatal Nursing, College of Health Science, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Goitom Girmay
- Department of Clinical Midwifery, College of Health Science, Aksum University, Aksum, Ethiopia
| | - Kidane Zereabruk
- Department of Adult Health Nursing, College of Health Science, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Woldu Aberhe
- Department of Adult Health Nursing, College of Health Science, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Degena Bahrey Tadesse
- Department of Adult Health Nursing, College of Health Science, School of Nursing, Aksum University, Aksum, Ethiopia
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Zaniku HR, Connolly E, Aron MB, Matanje BL, Ndambo MK, Complex Talama G, Munyaneza F, Ruderman T, Rylance J, Dullie LW, Lalitha R, Banda NPK, Muula AS. Prevalence and Associated Factors of Chronic Obstructive Pulmonary Disease Among Adults in Neno District, Malawi: A Cross-Sectional Analytical Study. Int J Chron Obstruct Pulmon Dis 2024; 19:389-401. [PMID: 38343494 PMCID: PMC10854231 DOI: 10.2147/copd.s444378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) continues to pose a global public health challenge. However, literature is scarce on the burden of COPD in Malawi. We assessed the prevalence and risk factors for COPD among adults in Neno, Malawi. Methodology We conducted a population-based analytical cross-sectional study in Neno District between December 2021 and November 2022. Using a multi-stage sampling technique, we included 525 adults aged≥40 years. All participants underwent spirometry according to the American Thoracic Society (ATS) guidelines and were interviewed using the IMPALA questionnaire. For this study, we utilized the definition of COPD as a post-bronchodilator FEV1/FVC <0.70. We collected data using Kobo collect, exported to Microsoft Excel, and analysed using R software. We used descriptive statistics and logistic regression analysis; a p-value of <0.05 was considered statistically significant. Results Out of 525 participants, 510 participants were included in the final analysis. Fifty-eight percent of the participants were females (n=296), and 62.2% (n=317) were between 40 and 49 years with a median (IQR) age of 46 (40-86). For patient characteristics, 15.1% (n=77) were current smokers, and 4.1% (n=21) had a history of pulmonary tuberculosis (PTB). Cough was the most commonly reported respiratory symptom (n=249, 48.8%). The prevalence of COPD was 10.0% (n=51) and higher (15.0%) among males compared to females (6.4%). Factors significantly associated with COPD were age 60 years and above (adjusted odds ratio [aOR] = 3.27, 95% CI: 1.48-7.34, p<0.004), ever smoked (aOR = 6.17, 95% CI:1.89-18.7, p<0.002), current smoker (aOR = 17.6, 95% CI: 8.47-38.4, p<0.001), and previous PTB (aOR = 4.42, 95% CI: 1.16-15.5, p<0.023). Conclusion The cross-sectional prevalence of COPD in rural Malawi is high, especially among males. Factors significantly associated were older age (60 years and above), cigarette smoking, and previous PTB. Longitudinal studies are needed to better understand disease etiology and progression in this setting.
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Affiliation(s)
- Haules Robbins Zaniku
- Department of Physiotherapy, Ministry of Health, Neno District Health Office, Neno, Lilongwe, Malawi
- Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Emilia Connolly
- Department of Partnerships and Policy, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45529, USA
| | - Moses Banda Aron
- Monitoring and Evaluation Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
- Snakebite Envenoming Department, Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Beatrice Lydia Matanje
- Clinical Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Myness Kasanda Ndambo
- Department of Health Systems and Policy, Training and Research Unit of Excellence (TRUE), Kamuzu University of Health Sciences, Lilongwe, Malawi
| | | | - Fabien Munyaneza
- Research Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Todd Ruderman
- Clinical Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Jamie Rylance
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Luckson Wandani Dullie
- Global Leadership Ecosystem, Partners in Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi
| | - Rejani Lalitha
- Pulmonary Division, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ndaziona Peter Kwanjo Banda
- Department of Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Adamson S Muula
- Community and Environmental Health Department, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
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Shahid S, Alqahtani SS, Bajwa M, Rashid M, Sana A, Bajwa A, Ali AN, Ariffin AK, Mahmood M, Ahmed F, Mustafa MA. The Effect of Obesity on Severity of Asthma: An Observational Prospective Study from Pakistan. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:38-43. [PMID: 38694965 PMCID: PMC11060623 DOI: 10.4103/jpbs.jpbs_238_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/24/2023] [Accepted: 05/20/2023] [Indexed: 05/04/2024] Open
Abstract
Objective The current research study aimed to access the relationship between obesity and asthma exacerbations and severity among adult patients at the outpatient section of a federal hospital (PIMS) in Islamabad, Pakistan. Methods A cross-sectional research study was carried out on 207 asthma adult patients belonging to different areas and ethnic groups from the country. The study setting was the PIMS hospital, which attracts patients from all over the country due to its facilities and cost-effective treatments. The body mass index (BMI) of asthma patients was calculated using the heights and weights of the study subjects. However, the pulmonary functions were calculated using a computerized spirometer i-e Spirolab III S/N 303681 in line with Winspiro PRO 7.1.version software. It presents the patient's forced vital capacity that expires in the first second of expiration to full (FEV1) in comparison to forced vital capacity (FVC) ratio, that is, Tiffeneau-Pinelli index was also recorded to determine the asthma severity. Results According to recent surveys, the overall prevalence of patients with overweight and obesity was 29.0% and 23.7%, respectively. A Chi-square test was used, and a statistically significant relationship was observed between BMI and asthma severity (P < 0.001). The adult obese female patients presented poor pulmonary functions. The average FEV1/FVC ratio presented significant variance among four different categories of BMI with P < 0.05. This difference was due to the normal BMI category as the Tiffeneau-Pinelli index, that is, FEV1/FVC in the normal BMI group was significantly lower as compared to that in underweight and obese patients. Conclusion The study subjects presented raised asthma severity in accordance with the raised BMI. Obese patients presented comparatively raised asthma exacerbations. Moreover, a statistically significant association of gender difference was observed between obesity and asthma severity. It was concluded that adult asthmatic women with obesity presented raised asthma severity as compared to adult asthmatic males.
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Affiliation(s)
- Sara Shahid
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Saad S. Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Mishal Bajwa
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Mahnoor Rashid
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Anosh Sana
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amna Bajwa
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, Pakistan
| | - Abdul N. Ali
- Department of Pharmacy Practice, Geethanjali College of Pharmacy, Cheeryal (V), Keesara (M), Hyderabad, Telangana, India
| | - Ahmad K. Ariffin
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, UniSZA, Besut, Terengganu, Malaysia
| | - Mahgull Mahmood
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
| | - Fahad Ahmed
- Faculty of Pharmacy, University of Sargodha, Sargodha, Punjab, Pakistan
| | - Muhammad Abid Mustafa
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
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Kassa Y, Geremew H, Gashu C. Modelling the longitudinal measurement of chronic obstructive pulmonary disease outpatient follow-up in the northwestern Ethiopia. Sci Rep 2023; 13:21526. [PMID: 38057425 PMCID: PMC10700296 DOI: 10.1038/s41598-023-48945-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023] Open
Abstract
Chronic obstructive pulmonary disease is a condition which can be prevented and treated and is characterized by difficulty of breathing that is not entirely curable. The overall objective of this study was to model the variation of longitudinal measurement over time for outpatients with chronic obstructive pulmonary diseases at the University of Gondar referral hospital. From February 1, 2019, to February 1, 2022, a retrospective study of outpatients with chronic obstructive pulmonary disease was conducted in a hospital. The data was extracted from all patients' data records from the patient's chart. The information includes the fundamental demographic and clinical details of each outpatients with chronic obstructive pulmonary disease. Mixed linear model were used to investigate the determinant factor of chronic obstructive pulmonary disease. From a total of 266 outpatients, Averages of the ratio of forced expiratory volume to forced vital capacity among chronic obstructive pulmonary disease patients were 0.65, with a standard deviation of 0.043. Comorbidities (average = 2.18, 95% CI 0.43:3.9, P = 0.0133), HIV(average = 4.83, 95% CI 1.94:7.72, P = 0.0012), education (average = 2.98; 95% CI 0.75:4.8, P = 0.008), and weight (average = 0.178, 95% CI 0.045:0.311, P = 0.009) are risk factors for change in forced vital capacity. This study clearly shows that there is a high COPD prevalence in Ethiopia. The risk factors for chronic obstructive pulmonary diseases are the smoking status, comorbidities, HIV, education status of the patient, weight, and time of the visit.
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Affiliation(s)
- Yoseph Kassa
- Department of Statistics, College of Natural and Computational Science, Oda Bultum University, Chiro, Ethiopia.
| | - Habtamu Geremew
- Department of Nursing College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Chalachew Gashu
- Department of Statistics, College of Natural and Computational Science, Oda Bultum University, Chiro, Ethiopia
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Kassa Y, Melese D, Asmare A, Workneh G. Joint modeling of forced vital capacity measures with time to onset of polycythemia among chronic obstructive pulmonary outpatients follows-up: A case of University of Gondar Referral Hospital. Health Sci Rep 2023; 6:e1587. [PMID: 37779661 PMCID: PMC10539680 DOI: 10.1002/hsr2.1587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
Background and Aims Chronic obstructive pulmonary disease (COPD) causes airflow obstruction and respiratory problems. Thus, the main objective of this study was to determine the risk factors for the progression of COPD using longitudinally measured forced vital capacity with time to onset of polycythemia outpatients follow-up. Methods A retrospective study design was used to gather the related data on longitudinal change of forced vital capacity and time to onset of polycythemia from the medical charts. The joint model consists of a longitudinal submodel for the change of forced vital capacity and a survival submodel for the time to onset of polycythemia of chronic obstructive pulmonary patients. Results From the total of 266 patient's estimated value of forced vital capacity of chronic obstructive pulmonary patients was 74.45 years with a standard deviation of 8.59. The estimated value of the association parameter was -0.006, which indicates that the lower value for a forced vital capacity measure was associated with the higher risk of polycythemia and vice versa "Based on the joint model analysis found that the predictor smoking, comorbidities, marital status, weight, and HIV" jointly affected the two responses, which are change of forced vital capacity and time to onset of polycythemia among chronic obstructive pulmonary patients. Conclusion The overall performance of separate and joint models, joint modeling of longitudinal measures with the time-to-event outcome was the best model due to smaller standard errors and statistical significance of both the association parameters.
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Affiliation(s)
- Yoseph Kassa
- Department of Statistics, College of Natural and Computational ScienceOda Bultum UniversityChiroEthiopia
| | - Dessie Melese
- Department of Statistics, College of Natural and Computational ScienceUniversity of GondarGondarEthiopia
| | - Anteneh Asmare
- Department of Statistics, College of Natural and Computational ScienceUniversity of GondarGondarEthiopia
| | - Gashu Workneh
- Department of Statistics, College of Natural and Computational ScienceUniversity of GondarGondarEthiopia
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Ahmed SA, Ismail M, Albirair M, Nail AMA, Denning DW. Fungal infections in Sudan: An underestimated health problem. PLoS Negl Trop Dis 2023; 17:e0011464. [PMID: 37656764 PMCID: PMC10501601 DOI: 10.1371/journal.pntd.0011464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/14/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023] Open
Abstract
Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.
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Affiliation(s)
- Sarah A. Ahmed
- Center of Expertise in Mycology Radboudumc / Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, The Netherlands
| | - Mawahib Ismail
- Mycology Reference laboratory, faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed Albirair
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington State, United States of America
| | - Abdelsalam Mohamed Ahmed Nail
- Tropical Diseases Teaching Hospital, Khartoum, Sudan
- Department of Internal Medicine, Faculty of Medicine and Health Sciences (OIU), Khartoum, Sudan
| | - David W. Denning
- Manchester Fungal Infection Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Navuluri N, Lagat D, Egger JR, Birgen E, Diero L, Murdoch DM, Thielman N, Kussin PS, Que LG, Paul D. Asthma, Airflow Obstruction, and Eosinophilic Airway Inflammation Prevalence in Western Kenya: A Population-Based Cross-Sectional Study. Int J Public Health 2023; 68:1606030. [PMID: 37663373 PMCID: PMC10468572 DOI: 10.3389/ijph.2023.1606030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives: Determine the prevalence of airway disease (e.g., asthma, airflow obstruction, and eosinophilic airway inflammation) in Kenya, as well as related correlates of airway disease and health-related quality of life. Methods: A three-stage, cluster-randomized cross-sectional study in Uasin Gishu County, Kenya was conducted. Individuals 12 years and older completed questionnaires (including St. George's Respiratory Questionnaire for COPD, SGRQ-C), spirometry, and fractional exhaled nitric oxide (FeNO) testing. Prevalence ratios with 95% confidence intervals (CIs) were calculated. Multivariable models were used to assess correlates of airflow obstruction and high FeNO. Results: Three hundred ninety-two participants completed questionnaires, 369 completed FeNO testing, and 305 completed spirometry. Mean age was 37.5 years; 64% were women. The prevalence of asthma, airflow obstruction on spirometry, and eosinophilic airway inflammation was 21.7%, 12.3% and 15.7% respectively in the population. Women had significantly higher SGRQ-C scores compared to men (15.0 vs. 7.7). Wheezing or whistling in the last year and SGRQ-C scores were strongly associated with FeNO levels >50 ppb after adjusting for age, gender, BMI, and tobacco use. Conclusion: Airway disease is a significant health problem in Kenya affecting a young population who lack a significant tobacco use history.
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Affiliation(s)
- Neelima Navuluri
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - David Lagat
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Joseph R. Egger
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Elcy Birgen
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - David M. Murdoch
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC, United States
| | - Nathan Thielman
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Division of Infectious Disease, Duke University School of Medicine, Durham, NC, United States
| | - Peter S. Kussin
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Loretta G. Que
- Division of Pulmonary, Allergy and Critical Care, Duke University School of Medicine, Durham, NC, United States
| | - Devon Paul
- Division of Pulmonary and Critical Care, Mt. Sinai Hospital Medical Center, Chicago, IL, United States
- Department of Medicine, Rosalind Franklin School of Medicine, North Chicago, IL, United States
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Mboera LEG, Kishamawe C, Rumisha SF, Chiduo MG, Kimario E, Bwana VM. Patterns and trends of in-hospital mortality due to non-communicable diseases and injuries in Tanzania, 2006-2015. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000281. [PMID: 37410764 DOI: 10.1371/journal.pgph.0000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/10/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Globally, non-communicable diseases (NCD) kill about 40 million people annually, with about three-quarters of the deaths occurring in low- and middle-income countries. This study was carried out to determine the patterns, trends, and causes of in-hospital non-communicable disease (NCD) and injury deaths in Tanzania from 2006-2015. METHODS This retrospective study involved primary, secondary, tertiary, and specialized hospitals. Death statistics were extracted from inpatient department registers, death registers, and International Classification of Diseases (ICD) report forms. The ICD-10 coding system was used to assign each death to its underlying cause. The analysis determined leading causes by age, sex, annual trend and calculate hospital-based mortality rates. RESULTS Thirty-nine hospitals were involved in this study. A total of 247,976 deaths (all causes) were reported during the 10-year period. Of the total deaths, 67,711 (27.3%) were due to NCD and injuries. The most (53.4%) affected age group was 15-59 years. Cardio-circulatory diseases (31.9%), cancers (18.6%), chronic respiratory diseases (18.4%), and injuries (17.9%) accounted for the largest proportion (86.8%) of NCD and injuries deaths. The overall 10-year hospital-based age-standardized mortality rate (ASMR) for all NCDs and injuries was 559.9 per 100,000 population. It was higher for males (638.8/100,000) than for females (444.6/100,000). The hospital-based annual ASMR significantly increased from 11.0 in 2006 to 62.8 per 100,000 populations in 2015. CONCLUSIONS There was a substantial increase in hospital-based ASMR due to NCDs and injuries in Tanzania from 2006 to 2015. Most of the deaths affected the productive young adult group. This burden indicates that families, communities, and the nation at large suffer from premature deaths. The government of Tanzania should invest in early detection and timely management of NCDs and injuries to reduce premature deaths. This should go hand-in-hand with continuous efforts to improve the quality of health data and its utilization.
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Affiliation(s)
- Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
- Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, West Perth, Western Australia
| | - Mercy G Chiduo
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Evord Kimario
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Veneranda M Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzanian
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12
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Pauli G, Wurmser C, Roos A, Kokou C, Huang HJ, D’souza N, Lupinek C, Zakzuk J, Regino R, Acevedo N, Caraballo L, Vrtala S, Valenta R. Frequent IgE recognition of Blomia tropicalis allergen molecules in asthmatic children and young adults in equatorial Africa. Front Immunol 2023; 14:1133935. [PMID: 37359512 PMCID: PMC10286740 DOI: 10.3389/fimmu.2023.1133935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Abstract
Background Asthma is not well investigated in equatorial Africa and little is known about the disease-associated allergen molecules recognized by IgE from patients in this area. The aim was to study the molecular IgE sensitization profile of asthmatic children and young adults in a semi-rural area (Lambaréné) of an equatorial African country (Gabon), to identify the most important allergen molecules associated with allergic asthma in equatorial Africa. Methods Fifty-nine asthmatic patients, mainly children and few young adults, were studied by skin prick testing to Dermatophagoides pteronyssinus (Der p), D. farinae (Der f), cat, dog, cockroach, grass, Alternaria and peanut. Sera were obtained from a subset of 35 patients, 32 with positive and 3 with negative skin reaction to Der p and tested for IgE reactivity to 176 allergen molecules from different allergen sources by ImmunoCAP ISAC microarray technology and to seven recombinant Blomia tropicalis (Blo t) allergens by IgE dot blot assay. Results Thirty-three of the 59 patients (56%) were sensitized to Der p and 23 of them (39%) were also sensitized to other allergen sources, whereas 9 patients (15%) were only sensitized to allergen sources other than Der p. IgE serology analyses (n=35) showed high IgE-binding frequencies to the Blo t allergens Blo t 5 (43%), Blo t 21 (43%) and Blo t 2 (40%), whereas the Der p allergens rDer p 2, rDer p 21 and rDer p 5 (34%, 29% and 26%) were less frequently recognized. Only few patients showed IgE reactivity to allergens from other allergen sources, except to allergens containing carbohydrate determinants (CCDs) or to wasp venom allergens (i.e., antigen 5). Conclusion Our results thus demonstrate that IgE sensitization to mite allergens is very prevalent in asthmatics in Equatorial Africa with B. tropicalis allergen molecules representing the most important ones associated with allergic asthma.
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Affiliation(s)
- Gabrielle Pauli
- Faculty of Medicine, University Louis Pasteur, Strasbourg, France
- Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Carole Wurmser
- Faculty of Medicine, University Louis Pasteur, Strasbourg, France
- Hôpital Albert Schweitzer, Lambaréné, Gabon
| | - Antoine Roos
- Faculty of Medicine, University Louis Pasteur, Strasbourg, France
- Hôpital Albert Schweitzer, Lambaréné, Gabon
| | | | - Huey-Jy Huang
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Nishelle D’souza
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Christian Lupinek
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Josefina Zakzuk
- Institute for Immunological Research, Universidad de Cartagena, Cartagena, Colombia
| | - Ronald Regino
- Institute for Immunological Research, Universidad de Cartagena, Cartagena, Colombia
| | - Nathalie Acevedo
- Institute for Immunological Research, Universidad de Cartagena, Cartagena, Colombia
| | - Luis Caraballo
- Institute for Immunological Research, Universidad de Cartagena, Cartagena, Colombia
| | - Susanne Vrtala
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- National Research Center, Institute of Immunology FMBA of Russia, Moscow, Russia
- Laboratory for Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
- Karl Landsteiner University of Health Sciences, Krems, Austria
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13
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Alwafi H, Naser AY, Ashoor DS, Aldhahir AM, Alqahtani JS, Minshawi F, Salawati E, Samannodi M, Dairi MS, Alansari AK, Ekram R. Trends in hospital admissions and prescribing due to chronic obstructive pulmonary disease and asthma in England and Wales between 1999 and 2020: an ecological study. BMC Pulm Med 2023; 23:49. [PMID: 36726097 PMCID: PMC9893556 DOI: 10.1186/s12890-023-02342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To investigate the trends in hospital admissions and medication prescriptions related to asthma and chronic obstructive pulmonary disease (COPD) in England and Wales. METHODS An ecological study was conducted between April 1999 and April 2020 using data extracted from the hospital episode statistics database in England and the patient episode database for Wales. The Office of National Statistics mid-year population estimates for 1999 through 2020 were collected, and medication prescription data for 2004-2020 were extracted from the prescription cost analysis database. RESULTS The total annual number of COPD and asthma hospital admissions for various causes increased by 82.2%, from 210,525 in 1999 to 383,652 in 2020, representing a 59.1% increase in hospital admission rate (from 403.77 in 1999 to 642.42 per 100,000 persons in 2020, p < 0.05). Chronic obstructive pulmonary disease with acute lower respiratory infection accounted for 38.7% of hospital admissions. Around 34.7% of all hospital admissions involved patients aged 75 and older. Around 53.8% of all COPD and asthma hospital admissions were attributable to females. The annual number of prescriptions dispensed for COPD and asthma medications increased by 42.2%. CONCLUSIONS Throughout the study period, hospital admissions due to chronic obstructive pulmonary disease and asthma, as well as medication prescriptions, increased dramatically among all age groups. Hospitalization rates were higher for women. Further observational and epidemiological research is required to identify the factors contributing to increased hospitalization rates.
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Affiliation(s)
- Hassan Alwafi
- grid.412832.e0000 0000 9137 6644Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia ,grid.413517.50000 0004 1796 5802Al-Noor Specialist Hospital, Mecca, Saudi Arabia
| | - Abdallah Y. Naser
- grid.460941.e0000 0004 0367 5513Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Deema Sami Ashoor
- grid.412832.e0000 0000 9137 6644Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Abdulelah M. Aldhahir
- grid.411831.e0000 0004 0398 1027Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Faisal Minshawi
- grid.412832.e0000 0000 9137 6644Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Emad Salawati
- grid.412125.10000 0001 0619 1117Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Samannodi
- grid.412832.e0000 0000 9137 6644Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Mohammad Saleh Dairi
- grid.412832.e0000 0000 9137 6644Faculty of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Aisha Khaled Alansari
- grid.415696.90000 0004 0573 9824Maternity and Children Hospital, Ministry of Health, Mecca, Saudi Arabia
| | - Rakan Ekram
- grid.412832.e0000 0000 9137 6644School of Public Health and Health Informatics, Umm Al Qura University, Mecca, Saudi Arabia
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Khattab A, Madkour A, Ambaram A, Smith C, Muhwa CJ, Mecha JO, Alsayed M, Beekman MJHI. Over-prescription of short-acting β 2-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study. Curr Med Res Opin 2022; 38:1983-1995. [PMID: 36031882 DOI: 10.1080/03007995.2022.2100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The extent of short-acting β2-agonist (SABA) overuse in Africa remains poorly documented. As part of the SABA use IN Asthma (SABINA) III study, we assessed SABA prescriptions/clinical outcomes in 3 African countries. METHODS Data on disease characteristics/asthma treatments were collected from patients (≥12 years) using electronic case report forms. Patients were classified by investigator-defined asthma severity (guided by the 2017 Global Initiative for Asthma) and practice type (primary/specialist care). Multivariable regression models analyzed associations between SABA prescriptions and outcomes. RESULTS Data from 1778 patients (mean age, 43.7 years) were analyzed. Most patients were female (62.4%) and had moderate-to-severe asthma (63.3%), with 57.1 and 42.9% of patients treated in specialist and primary care, respectively. Asthma was partly controlled/uncontrolled in 66.2% of patients, with 57.9% experiencing ≥1 severe exacerbation in the previous 12 months. Overall, 46.5% of patients were prescribed ≥3 SABA canisters in the preceding 12 months (over-prescription); 26.2% were prescribed ≥10 canisters. SABAs were purchased over-the-counter by 32.6% of patients, of whom 79.3% had received SABA prescriptions; 71.9% and 40.1% for ≥3 and ≥10 canisters, respectively. Higher SABA prescriptions (vs. 1-2 canisters) were associated with increased incidence rate of severe exacerbations and lower odds of having at least partly controlled asthma (except 3-5 canisters). CONCLUSIONS Findings from this African cohort of the SABINA III study indicate that SABA over-prescription and SABA over-the-counter purchase are common and associated with poor asthma-related outcomes. This highlights the need for healthcare providers/policymakers to align clinical practices with the latest treatment recommendations.
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Affiliation(s)
- Adel Khattab
- Pulmonary Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ashraf Madkour
- Pulmonary Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Anish Ambaram
- Department of Pulmonology, Gateway Centre for Respiratory and Gastrointestinal Disease, Durban, South Africa
| | - Clifford Smith
- Morningside Mediclinic, Sandton, Johannesburg, South Africa
| | - Chakaya J Muhwa
- Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jared O Mecha
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Mohamed Alsayed
- Medicinal Department, AstraZeneca, Dubai, United Arab Emirates
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15
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Magwenzi P, Rusakaniko S, Sibanda EN, Gumbo FZ. Challenges in the diagnosis of asthma in children, what are the solutions? A scoping review of 3 countries in sub Saharan Africa. Respir Res 2022; 23:254. [PMID: 36123720 PMCID: PMC9487077 DOI: 10.1186/s12931-022-02170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/09/2022] [Indexed: 08/29/2023] Open
Abstract
Background Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of ‘asthma’ defined by symptoms is high compared to ‘doctor diagnosed asthma’. The questions answered by this review are (i) What challenges have been experienced in the diagnosis of asthma in children? (ii) What solutions will address these challenges? Methods The Arksey and O’Malley’s framework for scoping reviews was used for the study methodology, while the PRISMA-ScR checklist guided the reporting process. Electronic databases: PubMed Central, EMBASE and Google Scholar were searched. Primary quantitative and qualitative studies and reviews from 2010 to 2021, from Nigeria, South Africa and Uganda written in English or translated to English, which answered the study questions were included. The author, title, country, study type, methods, purpose, findings and references were captured onto a predefined data collection table. The ‘Preview, Question, Read, Summarise’ system was used and a narrative report was used to summarise the findings. Results A total of 28 studies were included. The causes of under-diagnosis of asthma include lack of community knowledge and perception of asthma, poor accessibility to health care, strained health systems, lack of diagnostic tests including spirometry, low levels of knowledge among health-care workers and lack of or non-implementation of asthma guidelines. Strategies to improve asthma diagnosis will include community and school based education programmes, revision of asthma diagnostic terms, guideline development and implementation and health systems strengthening. Conclusion This scoping review provides research evidence for policy makers and health-workers involved in the care of asthmatic children on challenges faced in asthma diagnosis and strategies to improve asthma diagnosis. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02170-y.
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Affiliation(s)
- P Magwenzi
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe.
| | - S Rusakaniko
- Family Medicine, Global and Public Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
| | - E N Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, 113, Kwame Nkrumah Avenue, Harare, Zimbabwe
| | - F Z Gumbo
- Child and Adolescent Health Unit, Faculty of Medical Sciences, University of Zimbabwe, P O Box A178, Avondale, Harare, Zimbabwe
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Ale BM, Ozoh OB, Gadanya MA, Li Y, Harhay MO, Adebiyi AO, Adeloye D. Estimating the prevalence of COPD in an African country: evidence from southern Nigeria. JOURNAL OF GLOBAL HEALTH REPORTS 2022; 6. [DOI: 10.29392/001c.38200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Though several environmental and demographic factors would suggest a high burden of chronic obstructive pulmonary disease (COPD) in many African countries, there is insufficient country-level synthesis to guide public health policy. Methods A systematic search of MEDLINE, EMBASE, Global Health and African Journals Online identified studies reporting the prevalence of COPD in Nigeria. We provided a detailed synthesis of study characteristics, and overall median and interquartile range (IQR) of COPD prevalence in Nigeria by case definitions (spirometry or non-spirometry). Results Of 187 potential studies, eight studies (6 spirometry and 2 non-spirometry) including 4,234 Nigerians met the criteria. From spirometry assessment, which is relatively internally consistent, the median prevalence of COPD in Nigeria was 9.2% (interquartile range, IQR: 7.6-10.0), compared to a lower prevalence (5.1%, IQR: 2.2-15.4) from studies based on British Medical Research Council (BMRC) criteria or doctor’s diagnosis. The median prevalence of COPD was almost the same among rural (9.5%, IQR: 7.6-10.3) and urban dwellers (9.0%, IQR: 5.3-9.3) from spirometry studies. Conclusions A limited number of studies on COPD introduces imprecision in prevalence estimates and presents concerns on the level of response available across different parts of Nigeria, and indeed across many countries in sub-Saharan Africa.
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Affiliation(s)
- Boni M. Ale
- Cardiovascular Research Unit, University of Abuja, and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria; Holo Healthcare Limited, Nairobi, Kenya
| | - Obianuju B. Ozoh
- Department of Medicine, College of Medicine, The University of Lagos and The Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - Yiyang Li
- Department of Statistics, University of Warwick, Warwick, UK
| | - Michael O. Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Davies Adeloye
- Centre for Global Health, Usher Institute, University of Edinburgh, UK
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Mulupi S, Ayakaka I, Tolhurst R, Kozak N, Shayo EH, Abdalla E, Osman R, Egere U, Mpagama SG, Chinouya M, Chikaphupha KR, ElSony A, Meme H, Oronje R, Ntinginya NE, Obasi A, Taegtmeyer M. What are the barriers to the diagnosis and management of chronic respiratory disease in sub-Saharan Africa? A qualitative study with healthcare workers, national and regional policy stakeholders in five countries. BMJ Open 2022; 12:e052105. [PMID: 35906045 PMCID: PMC9345041 DOI: 10.1136/bmjopen-2021-052105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Chronic respiratory diseases (CRD) are among the top four non-communicable diseases globally. They are associated with poor health and approximately 4 million deaths every year. The rising burden of CRD in low/middle-income countries will strain already weak health systems. This study aimed to explore the perspectives of healthcare workers and other health policy stakeholders on the barriers to effective diagnosis and management of CRD in Kenya, Malawi, Sudan, Tanzania and Uganda. STUDY DESIGN Qualitative descriptive study. SETTINGS Primary, secondary and tertiary health facilities, government agencies and civil society organisations in five sub-Saharan African countries. PARTICIPANTS We purposively selected 60 national and district-level policy stakeholders, and 49 healthcare workers, based on their roles in policy decision-making or health provision, and conducted key informant interviews and in-depth interviews, respectively, between 2018 and 2019. Data were analysed through framework approach. RESULTS We identified intersecting vicious cycles of neglect of CRD at strategic policy and healthcare facility levels. Lack of reliable data on burden of disease, due to weak information systems and diagnostic capacity, negatively affected inclusion in policy; this, in turn, was reflected by low budgetary allocations for diagnostic equipment, training and medicines. At the healthcare facility level, inadequate budgetary allocations constrained diagnostic capacity, quality of service delivery and collection of appropriate data, compounding the lack of routine data on burden of disease. CONCLUSION Health systems in the five countries are ill-equipped to respond to CRD, an issue that has been brought into sharp focus as countries plan for post-COVID-19 lung diseases. CRD are underdiagnosed, under-reported and underfunded, leading to a vicious cycle of invisibility and neglect. Appropriate diagnosis and management require health systems strengthening, particularly at the primary healthcare level.
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Affiliation(s)
- Stephen Mulupi
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Irene Ayakaka
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Institute, Makerere University, Kampala, Uganda
| | - Rachel Tolhurst
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicole Kozak
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Health Systems and Policy Research Unit, REACH Trust Malawi, Lilongwe, Malawi
| | - Elizabeth Henry Shayo
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- National Institute of Medical Research, Mbeya, United Republic of Tanzania
| | | | - Rashid Osman
- Lung Health Department, Epi-Lab, Khartoum, Sudan
| | - Uzochukwu Egere
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stellah G Mpagama
- Medical Department, Kibong'oto Infectious Diseases Hospital/Kilimanjaro Christian Medical University, Kilimanjaro, United Republic of Tanzania
| | - Martha Chinouya
- Education Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Asma ElSony
- Lung Health Department, Epi-Lab, Khartoum, Sudan
| | - Helen Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Rose Oronje
- African Institute for Development Policy (AFIDEP), Nairobi, Kenya
| | - Nyanda Elias Ntinginya
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre, Mbeya, Tanzania, United Republic of
| | - Angela Obasi
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- AXESS Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Miriam Taegtmeyer
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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18
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Awokola BI, Amusa GA, Jewell CP, Okello G, Stobrink M, Finney LJ, Mohammed N, Erhart A, Mortimer KJ. Chronic obstructive pulmonary disease in sub-Saharan Africa. Int J Tuberc Lung Dis 2022; 26:232-242. [PMID: 35197163 PMCID: PMC8886964 DOI: 10.5588/ijtld.21.0394] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and an important cause of death in sub-Saharan Africa (SSA). We conducted a systematic review and meta-analysis on the prevalence of and risk factors for COPD in SSA.METHODS: We conducted a protocol-driven systematic literature search in MEDLINE, EMBASE, CINAHL and Global Health, supplemented by a manual search of the abstracts from thoracic conference proceedings from 2017 to 2020. We did a meta-analysis of COPD prevalence and its association with current smoking.RESULTS: We identified 831 titles, of which 27 were eligible for inclusion in the review and meta-analysis. The population prevalence of COPD ranged from 1.7% to 24.8% (pooled prevalence: 8%, 95% CI 6-11). An increased prevalence of COPD was associated with increasing age, smoking and biomass smoke exposure. The pooled odds ratio for the effect of current smoking (vs. never smoked) on COPD was 2.20 (95% CI 1.62-2.99).CONCLUSION: COPD causes morbidity and mortality in adults in SSA. Smoking is an important risk factor for COPD in SSA, and this exposure needs to be reduced through the combined efforts of clinicians, researchers and policymakers to address this debilitating and preventable lung disease.
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Affiliation(s)
- B I Awokola
- Centre for Health Informatics, Computing & Statistics (CHICAS), Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - G A Amusa
- Department of Internal Medicine, Jos University Teaching Hospital, Jos, Nigeria, Department of Medicine, University of Jos, Jos, Nigeria
| | - C P Jewell
- Centre for Health Informatics, Computing & Statistics (CHICAS), Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, UK
| | - G Okello
- University of Cambridge Institute for Sustainability Leadership, Cambridge, UK, African Centre for Clean Air, Kampala, Uganda
| | - M Stobrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - L J Finney
- COPD Research Group, Imperial College, London, UK
| | - N Mohammed
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - A Erhart
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - K J Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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19
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Gilbert RF, Cichowitz C, Bibangambah P, Kim JH, Hemphill LC, Yang IT, Sentongo RN, Kakuhikire B, Christiani DC, Tsai AC, Okello S, Siedner MJ, North CM. Lung function and atherosclerosis: a cross-sectional study of multimorbidity in rural Uganda. BMC Pulm Med 2022; 22:12. [PMID: 34983492 PMCID: PMC8728924 DOI: 10.1186/s12890-021-01792-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure. METHODS We measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status. RESULTS Of 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT. CONCLUSIONS Impaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.
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Affiliation(s)
- Rebecca F Gilbert
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
| | - Cody Cichowitz
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
| | | | - June-Ho Kim
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Linda C Hemphill
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Ruth N Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David C Christiani
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexander C Tsai
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, MA, USA
| | - Crystal M North
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, USA.
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20
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Binegdie AB, Meme H, El Sony A, Haile T, Osman R, Miheso B, Zurba L, Lesosky M, Balmes J, Burney PJ, Mortimer K, Devereux G. Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study. Int J Tuberc Lung Dis 2022; 26:18-25. [PMID: 34969424 PMCID: PMC8734192 DOI: 10.5588/ijtld.21.0362] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent population-based studies reporting substantial levels of obstructive and restrictive lung function.OBJECTIVE: To characterise the common chronic respiratory diseases encountered in hospital outpatient clinics in three African countries.METHODS This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8 weeks) attending hospital outpatient departments in Ethiopia, Kenya and Sudan. Patients were assessed using a respiratory questionnaire, spirometry and chest radiography. The diagnoses of the reviewing clinicians were ascertained.RESULT: A total of 519 patients (209 Kenya, 170 Ethiopia, 140 Sudan) participated; the mean age was 45.2 years (SD 16.2); 53% were women, 83% had never smoked. Reviewing clinicians considered that 36% (95% CI 32-40) of patients had asthma, 25% (95% CI 21-29) had chronic bronchitis, 8% (95% CI 6-11) chronic obstructive pulmonary disease (COPD), 5% (95% CI 4-8) bronchiectasis and 4% (95% CI 3-6) post-TB lung disease. Spirometry consistent with COPD was present in 35% (95% CI 30-39). Restriction was evident in 38% (95% CI 33-43). There was evidence of sub-optimal diagnosis of asthma and COPD.CONCLUSION: In Ethiopia, Kenya and Sudan, asthma, COPD and chronic bronchitis account for the majority of diagnoses in non-TB patients with chronic respiratory symptoms. The suboptimal diagnosis of these conditions will require the widespread use of spirometry.
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Affiliation(s)
- A B Binegdie
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - H Meme
- Centre for Respiratory Diseases Research, Kenyan Medical Research Institute (KEMRI), Nairobi, Kenya
| | - A El Sony
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - T Haile
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - R Osman
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - B Miheso
- Centre for Respiratory Diseases Research, Kenyan Medical Research Institute (KEMRI), Nairobi, Kenya
| | - L Zurba
- Education for Health Africa, Durban, South Africa
| | - M Lesosky
- Division of Epidemiology Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Balmes
- University of California, San Francisco, CA, USA
| | - P J Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - G Devereux
- Liverpool School of Tropical Medicine, Liverpool, UK
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21
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Abebe Y, Ali A, Kumie A, Haile T, Tamire M, Addissie A. Determinants of asthma in Ethiopia: age and sex matched case control study with special reference to household fuel exposure and housing characteristics. Asthma Res Pract 2021; 7:14. [PMID: 34823608 PMCID: PMC8613982 DOI: 10.1186/s40733-021-00080-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma is a chronic inflammatory disorder characterized by airway obstruction and hyper-responsiveness. Studies suggest that household fuel exposure and housing characteristics are associated with air way related allergy. But there remains to be a considerable uncertainty about whether that reflects an association with asthma. This study endeavored to bridge the gap by identifying factors associated with asthma, with special reference to household fuel exposure and housing characteristics in selected public hospitals in Addis Ababa, Ethiopia. METHODS We conducted a hospital-based matched case-control study. A total of 483 study participants were selected from two Ethiopian referral hospitals using a sequential sampling technique, with 161 cases and 322 controls. Standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) and the American Thoracic Society Division of Lung Disease (ATS-DLD-78) were used to collect household related data. Conditional logistic regression model was applied to identify the determinants of asthma. Both crude and adjusted odds ratios with 95% confidence interval (CI) were used to identify predictors of asthma. RESULTS The response rate for both cases and controls was 99.17%. The odds of developing asthma was about four times higher among those who used agricultural residues for cooking (AOR: 3.81, 95% CI: 1.05, 13.79)., about five times higher among those who used wood for cooking (AOR: 4.95, 95% CI: 2.1, 11.69), nearly five times higher among those who had family history of asthma (AOR: 4.72, 95% CI: 1.54, 14.45), just over six times higher among those who smoke tobacco (AOR: 6.16, 95% CI: 1.31, 29.09) and over ten times higher among those who do not practice door opening, while cooking (AOR: 10.25, 95% CI: 3.97, 26.49). CONCLUSION Family history of asthma, tobacco smoking, use of solid fuels including, woods and agricultural residues were associated with development of asthma. To reduce the risk of asthma, people should practice door opening, while cooking, and must avoid using wood and agricultural residues for cooking and should also refrain from tobacco smoking.
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Affiliation(s)
- Yonas Abebe
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Ahmed Ali
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abera Kumie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tewodros Haile
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mulugeta Tamire
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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22
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Aboagye VS, Kyei KA, Nortey PA, Kitson-Mills D, Daniels J, Korsah C. Factors associated with the appropriate use of asthma medications among adult asthmatic patients attending asthma clinic in a teaching hospital. Pan Afr Med J 2021; 40:44. [PMID: 34795825 PMCID: PMC8571923 DOI: 10.11604/pamj.2021.40.44.29137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction asthma tends to be more severe with worse symptoms in Africa due to late diagnosis and delayed initiation of treatment. To identify patient and treatment-related factors which influence the appropriate use of asthma medications. Methods the study was institution based cross-sectional design. Patients were invited to provide information regarding the use of their asthma medications and factors potentially associated with appropriate use of these medications. A stepwise multivariate logistic regression analysis was used to evaluate the most important factor at a 0.05 level of significance. Results respondents with better knowledge of their asthma medications were more likely to use them appropriately (OR 5.82 [CI 95% 2.25-15.04]) as were those with positive attitudes and beliefs towards asthma and asthma medications (OR 3.88 [CI 95% 1.44-10.44]). Conclusion patients need to understand the importance of adhering to the prescribed regimen for their asthma medications even in the absence of overt symptoms in order to optimize clinical outcome.
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Affiliation(s)
- Victoria Sakyibea Aboagye
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kofi Adesi Kyei
- School of Biomedical and Allied Health Sciences, Department of Radiography, University of Ghana, Accra, Ghana
| | - Priscilla Awo Nortey
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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23
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Agarwal D, Hanafi NS, Khoo EM, Parker RA, Ghorpade D, Salvi S, Abu Bakar AI, Chinna K, Das D, Habib M, Hussein N, Isaac R, Islam MS, Khan MS, Liew SM, Pang YK, Paul B, Saha SK, Wong LP, Yusuf OM, Yusuf SO, Juvekar S, Pinnock H. Predictors for detecting chronic respiratory diseases in community surveys: A pilot cross-sectional survey in four South and South East Asian low- and middle-income countries. J Glob Health 2021; 11:04065. [PMID: 34737865 PMCID: PMC8561335 DOI: 10.7189/jogh.11.04065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Our previous scoping review revealed limitations and inconsistencies in population surveys of chronic respiratory disease. Informed by this review, we piloted a cross-sectional survey of adults in four South/South-East Asian low-and middle-income countries (LMICs) to assess survey feasibility and identify variables that predicted asthma or chronic obstructive pulmonary disease (COPD). Methods We administered relevant translations of the BOLD-1 questionnaire with additional questions from ECRHS-II, performed spirometry and arranged specialist clinical review for a sub-group to confirm the diagnosis. Using random sampling, we piloted a community-based survey at five sites in four LMICs and noted any practical barriers to conducting the survey. Three clinicians independently used information from questionnaires, spirometry and specialist reviews, and reached consensus on a clinical diagnosis. We used lasso regression to identify variables that predicted the clinical diagnoses and attempted to develop an algorithm for detecting asthma and COPD. Results Of 508 participants, 55.9% reported one or more chronic respiratory symptoms. The prevalence of asthma was 16.3%; COPD 4.5%; and ‘other chronic respiratory disease’ 3.0%. Based on consensus categorisation (n = 483 complete records), “Wheezing in last 12 months” and “Waking up with a feeling of tightness” were the strongest predictors for asthma. For COPD, age and spirometry results were the strongest predictors. Practical challenges included logistics (participant recruitment; researcher safety); misinterpretation of questions due to local dialects; and assuring quality spirometry in the field. Conclusion Detecting asthma in population surveys relies on symptoms and history. In contrast, spirometry and age were the best predictors of COPD. Logistical, language and spirometry-related challenges need to be addressed.
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Affiliation(s)
- Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital Research Centre (KEMHRC), Pune, India
| | | | - Ee Ming Khoo
- Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Richard A Parker
- Edinburgh Clinical Trials Unit, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Deesha Ghorpade
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | - Sundeep Salvi
- Pulmocare Research and Education (PURE) Foundation, Pune, India
| | | | - Karuthan Chinna
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
| | - Deepa Das
- Christian Medical College (CMC), Vellore, India
| | - Monsur Habib
- Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh
| | - Norita Hussein
- Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Rita Isaac
- Christian Medical College (CMC), Vellore, India
| | | | | | - Su May Liew
- Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Yong Kek Pang
- Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | | | - Samir K Saha
- Child Health Research Foundation (CHRF), Dhaka, Bangladesh
| | - Li Ping Wong
- Faculty of Medicine, University of Malaya (UM), Kuala Lumpur, Malaysia
| | - Osman M Yusuf
- The Allergy & Asthma Institute (AAI), Islamabad, Pakistan
| | | | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre (KEMHRC), Pune, India
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
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24
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Philip KE, Cartwright LL, Westlake D, Nyakoojo G, Kimuli I, Kirenga B, Brakema EA, Orme MW, Fancourt D, Hopkinson NS, Jones R, Katagira W. Music and dance in respiratory disease management in Uganda: a qualitative study of patient and healthcare professional perspectives. BMJ Open 2021; 11:e053189. [PMID: 34556518 PMCID: PMC8461694 DOI: 10.1136/bmjopen-2021-053189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Music and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking. METHODS We delivered sample sessions of music and dance for chronic respiratory disease (CRD) to patients and healthcare professionals. Seven participants took part in one singing and dance sample session. One patient completed only the dance session. We then conducted an exploratory qualitative study using thematic analysis of semistructured interviews with healthcare professionals and patients regarding (1) the role of music and dance in Ugandan life and (2) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda. RESULTS We interviewed 19 participants, made up of 11 patients with long-term respiratory conditions and 8 healthcare professionals, who were selected by purposeful convenience sampling. Four key themes were identified from interview analysis: music and dance (1) were central components of daily life; (2) had an established role supporting health and well-being; and (3) had strong therapeutic potential in respiratory disease management. The fourth theme was (4) the importance of modulating demographic considerations of culture, religion and age. CONCLUSION Music and dance are central to life in Uganda, with established roles supporting health and well-being. These roles could be built on in the development of music and dance interventions as adjuncts to established components of CRD disease management like pulmonary rehabilitation. Through consideration of key contextual factors and codevelopment and adaptation of interventions, such approaches are likely to be well received.
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Affiliation(s)
- Keir Ej Philip
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, Imperial College London, London, UK
| | | | | | - Grace Nyakoojo
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | - Ivan Kimuli
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
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25
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Egere U, Shayo E, Ntinginya N, Osman R, Noory B, Mpagama S, Hussein E, Tolhurst R, Obasi A, Mortimer K, Sony AE, Taegtmeyer M. Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems? BMC Health Serv Res 2021; 21:734. [PMID: 34303370 PMCID: PMC8310588 DOI: 10.1186/s12913-021-06759-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Chronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system. Methods We conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains. Results One health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care. Conclusions Gaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06759-9.
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Affiliation(s)
- Uzochukwu Egere
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
| | - Elizabeth Shayo
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.,National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | | | | | - Stella Mpagama
- Kibong'oto Infectious Diseases Hospital, Mae Street, Kilimanjaro, Tanzania
| | | | - Rachel Tolhurst
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.,Tropical Infectious Diseases Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, UK
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26
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Kwizera R, Bongomin F, Olum R, Meya DB, Worodria W, Bwanga F, Fowler SJ, Gore R, Denning DW, Kirenga BJ. Fungal asthma among Ugandan adult asthmatics. Med Mycol 2021; 59:923-933. [PMID: 33945622 DOI: 10.1093/mmy/myab023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
Fungal sensitization is associated with poor asthma control. We aimed to determine the prevalence and factors associated with fungal asthma among Ugandan adults. Individuals aged ≥18 years with a new diagnosis of asthma in the last 12 months participating in the African Severe Asthma Program constituted the study population. Skin prick test results, clinical and demographic data were retrieved from the database, and serum Aspergillus fumigatus specific antibodies and total IgE were measured in stored blood. We enrolled 374 patients, median (IQR) age 34 (25-45) years, 286 (76.5%) females and 286 (76.5%) with severe asthma. Prevalence of Aspergillus fumigatus sensitization was 42.0% (95% CI: 37.1-47.0%), allergic bronchopulmonary aspergillosis (ABPA) 3.2% (1.8-5.5%), severe asthma with fungal sensitization (SAFS) 16% (12.7-20.1%) and allergic bronchopulmonary mycosis (ABPM) 2.9% (1.7-5.2%). Older age (55-64 years) (crude odds ratio (cOR) = 2.6), sensitization to at least one allergen (cOR = 9.38) and hypertension (cOR = 1.99) were significantly associated with Aspergillus sensitization, whereas tertiary education level (cOR = 0.29), severe depression (cOR = 0.15) and strong emotions (cOR = 0.47) were not. High occupational exposure to Aspergillus (cOR = 4.26) and contact with moulds (cOR = 14.28) were significantly associated with ABPA. Palpitations (cOR = 5.54), uncontrolled asthma (cOR = 3.54), eczema/dermatitis (cOR = 3.07), poor lung function (cOR = 2.11) and frequent exacerbations (cOR = 1.01) were significantly associated with SAFS. Eczema/dermatitis (cOR = 1.55) was significantly associated with ABPM, but cold weather trigger (cOR = 0.24) was not. Fungal asthma is a significant problem among Ugandans with asthma and should be particularly considered in individuals who remain uncontrolled despite optimal standard of care for asthma, as it is responsive to available and affordable oral antifungal therapy. LAY SUMMARY This study showed that fungal asthma is a significant problem among Ugandans with asthma with a high prevalence. Fungal asthma should be considered in patients with uncontrolled asthma despite receiving optimal standard of care. This is the first modern attempt to define these endotypes of asthma in Africa.
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Affiliation(s)
- Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda.,Makerere University Lung Institute, College of Health Sciences, Makerere University, P.O. Box 7749, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology, Faculty of Medicine, Gulu University, P.O. Box, 166, Gulu, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - David B Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, Kampala, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - William Worodria
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.,Division of Pulmonology, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
| | - Freddie Bwanga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Stephen J Fowler
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Robin Gore
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - David W Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK
| | - Bruce J Kirenga
- Makerere University Lung Institute, College of Health Sciences, Makerere University, P.O. Box 7749, Kampala, Uganda.,Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.,Division of Pulmonology, Mulago National Referral Hospital, P.O. Box 7051, Kampala, Uganda
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27
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Abegaz SM, Wassie M, Azagew AW. Self-care practice and associated factors among adult asthmatic patients on follow-up care at Northwest Amhara referral hospitals, Northwest Ethiopia 2020. BMC Pulm Med 2021; 21:140. [PMID: 33926435 PMCID: PMC8082826 DOI: 10.1186/s12890-021-01508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/14/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Self-care practice of asthma is the strategy for asthma symptom control and future reduction of exacerbation, but it is poorly implemented in clinical settings due to the patients, professionals, and organizational related factors. Therefore, the study aimed to assess the self-care practice and associated factors among adult asthmatic patients at Northwest Amhara referral hospitals. METHODS Institution-based cross-sectional study was conducted among asthmatic patients on follow-up care at Northwest Amhara Regional State referral hospitals from February 1st, 2020 to March 30, 2020. Data were collected through an interviewer-administered technique. Asthma self-care practice tool was used to measure the outcome. Data were entered into EPI info version 7 and exported to SPSS version 22 for analysis. A binary logistic regression analysis was used. In multivariable logistic regression analysis, those independent variables having p value < 0.05 were considered as statistically significant with poor self-care practice of asthma. RESULTS A total of 470 participants enrolled in the study with a response rate of 100%. The proportion of good self-care practice among asthmatic patients was found to be 42.3%. The study revealed that; age group ≥ 55 years, having a co-morbid illness and borderline anxiety, having no social support, and drinking alcohol were significantly associated with poor asthma self-care practice. CONCLUSIONS Poor-self care practice in this study was high. Efforts need to be implemented for asthmatic patients with older age, having co-morbid illness and borderline anxiety, having no social support, and drinking alcohol.
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Affiliation(s)
| | - Mulugeta Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abere Woretaw Azagew
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Patil R, Shrivastava R, Juvekar S, McKinstry B, Fairhurst K. Specialist to non-specialist teleconsultations in chronic respiratory disease management: A systematic review. J Glob Health 2021; 11:04019. [PMID: 34326988 PMCID: PMC8294828 DOI: 10.7189/jogh.11.04019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Chronic respiratory diseases (CRD), are common public health problems with high prevalence, disability and mortality rates worldwide. Further uneven distribution of the health workforce is a major barrier to the effective diagnosis and treatment of CRDs. Teleconsultation between a specialist and non-specialist could possibly bridge the gap in access to health care and decrease CRD burden in remote areas. This review investigates the evidence for the effective use of specialist to non-specialist teleconsultation in the management of CRDs in remote areas and identifies instances of good practice and knowledge gaps. METHODS We searched for articles till November 2020, which focused on specialist to non-specialist teleconsultations for CRD diagnosis or management. Two independent reviewers conducted the title and abstract screening and extracted data from the selected papers and the quality was assessed by Joanna Briggs Institute's (JBI) tool. A descriptive and narrative approach was used due to the heterogeneous nature of the selected studies. RESULTS We found 1715, articles that met the initial search criteria, but after excluding duplicates and non-eligible articles, we included 10 research articles of moderate quality. These articles were from nine different studies, all of which, except one, were conducted in high-income countries. The studies reported results in terms of impact on the patients, and the health care providers including primary care physicians (PCP) and specialists. The teleconsulting systems used in all the selected papers primarily used audio modes in addition to other modes like the audio-video medium. The included studies reported primarily non-clinical outcomes including effectiveness, feasibility, acceptability and usability of the teleconsultation systems and only three described the clinical outcomes. The teleconsultation was predominantly conducted in the PCP's office with the specialist located remotely. CONCLUSIONS We found relatively few, papers which explored specialist to non-specialist teleconsultation in management of CRDs, and no controlled trials. Two of the included papers described systems, which were used for other diseases in addition to the CRD. The available literature although not generalisable, encourages the use of specialist to non-specialist teleconsultation for diagnosis and management of CRDs.
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Affiliation(s)
- Rutuja Patil
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Sanjay Juvekar
- Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
- Savitribai Phule Pune University, Pune, India
| | - Brian McKinstry
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Karen Fairhurst
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
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Ughasoro MD, Eze JN, Ayuk AC, Obumneme-Anyim I, Akubuilo U, Oguonu T. Economic burden of childhood asthma in children attending a follow-up clinic in a resource-poor setting of Southeast Nigeria. Paediatr Respir Rev 2021; 37:74-79. [PMID: 32169438 DOI: 10.1016/j.prrv.2020.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/06/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Beyond its chronicity, childhood asthma carries an economic burden for households. In this study we evaluated the cost of care of childhood asthma in a Nigerian household. METHODS A cross-sectional hospital-based study. Relevant information was obtained through an interviewer-administered questionnaire. The cost of asthma treatment was estimated using direct medical costs and loss in productivity. Data analysis was done with SPSS version 22. A significant value of p < 0.05 was used. RESULTS Sixty-six participants were enrolled, mean ± SD age (11.6 ± ) the average direct cost was USD10.35. The cost of drug was USD5.8 and accounted for 56% of the direct cost. The loss in productivity was USD16.73. The mean cost per clinic visit was USD27.08, which was catastrophic in 12 (18.2%) households. The calculated annual cost of asthma treatment was USD162.49, with a cumulative national cost of USD 0.16 billion, which makes up 0.002% of the national GDP. CONCLUSION The cost burden of asthma treatment may be low on the households but carries a huge national cost impact. We recommend the inclusion of asthma care in the Nigerian social health insurance as this may help reduce the financial burden due to asthma.
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Affiliation(s)
- Maduka D Ughasoro
- Department of Paediatrics, University of Nigeria, Enugu Campus, Enugu, Nigeria; Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla Enugu, Nigeria.
| | - Joy N Eze
- Department of Paediatrics, University of Nigeria, Enugu Campus, Enugu, Nigeria; Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla Enugu, Nigeria
| | - Adaeze C Ayuk
- Department of Paediatrics, University of Nigeria, Enugu Campus, Enugu, Nigeria; Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla Enugu, Nigeria
| | - Ijeoma Obumneme-Anyim
- Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla Enugu, Nigeria
| | - Uzoamaka Akubuilo
- Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla Enugu, Nigeria
| | - Tagbo Oguonu
- Department of Paediatrics, University of Nigeria, Enugu Campus, Enugu, Nigeria; Department of Paediatrics, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla Enugu, Nigeria
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Plum C, Stolbrink M, Zurba L, Bissell K, Ozoh BO, Mortimer K. Availability of diagnostic services and essential medicines for non-communicable respiratory diseases in African countries. Int J Tuberc Lung Dis 2021; 25:120-125. [PMID: 33656423 PMCID: PMC7987206 DOI: 10.5588/ijtld.20.0762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: The global burden of disease due to asthma and chronic obstructive pulmonary disease (COPD) is substantial and particularly great in low- and middle-income countries, including many African countries. Management is affected by availability of diagnostic tests and essential medicines. The study aimed to explore the availability of spirometry services and essential medicines for asthma and COPD in African countries.METHOD: Questionnaires were delivered to healthcare workers at the annual meeting of the Pan African Thoracic Society Methods in Epidemiology and Clinical Research (PATS MECOR) and International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA). Data were analysed using simple descriptive statistics.RESULTS: A total of 37 questionnaires representing 13 African countries were returned. Spirometry availability was 73.0%. The most common reasons for non-availability were lack of knowledge of the utility of the test. Within the study sample, 33.3% faced sporadic availability due to maintenance issues. Essential medicines availability ranged from 37.8% for inhaled corticosteroid-long-acting beta-agonist inhalers to 100% for prednisolone 5 mg tablets, mainly due to supply chain problems.CONCLUSION: There is varied availability of spirometry and WHO essential medicines for COPD and asthma in African countries. Strategies are needed to improve access to basic effective care for people with non-communicable lung disease in Africa.
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Affiliation(s)
- C Plum
- Liverpool School of Tropical Medicine, Liverpool
| | - M Stolbrink
- Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
| | - L Zurba
- Education for Health Africa, Durban, South Africa
| | - K Bissell
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - B O Ozoh
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool
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Nagourney EM, Robertson NM, Rykiel N, Siddharthan T, Alupo P, Encarnacion M, Kirenga BJ, Kalyesubula R, Quaderi SA, Hurst JR, Checkley W, Pollard SL. Illness representations of chronic obstructive pulmonary disease (COPD) to inform health education strategies and research design-learning from rural Uganda. HEALTH EDUCATION RESEARCH 2020; 35:258-269. [PMID: 32702133 PMCID: PMC7787214 DOI: 10.1093/her/cyaa016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
More than 90% of chronic obstructive pulmonary disease (COPD)-related deaths occur in low- and middle-income countries; however, few studies have examined the illness experiences of individuals living with and providing treatment for COPD in these settings. This study characterizes illness representations for COPD in Nakaseke, Uganda from the perspectives of health care providers, village health teams and community members (CMs) with COPD. We conducted 40 in-depth, semi-structured interviews (16 health care providers, 12 village health teams and 12 CMs, aged 25-80 years). Interviews were analyzed using inductive coding, and the Illness Representations Model guided our analysis. Stakeholder groups showed concordance in identifying causal mechanisms of COPD, but showed disagreement in reasons for care seeking behaviors and treatment preferences. CMs did not use a distinct label to differentiate COPD from other respiratory illnesses, and described both the physical and social consequences of COPD. Local representations can inform development of adapted educational and self-management tools for COPD.
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Affiliation(s)
- Emily M Nagourney
- Department fo International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
| | - Nicole M Robertson
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
| | - Natalie Rykiel
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
| | - Trishul Siddharthan
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
| | - Patricia Alupo
- College of Health Sciences Lung Institute, Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Marysol Encarnacion
- Department fo International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Bruce J Kirenga
- College of Health Sciences Lung Institute, Makerere University, Upper Mulago Hill Road, Kampala, Uganda
- Department of Medicine, College of Health Sciences, Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Physiology, College of Health Sciences, Makerere University, Upper Mulago Hill Road, Kampala, Uganda
| | - Shumonta A Quaderi
- UCL Respiratory, University College London, Gower Street, London, WC1E 6BT, UK
| | - John R Hurst
- UCL Respiratory, University College London, Gower Street, London, WC1E 6BT, UK
| | - William Checkley
- Department fo International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
| | - Suzanne L Pollard
- Department fo International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
- Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21205, USA
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Mpairwe H, Namutebi M, Nkurunungi G, Tumwesige P, Nambuya I, Mukasa M, Onen C, Nnaluwooza M, Apule B, Katongole T, Oduru G, Kahwa J, Webb EL, Lubyayi L, Pearce N, Elliott AM. Risk factors for asthma among schoolchildren who participated in a case-control study in urban Uganda. eLife 2019; 8:49496. [PMID: 31729315 PMCID: PMC6914334 DOI: 10.7554/elife.49496] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
Data on asthma aetiology in Africa are scarce. We investigated the risk factors for asthma among schoolchildren (5–17 years) in urban Uganda. We conducted a case-control study, among 555 cases and 1115 controls. Asthma was diagnosed by study clinicians. The main risk factors for asthma were tertiary education for fathers (adjusted OR (95% CI); 2.32 (1.71–3.16)) and mothers (1.85 (1.38–2.48)); area of residence at birth, with children born in a small town or in the city having an increased asthma risk compared to schoolchildren born in rural areas (2.16 (1.60–2.92)) and (2.79 (1.79–4.35)), respectively; father’s and mother’s history of asthma; children’s own allergic conditions; atopy; and cooking on gas/electricity. In conclusion, asthma was associated with a strong rural-town-city risk gradient, higher parental socio-economic status and urbanicity. This work provides the basis for future studies to identify specific environmental/lifestyle factors responsible for increasing asthma risk among children in urban areas in LMICs. Asthma is a chronic disease of the airways that leads to breathing difficulty and sometimes death: the condition affects about 235 million people worldwide, especially children. Scientists still do not know exactly what causes asthma, but studies in Europe and North America suggest that individuals born or raised in rural areas are less likely to be affected. However, few studies have examined asthma in African countries, where urbanization is often quickly increasing. Examining the factors associated with the disease as more people move to cities may provide new clues about how asthma emerges, and how to prevent it. To this end, Mpairwe et al. conducted a study with over 1,670 schoolchildren in Uganda. Those born or raised in rural areas were least likely to have asthma, but the risk doubled among children from small towns, and tripled in those born or who grew up in the city. Children whose parents had a higher education and socioeconomic status had the highest asthma risk, but more work is required to understand why this is the case. The study by Mpairwe et al. is the first step towards identifying environmental and lifestyle factors associated with increased asthma risk in Africa. Further studies may help scientists to understand how beginning life in a more urban area plays a role in the development of the disease.
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Affiliation(s)
- Harriet Mpairwe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Milly Namutebi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Gyaviira Nkurunungi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Pius Tumwesige
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Irene Nambuya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Mike Mukasa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Caroline Onen
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Marble Nnaluwooza
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Barbara Apule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Tonny Katongole
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Gloria Oduru
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Joseph Kahwa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emily L Webb
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lawrence Lubyayi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Neil Pearce
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, United Kingdom
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Woldeamanuel GG, Mingude AB, Geta TG. Prevalence of chronic obstructive pulmonary disease (COPD) and its associated factors among adults in Abeshge District, Ethiopia: a cross sectional study. BMC Pulm Med 2019; 19:181. [PMID: 31623601 PMCID: PMC6798340 DOI: 10.1186/s12890-019-0946-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is one of the major public health problems worldwide. Despite an increasing burden of COPD in the world, it is often a neglected disease in low income countries and COPD prevalence studies are rare in Sub-Saharan Africa. The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Ethiopia. METHODS A community based cross sectional study was conducted from February 5 to May 20, 2019 in Abeshge district, Southern Ethiopia. A total of 734 adults aged at least 30 years were selected using multistage cluster sampling technique and included in the study. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Moreover, all participants underwent spirometry. We defined COPD as a post-bronchodilator FEV1/FVC of less than 70%. Data were entered into Epi-data manager 4.4 and analyzed using SPSS version 23. Descriptive statistics and binary logistic regression analysis were used and p-value < 0.05 was considered as significant. RESULTS Of the 779 adults invited to participate, 734 adults (421 men and 313 women) were participated in this study. The mean (SD) age of the participants was 39.15 (± 9.36) years, within the age range of 30-75 years. The prevalence of COPD was 17.8% (95% confidence interval [CI], 15.1-20.6). Factors significantly associated with COPD were age above 50 years (adjusted odds ratio [AOR] = 1.91, 95% CI [1.10, 3.30]), being smoker (AOR = 4.54, 95% CI [2.69, 7.66]), Exposed to biomass smoke (AOR = 2.05, 95% CI [1.06, 3.95]) and poor ventilated kitchen (AOR = 4.12, 95% CI [2.67, 6.34]). CONCLUSION It is evident from this study that the prevalence of COPD in Ethiopia is high. Factors such as old age, cigarette smoking, exposure to biomass smoke and poor kitchen ventilation plays a role in the development of COPD.
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Affiliation(s)
- Gashaw Garedew Woldeamanuel
- Department of Biomedical Sciences, School of Medicine, College of Medicine and Health Sciences, Wolkite University, P.O. Box 07, Wolkite, Ethiopia.
| | - Alemu Basazin Mingude
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Teshome Gensa Geta
- Department of Biomedical Sciences, School of Medicine, College of Medicine and Health Sciences, Wolkite University, P.O. Box 07, Wolkite, Ethiopia
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Evaluation of the knowledge and correct use of metered-dose inhalers by healthcare professionals and medical students in Gauteng Province. Afr J Thorac Crit Care Med 2019; 25. [PMID: 34286261 PMCID: PMC8278855 DOI: 10.7196/ajtccm.2019.v25i3.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 11/08/2022] Open
Abstract
Background
The Global Initiative for Asthma (GINA) estimates that South Africa (SA) has over 3.9 million asthma sufferers, of whom 1.5%
die of the condition annually. SA has the world’s fourth highest asthma death rate among 5 - 35-year-olds. Chronic obstructive pulmonary
disease (COPD) will be the third leading cause of death globally by 2030, and will surpass HIV/AIDS in Africa. Uncontrolled asthma and
COPD are frequent causes of emergency department visits and hospital admissions. Poor metered-dose inhaler (MDI) technique is probably
a major contributory cause. It is the responsibility of all treating doctors and healthcare professionals to educate patients on inhaled therapy
with the correct MDI technique, as well as to routinely check and repeatedly demonstrate the technique to them.
Objectives
This study evaluated study participants’ knowledge of MDI technique, and their compliance in checking and demonstrating
MDI use to patients prescribed inhaled therapy. The study participants included doctors, nurses and final-year medical students at Helen
Joseph Hospital and Chris Hani Baragwanath Academic Hospital, in the Departments of Internal Medicine and Emergency Medicine, and
the Division of Pulmonology.
Methods
A total of 195 study participants volunteered to take part in the study. A questionnaire was administered to participants to gauge
their perceptions, level of knowledge and understanding of MDI technique. They were then requested to demonstrate correct inhaler
technique via a placebo MDI. Participants’ use of a placebo MDI was evaluated by a scoring system.
Results
The total sample of 195 comprised 130 (67%) female and 65 (33%) male participants. Of these, 133 (68%) were qualified medical
staff, and 62 were final-year medical students. Only 32 (16%) could demonstrate correct MDI technique. Over 50% of participants did not
demonstrate MDI technique to patients, or check their patients’ technique at every hospital-related visit.
Conclusion
Healthcare professionals and final-year medical students have poor knowledge of inhaler technique and are ill-prepared to teach
patients. Also of concern is that the majority do not routinely demonstrate or observe patients’ inhaler technique.
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Ndarukwa P, Chimbari MJ, Sibanda EN. Protocol on a systematic review of qualitative studies on asthma treatment challenges experienced in Sub-Saharan Africa. Syst Rev 2019; 8:149. [PMID: 31238974 PMCID: PMC6593567 DOI: 10.1186/s13643-019-1068-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Asthma is a major worldwide public health problem affecting an estimated 334 million people with over 300,000 deaths annually. Twenty-two million disability-adjusted life years (DALYs) are lost annually due to asthma. The condition may present many challenges if not managed well and effectively. This systematic review will provide a comprehensive synthesis of qualitative literature regarding the challenges experienced in the management of asthma and strategies adopted to counter these challenges. The review will answer the following questions: (i) what challenges have been experienced in the treatment of asthma in Sub-Saharan Africa (SSA)? and (ii) what strategies have been used to overcome asthma treatment challenges in SSA? METHODS The reviewers will search for the following databases for relevant qualitative studies: PubMed/MEDLINE, Scopus/Embase (Elsevier), EbscoHost, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar, using the Medical Subject Headings (MeSH) and controlled vocabulary. These articles must have been published in the English language between January 2008 and December 2018. The identified papers will then be assessed for meeting eligibility criteria. Two independent reviewers will screen titles and abstracts of articles and then review the full texts of the selected research articles. Standard data extraction forms will be utilised, and the quality of the included studies will be assessed using the Joanna Briggs checklist for qualitative research appraisal tool. Results from eligible articles will be qualitatively synthesised using the framework synthesis approach and reported according to the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement. DISCUSSION This systematic review will provide an overview of reported challenges in the treatment of asthma in Sub-Saharan Africa from 2008 to 2018. The review is expected to provide information that will help form the basis for future research, policy development and practice in treatment of asthma. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018095802.
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Affiliation(s)
- Pisirai Ndarukwa
- School of Nursing and Public Health, University of KwaZulu-Natal, 1st Floor, George Campbell Building, Howard College Campus, UKZN, Durban, 4000, South Africa.
| | - Moses John Chimbari
- School of Nursing and Public Health, University of KwaZulu-Natal, 1st Floor, George Campbell Building, Howard College Campus, UKZN, Durban, 4000, South Africa
| | - Elopy N Sibanda
- Asthma, Allergy and Immunedsyfunction Clinic, 113 Kwame Nkrumah Ave, Harare, Zimbabwe
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Burden of fungal asthma in Africa: A systematic review and meta-analysis. PLoS One 2019; 14:e0216568. [PMID: 31095641 PMCID: PMC6521988 DOI: 10.1371/journal.pone.0216568] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Background Asthma is one of the neglected diseases in Africa with a high prevalence. Allergic fungal diseases have been reported to complicate asthma progression and treatment outcomes. However, data about fungal asthma and its associated complications are limited in Africa. We aimed to estimate the burden of fungal asthma among adults and children in Africa using a systematic review. Methods We first engaged the Institute for Health Metrics and Evaluation (IHME) to highlight the trend in morbidity and mortality attributed to asthma in Africa. We then searched PubMed, HINARI and Google Scholar for all studies of any design focusing on fungal asthma in any African country. Languages were restricted to English and French, but not year of publication. We estimated the weighted prevalence of allergic fungal infections among asthmatics with a 95% CI and pooled the results using a random effects model. This study is registered with PROSPERO, number CRD42019117319. Results The IHME data showed that there has been a gradual increase in morbidity and mortality due to asthma in African adults with a prevalence of 4%. Our search retrieved 5233 citations. We retained 20 studies that met our selection criteria. These were from 13 African countries published between 1967 and 2018. There were eight cross-sectional studies and twelve review articles. The average asthma prevalence in Africa was 6% from these studies. The prevalence of fungal sensitisation was relatively high (3–52%) in the asthmatic population with an average of 28% and a pooled estimate of 23.3%, mostly due to Aspergillus species. Prevalence of Allergic bronchopulmonary apsergillosis was estimated at 1.6–21.2%. Diagnosis of fungal allergy was mostly made by skin prick tests. There was no data on the use of medication to manage fungal asthma. None of the studies evaluated the association between fungal allergy and asthma severity. Data were lacking in children. Conclusion There is a high prevalence of fungal sensitization among Africans with asthma. Fungal asthma is a significant problem in Africa but there remains a paucity of data on the epidemiology and associated complications. There is urgent need for national epidemiological studies to estimate the actual burden of fungal asthma in Africa.
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Shayo FK, Bintabara D. Are Tanzanian health facilities ready to provide management of chronic respiratory diseases? An analysis of national survey for policy implications. PLoS One 2019; 14:e0210350. [PMID: 30615663 PMCID: PMC6322729 DOI: 10.1371/journal.pone.0210350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Chronic respiratory diseases in Tanzania are prevalent and a silent burden to the affected population, and healthcare system. We aimed to explore the availability of services and level of health facilities readiness to provide management of chronic respiratory diseases and its associated factors. METHODS The current study is a secondary analysis of the 2014-2015 Tanzania Service Provision Assessment Survey data. Facilities were considered to have a high readiness to provide management of chronic respiratory diseases if they scored at least half (≥50%) of the indicators listed in each of the three domains (staff training and guideline, equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Descriptive, unadjusted and adjusted logistic regression analyses were performed. A P value < 0.05 was taken to indicate statistical significance. RESULTS Out of 723 facilities included in this analysis, approximately one-tenth had a high readiness to provide management of chronic respiratory diseases. Less than 10% of the facilities had at least one staff who received training for management of chronic respiratory diseases. In an adjusted model, privately owned facilities [AOR = 3.3; 95% CI, 1.5-7.5], hospitals [AOR = 11.6; 95% CI, 5.0-27.2], health centres [AOR = 5.0; 95% CI, 2.4-10.7], and performance of routine management meeting [AOR = 3.3; 95% CI, 1.4-7.8] were significantly associated with high readiness to provide management for chronic respiratory diseases. CONCLUSION Majority of Tanzanian health facilities have low readiness to provide management for chronic respiratory diseases. There is a need for the Tanzanian government to increase the availability of diagnostic equipment, medication, and to provide refresher training specifically in the lower-level and public health facilities for better management of chronic respiratory diseases and other non-communicable diseases.
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Affiliation(s)
- Festo K. Shayo
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deogratius Bintabara
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
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Robertson NM, Nagourney EM, Pollard SL, Siddharthan T, Kalyesubula R, Surkan PJ, Hurst JR, Checkley W, Kirenga BJ. Urban-Rural Disparities in Chronic Obstructive Pulmonary Disease Management and Access in Uganda. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2019; 6:17-28. [PMID: 30775421 PMCID: PMC6373590 DOI: 10.15326/jcopdf.6.1.2018.0143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 11/21/2022]
Abstract
Introduction: Almost 90% of chronic obstructive pulmonary disease (COPD) deaths occur in low- and middle-income countries (LMICs), where there are large rural populations and access to health care for COPD is poor. The purpose of this study was to compare urban-rural provider experiences regarding systemic facilitators and barriers to COPD management and treatment access. Methods: We conducted a qualitative study using direct observations and in-depth semi-structured interviews with 16 and 10 health care providers in urban Kampala and rural Nakaseke, Uganda, respectively. We analyzed interviews by performing inductive coding using generated topical codes. Results: In both urban and rural districts, exposure to evidence-based practices for COPD diagnosis and treatment was limited. The biomedical definition of COPD is not well distinguished in rural communities and was commonly confused with asthma and other respiratory diseases. Urban and rural participants alike described low availability of medications, limited access to diagnostic tools, poor awareness of the disease, and lack of financial means for medical care as common barriers to seeking and receiving care for COPD. While there was greater access to COPD treatment in urban areas, rural populations faced more pronounced barriers in access to diagnostic equipment, following standard treatment guidelines, and training medical personnel in non-communicable disease (NCD) management and treatment. Conclusion: Our results suggest that health system challenges for the treatment of COPD may disproportionately affect rural areas in Uganda. Implementation of diagnostic and treatment guidelines and training health professionals in COPD, with a special emphasis on rural communities, will assist in addressing these barriers.
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Affiliation(s)
- Nicole M Robertson
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Emily M Nagourney
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Suzanne L Pollard
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert Kalyesubula
- Department of Physiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Pamela J Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - John R Hurst
- UCL Respiratory, University College London, United Kingdom
| | - William Checkley
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Bruce J Kirenga
- Department of Medicine and Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Simba J, Marete I, Waihenya R, Kombe Y, Mwangi A, Mburugu P, Ogaro F. Knowledge and perceptions on childhood asthma among care-takers of children with asthma at a National Referral Hospital in Western Kenya: a descriptive study. Afr Health Sci 2018; 18:965-971. [PMID: 30766561 PMCID: PMC6354861 DOI: 10.4314/ahs.v18i4.16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Identifying knowledge gaps in asthma self-management and identifying existing myths is an important step in determining appropriate health education and demystifying the myths so as to enhance asthma control. Objective To identify existing knowledge gaps and perceptions among the caregivers of asthmatic children. Methods A cross sectional study was done among caretakers of asthmatic children aged 6–11 years at Moi Teaching and Referral Hospital. Data on knowledge and perceptions among caretakers was collected using a questionnaire. Results A total of 116 caretakers were recruited of whom 71.6% were mothers. Although 60% of the caretakers had asthma medications at home, only a third felt their children were asthmatic. Eighty four (72.4%) had basic asthma knowledge. Syrups were preferred to inhalers by 70.7%, with 64.7% believing that inhalers were for the very sick. Only 36 (31%) felt preventer medications in asthma were necessary. Acceptance of asthma as a diagnosis and presence of asthma drugs were significantly associated with better knowledge of asthma, p-values 0.015 and 0.009 respectively. Conclusion Most caregivers perceive syrups to be better despite having good basic knowledge on asthma. There is need to address asthma perceptions among caretakers in resource poor settings which is likely to improve control.
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Affiliation(s)
- Justus Simba
- Jomo Kenyatta University of Agriculture and Technology, Child Health and Paediatrics
| | - Irene Marete
- Moi University School of Medicine, Child Health and Paediatrics
| | | | | | - Ann Mwangi
- Moi University School of Medicine, Behavioural Sciences
| | - Patrick Mburugu
- Jomo Kenyatta University of Agriculture and Technology, Child Health and Paediatrics
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Ashbaugh HR, Cherry JD, Hoff NA, Doshi RH, Alfonso VH, Gadoth A, Mukadi P, Higgins SG, Budd R, Randall C, Okitolonda-Wemakoy E, Muyembe-Tamfum JJ, Gerber SK, Rimoin AW. Association of Previous Measles Infection With Markers of Acute Infectious Disease Among 9- to 59-Month-Old Children in the Democratic Republic of the Congo. J Pediatric Infect Dis Soc 2018; 8:531-538. [PMID: 30346573 PMCID: PMC6933309 DOI: 10.1093/jpids/piy099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/10/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transient immunosuppression and increased susceptibility to other infections after measles infection is well known, but recent studies have suggested the occurrence of an "immune amnesia" that could have long-term immunosuppressive effects. METHODS We examined the association between past measles infection and acute episodes of fever, cough, and diarrhea among 2350 children aged 9 to 59 months whose mothers were selected for interview in the 2013-2014 Democratic Republic of the Congo (DRC) Demographic and Health Survey (DHS). Classification of children who had had measles was completed using maternal recall and measles immunoglobulin G serostatus obtained via dried-blood-spot analysis with a multiplex immunoassay. The association with time since measles infection and fever, cough, and diarrhea outcomes was also examined. RESULTS The odds of fever in the previous 2 weeks were 1.80 (95% confidence interval [CI], 1.25-2.60) among children for whom measles was reported compared to children with no history of measles. Measles vaccination demonstrated a protective association against selected clinical markers of acute infectious diseases. CONCLUSION Our results suggest that measles might have a long-term effect on selected clinical markers of acute infectious diseases among children aged 9 to 59 months in the DRC. These findings support the immune-amnesia hypothesis suggested by others and underscore the need for continued evaluation and improvement of the DRC's measles vaccination program.
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Affiliation(s)
- Hayley R Ashbaugh
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles,Correspondence: H. R. Ashbaugh, DVM, PhD, UCLA Fielding School of Public Health, Department of Epidemiology, Box 951772, 650 Charles Young Dr., South, Los Angeles, CA 90095 ()
| | - James D Cherry
- David Geffen School of Medicine, University of California, Los Angeles
| | - Nicole A Hoff
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Reena H Doshi
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Vivian H Alfonso
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Adva Gadoth
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
| | - Patrick Mukadi
- School of Medicine, Kinshasa University, Democratic Republic of the Congo
| | | | - Roger Budd
- Dynex Technologies Incorporated, Chantilly, Virginia
| | | | | | | | - Sue K Gerber
- Bill and Melinda Gates Foundation, Seattle, Washington
| | - Anne W Rimoin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles
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Kahn N, Vanfleteren LEGW, Kaltsakas G, Andrianopoulos V, Gompelmann D, de Jong C, Herth FJF. Preview of highlighted presentations from the European Respiratory Society' clinical assembly. J Thorac Dis 2018; 10:S3034-S3042. [PMID: 30310696 PMCID: PMC6174136 DOI: 10.21037/jtd.2018.09.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/10/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Nicolas Kahn
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | | | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Vasileios Andrianopoulos
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Daniela Gompelmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Corina de Jong
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
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Questionnaires for Lung Health in Africa across the Life Course. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081615. [PMID: 30065166 PMCID: PMC6121394 DOI: 10.3390/ijerph15081615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022]
Abstract
Respiratory infections remain a leading cause of morbidity and mortality in many low and middle-income countries but non-communicable disease rates are rising fast. Prevalence studies have been primarily symptom-focused, with tools developed in countries in the Global North such as the United States and the United Kingdom. Systematic study in sub-Saharan African populations is necessary to accurately reflect disease risk factors present in these populations. We present tools for such studies, developed as part of the International Multidisciplinary Programme to Address Lung Health and TB in Africa ('IMPALA'), which includes lay representatives. At a preliminary meeting, the adequacy and suitability of existing tools was discussed and a new questionnaire set proposed. Individual questionnaires were developed, and an expert panel considered content and criterion validity. Questionnaires underwent a cross-cultural adaptation process, incorporating translation and contextual 'sense-checking', through the use of pre-established lay focus groups in Malawi, before consensus-approval by project collaborators. The complete set of research questionnaires, providing information on lung health symptoms and a relevant range of potential risk factors for lung disease, is now available online. In developing the tools, cultural and contextual insights were important, as were translational considerations. The process benefitted from a foundation in expert knowledge, starting with validated tools and internationally respected research groups, and from a coordinated collaborative approach. We present and discuss a newly devised, contextually appropriate set of questionnaires for non-communicable lung disease research in Africa that are now available in open access for all to use.
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van Gemert FA, Kirenga BJ, Gebremariam TH, Nyale G, de Jong C, van der Molen T. The complications of treating chronic obstructive pulmonary disease in low income countries of sub-Saharan Africa. Expert Rev Respir Med 2018; 12:227-237. [PMID: 29298106 DOI: 10.1080/17476348.2018.1423964] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In most low and middle-income countries, chronic obstructive pulmonary disease (COPD) is on the rise. Areas covered: Unfortunately, COPD is a neglected disease in these countries. Taking sub-Saharan Africa as an example, in rural areas, COPD is even unknown regarding public awareness and public health planning. Programs for the management of COPD are poorly developed, and the quality of care is often of a low standard. Inhaled medication is often not available or not affordable. Tobacco smoking is the most common encountered risk factor for COPD. However, in sub-Saharan Africa, household air pollution is another major risk factor for the development of COPD. Communities are also exposed to a variety of other risk factors, such as low birth weight, malnutrition, severe childhood respiratory infections, occupational exposures, outdoor pollution, human-immunodeficiency virus and tuberculosis. All these factors contribute to the high burden of poor respiratory health in sub-Saharan Africa. Expert commentary: A silent growing epidemic of COPD seems to be unravelling. Therefore, prevention and intervention programs must involve all the stakeholders and start as early as possible. More research is needed to describe, define and inform treatment approaches, and natural history of biomass-related COPD.
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Affiliation(s)
- Frederik A van Gemert
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda
| | - Bruce J Kirenga
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda.,c Department of Medicine , Makerere University , Kampala , Uganda
| | - Tewodros Haile Gebremariam
- d Department of Internal Medicine, Division of Pulmonary & Critical Care Medicine , Addis Ababa University, College of Health Science , Addis Ababa , Ethiopia
| | - George Nyale
- e Respiratory and Infectious Disease Unit , Kenyatta National Referral & Teaching Hospital , Nairobi , Kenya.,f Kenya Association of Physicians for Tuberculosis and other Lung Disease (KAPTLD) , Nairobi , Kenya
| | - Corina de Jong
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Thys van der Molen
- a Groningen Research Institute for asthma and COPD (GRIAC) , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.,b Makerere University Lung Institute (MLI), Mulago Hospital , Kampala , Uganda
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Jones R, Kirenga BJ, Katagira W, Singh SJ, Pooler J, Okwera A, Kasiita R, Enki DG, Creanor S, Barton A. A pre-post intervention study of pulmonary rehabilitation for adults with post-tuberculosis lung disease in Uganda. Int J Chron Obstruct Pulmon Dis 2017; 12:3533-3539. [PMID: 29270007 PMCID: PMC5729823 DOI: 10.2147/copd.s146659] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Setting The study was conducted at Mulago Hospital, Kampala, Uganda. Objective As chronic respiratory disease (CRD) is a huge, growing burden in Africa, with few available treatments, we aimed to design and evaluate a culturally appropriate pulmonary rehabilitation (PR) program in Uganda for people with post-tuberculosis lung disorder (p-TBLD). Design In a pre–post intervention study, a 6-week, twice-weekly PR program was designed for people with p-TBLD. Outcome measures included recruitment, retention, the Clinical COPD Questionnaire (CCQ), tests of exercise capacity, and biometrics. Given this was a developmental study, no formal statistical significance testing was undertaken. Results In all, 34 participants started PR and 29 (85%) completed all data collection. The mean age of the 29 participants was 45 years, and 52% were female. The mean (95% confidence interval) CCQ score at baseline was 1.8 (1.5, 2.0), at the end of PR was 1.0 (0.8, 1.2), and at 6 weeks after the end of PR was 0.8 (0.7, 1.0). The Incremental Shuttle Walking Test (ISWT) was 299 m (268.5, 329.4) at baseline, 377 (339.6, 413.8) at the end of PR, and 374 (334.2, 413.5) at 6 weeks after the end of PR. Improvements were seen in measures of chest pain; 13/29 (45%) participants reported chest pain at baseline but only 7/29 (24%) at the end of PR, and in those with persistent pain, the mean pain scores decreased. Mild hemoptysis was reported in 4/29 (17%) participants at baseline and in 2/29 (7%) at the end of PR. Conclusion PR for people with p-TBLD in Uganda was feasible and associated with clinically important improvements in quality of life, exercise capacity, and respiratory outcomes. PR uses local resources, requires little investment, and offers a new, sustainable therapy for p-TBLD in resource-limited settings. With the rising global burden of CRD, further studies are needed to assess the value of PR in p-TBLD and other prevalent forms of CRD.
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Affiliation(s)
- Rupert Jones
- Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Bruce J Kirenga
- Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Wincelsas Katagira
- Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Sally J Singh
- Cardio-Respiratory Directorate, University Hospitals of Leicester NHS Trust, Leicester
| | - Jill Pooler
- Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Alphonse Okwera
- Population Studies and Clinical Trials, Makerere Lung Institute, Makerere University College of Health Sciences, Mulago Hospital, Kampala, Uganda
| | - Richard Kasiita
- Department of Physiotherapy, Mulago Hospital, Kampala, Uganda
| | - Doyo G Enki
- Medical Statistics, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Siobhan Creanor
- Medical Statistics, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
| | - Andy Barton
- Population Studies and Clinical Trials, Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK
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Banda HT, Thomson R, Mortimer K, Bello GAF, Mbera GB, Malmborg R, Faragher B, Squire SB. Community prevalence of chronic respiratory symptoms in rural Malawi: Implications for policy. PLoS One 2017; 12:e0188437. [PMID: 29216193 PMCID: PMC5720679 DOI: 10.1371/journal.pone.0188437] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 11/07/2017] [Indexed: 12/02/2022] Open
Abstract
Background No community prevalence studies have been done on chronic respiratory symptoms of cough, wheezing and shortness of breath in adult rural populations in Malawi. Case detection rates of tuberculosis (TB) and chronic airways disease are low in resource-poor primary health care facilities. Objective To understand the prevalence of chronic respiratory symptoms and recorded diagnoses of TB in rural Malawian adults in order to improve case detection and management of these diseases. Methods A population proportional, cross-sectional study was conducted to determine the proportion of the population with chronic respiratory symptoms that had a diagnosis of tuberculosis or chronic airways disease in two rural communities in Malawi. Households were randomly selected using Google Earth Pro software. Smart phones loaded with Open Data Kit Essential software were used for data collection. Interviews were conducted with 15795 people aged 15 years and above to enquire about symptoms of chronic cough, wheeze and shortness of breath. Results Overall 3554 (22.5%) participants reported at least one of these respiratory symptoms. Cough was reported by 2933, of whom 1623 (55.3%) reported cough only and 1310 (44.7%) combined with wheeze and/or shortness of breath. Only 4.6% (164/3554) of participants with chronic respiratory symptoms had one or more of the following diagnoses in their health passports (patient held medical records): TB, asthma, bronchitis and chronic obstructive pulmonary disease) Conclusions The high prevalence of chronic respiratory symptoms coupled with limited recorded diagnoses in patient-held medical records in these rural communities suggests a high chronic respiratory disease burden and unmet health need.
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Affiliation(s)
| | - Rachael Thomson
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kevin Mortimer
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Grace B. Mbera
- Research for Equity and Community Health Trust, Lilongwe, Malawi
| | | | - Brian Faragher
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - S. Bertel Squire
- Collaboration for Applied Health Research & Delivery, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Belachew SA, Tilahun F, Ketsela T, Achaw Ayele A, Kassie Netere A, Getnet Mersha A, Befekadu Abebe T, Melaku Gebresillassie B, Getachew Tegegn H, Asfaw Erku D. Competence in metered dose inhaler technique among community pharmacy professionals in Gondar town, Northwest Ethiopia: Knowledge and skill gap analysis. PLoS One 2017; 12:e0188360. [PMID: 29176836 PMCID: PMC5703544 DOI: 10.1371/journal.pone.0188360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND When compared to systemic administration, if used correctly inhalers deliver a smaller enough percent of the drug right to the site of action in the lungs, with a faster onset of effect and with reduced systemic availability that minimizes adverse effects. However, the health professionals' and patients' use of metered dose inhaler is poor. OBJECTIVE This study was aimed to explore community pharmacy professionals' (pharmacists' and druggists') competency on metered dose inhaler (MDI) technique. METHOD A cross sectional study was employed on pharmacy professionals working in community drug retail outlets in Gondar town, northwest Ethiopia from March to May 2017. Evaluation tool was originally taken and adapted from the National Asthma Education and Prevention Programmes of America (NAEPP) step criteria for the demonstration of a metered dose inhaler to score the knowledge/proficiency of using the inhaler. RESULT Among 70 community pharmacy professionals approached, 62 (32 pharmacists and 30 druggists/Pharmacy technicians) completed the survey with a response rate of 85.6%. Only three (4.8%) respondents were competent by demonstrating the vital steps correctly. Overall, only 13 participants got score seven or above, but most of them had missed the essential steps which included steps 1, 2, 5, 6, 7 or 8. There was a significant difference (P = 0.015) in competency of demonstrating adequate inhalational technique among respondents who took training on basic inhalational techniques and who did not. CONCLUSION This study shown that, community pharmacy professionals' competency of MDI technique was very poor. So as to better incorporate community pharmacies into future asthma illness management and optimize the contribution of pharmacists, interventions would emphasis to improve the total competence of community pharmacy professionals through establishing and providing regular educational programs.
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Affiliation(s)
- Sewunet Admasu Belachew
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Fasil Tilahun
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Tirsit Ketsela
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Asnakew Achaw Ayele
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Amanual Getnet Mersha
- Department of Gynecology and obstetrics, School of Medicine, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Begashaw Melaku Gebresillassie
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
| | - Daniel Asfaw Erku
- Department of Clinical Pharmacy, School of Pharmacy, University of Gondar Chechela Street, Lideta Sub city Kebele, Gondar, Ethiopia
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47
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Ayele AA, Tegegn HG. Non adherence to inhalational medications and associated factors among patients with asthma in a referral hospital in Ethiopia, using validated tool TAI. Asthma Res Pract 2017; 3:7. [PMID: 29046815 PMCID: PMC5639592 DOI: 10.1186/s40733-017-0035-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/02/2017] [Indexed: 11/15/2022] Open
Abstract
Background Asthma is a chronic inflammatory condition of the airways that affects roughly 358 million people globally. It is a serious global health problem with an increasing prevalence worldwide. Most people affected are in low- and middle-income countries including Ethiopia. The association between non -adherence and poor disease control is clearly stated in different literatures. The main objective of the present study was to assess self-reported non- adherence level and to identify the potential factors associated with non-adherence. Methods An institution based cross-sectional study was conducted in university of Gondar teaching and referral hospital. The data was collected using a validated tool called Test of Adherence to Inhalers (TAI). Result Among the total of study participants, higher proportions of patients were female (57.3%). Large number of the respondents (59.1%) were Unable to read and write. 18.3% of inhalational user asthmatic patients were not adherent to inhalational medications. According to this study only 49.4% of the respondents were adherent to inhalations and 32.3% of them were intermediate adherent to inhalational anti asthmatics medications. Lack of education about the Proper use of inhalational anti-asthmatics medications, poly pharmacy and co-morbidities were statistically significant factors associated with non-adherence. Conclusion The rate of non-adherence to inhalational anti asthmatics is high. Therefore, promoting optimal medication adherences through education, proper patient consultation is essential to optimize the benefits of treatment. Measurement of the degree of non-adherence to inhaled treatment in each individual patient is important in early interventional practice.
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Affiliation(s)
- Asnakew Achaw Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia
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Ahmed R, Robinson R, Mortimer K. The epidemiology of noncommunicable respiratory disease in sub-Saharan Africa, the Middle East, and North Africa. Malawi Med J 2017; 29:203-211. [PMID: 28955434 PMCID: PMC5610297 DOI: 10.4314/mmj.v29i2.24] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Noncommunicable diseases (NCDs) are a major and increasing global health issue. The World Health Organization (WHO) estimates that NCDs represent 63% of all global deaths of which 3.9 million are due to chronic respiratory diseases (CRDs) and Chronic Obstructive Pulmonary Disease (COPD) in particular. COPD is now the third most common cause of death globally; 90% of these deaths occur in Low and Middle Income Countries (LMICs). COPD affects 329 million people, almost 5% of the world's population. In addition, asthma affects 334 million people, again representing almost 5% of the world's population. There is limited literature published on the epidemiology of COPD and Asthma from Sub-Saharan Africa (SSA) and Middle East and North Africa (MENA). Both diseases are under-diagnosed and underestimated in both SSA and MENA regions. The burden of COPD in sub-Saharan Africa is disputed and reports offer variable prevalence estimates, ranging from 4.1% to almost 22.2%. SSA and MENA countries report similar mortality rates from COPD of 18 per 100,000 population (2001 data). Asthma is a less common cause of death than COPD but is a major cause of morbidity; WHO estimates that there are 250,000 deaths per year from asthma, mainly in LMICs and it remains in the top twenty causes of disability in children globally. Risk factors for CRD are genetic and environmental; the latter dominated by air pollution exposures including tobacco smoke, household air pollution, outdoor air pollution and occupational exposures.
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Affiliation(s)
- Rana Ahmed
- The Epidemiological Laboratory, Khartoum, Sudan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ryan Robinson
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Moore A, Riddell K, Joshi S, Chan R, Mehta R. Pharmacokinetics of Salbutamol Delivered from the Unit Dose Dry Powder Inhaler: Comparison with the Metered Dose Inhaler and Diskus Dry Powder Inhaler. J Aerosol Med Pulm Drug Deliv 2017; 30:164-172. [DOI: 10.1089/jamp.2015.1277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Robert Chan
- GSK, Stockley Park, Uxbridge, United Kingdom
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50
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Obel KB, Ntumba KJM, Kalambayi KP, Zalagile AP, Kinkodi KD, Munogolo KZ. Prevalence and determinants of asthma in adults in Kinshasa. PLoS One 2017; 12:e0176875. [PMID: 28464036 PMCID: PMC5413054 DOI: 10.1371/journal.pone.0176875] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/18/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Epidemiological data on asthma among adults in sub-Saharan Africa are sparse. OBJECTIVE To determine the prevalence of and factors associated with asthma among adults in Kinshasa. METHODS A previously validated asthma questionnaire was administered to an adult population aged ≥18 years in urban and peri-urban suburbs of Kinshasa. A random stratified multi-stage sampling plan was used to select the study participants. Logistic regression was used to identify factors associated with asthma. RESULTS The mean age of respondents was 36.7 (SD 15.36) years, 75% lived in an urban environment, and 57% were women. The prevalence of asthma-ever was 6.9% (95% CI: 5.4-8.4). Among asthmatic patients, intermittent asthma was estimated at 75.7% and severe asthma at 9.3%. Family atopy (OR: 3.97; 95% CI: 2.42-6.50; p<0.001), and the presence of a cat in the house (OR: 1.82; 95% CI: 1.01-3.28; p = 0.045) were associated with self-reported asthma. CONCLUSION Asthma is relatively frequent in adults in Kinshasa, a prevalence similar to those reported elsewhere in Africa. Family atopy and the presence of a cat in the house could be the most common determinants to be confirmed with national survey in order to design guidelines for the control of asthma.
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Affiliation(s)
- Kabengele Benoit Obel
- Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | | | | | - Kaba Didine Kinkodi
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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