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Jayasooriya S, Stolbrink M, Khoo EM, Sunte IT, Awuru JI, Cohen M, Lam DC, Spanevello A, Visca D, Centis R, Migliori GB, Ayuk AC, Buendia JA, Awokola BI, Del-Rio-Navarro BE, Muteti-Fana S, Lao-Araya M, Chiarella P, Badellino H, Somwe SW, Anand MP, Garcí-Corzo JR, Bekele A, Soto-Martinez ME, Ngahane BHM, Florin M, Voyi K, Tabbah K, Bakki B, Alexander A, Garba BL, Salvador EM, Fischer GB, Falade AG, ŽivkoviĆ Z, Romero-Tapia SJ, Erhabor GE, Zar H, Gemicioglu B, Brandão HV, Kurhasani X, El-Sharif N, Singh V, Ranasinghe JC, Kudagammana ST, Masjedi MR, Velásquez JN, Jain A, Cherrez-Ojeda I, Valdeavellano LFM, Gómez RM, Mesonjesi E, Morfin-Maciel BM, Ndikum AE, Mukiibi GB, Reddy BK, Yusuf O, Taright-Mahi S, Mérida-Palacio JV, Kabra SK, Nkhama E, Filho NR, Zhjegi VB, Mortimer K, Rylance S, Masekela RR. Clinical standards for the diagnosis and management of asthma in low- and middle-income countries. Int J Tuberc Lung Dis 2023; 27:658-667. [PMID: 37608484 PMCID: PMC10443788 DOI: 10.5588/ijtld.23.0203] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: The aim of these clinical standards is to aid the diagnosis and management of asthma in low-resource settings in low- and middle-income countries (LMICs).METHODS: A panel of 52 experts in the field of asthma in LMICs participated in a two-stage Delphi process to establish and reach a consensus on the clinical standards.RESULTS: Eighteen clinical standards were defined: Standard 1, Every individual with symptoms and signs compatible with asthma should undergo a clinical assessment; Standard 2, In individuals (>6 years) with a clinical assessment supportive of a diagnosis of asthma, a hand-held spirometry measurement should be used to confirm variable expiratory airflow limitation by demonstrating an acute response to a bronchodilator; Standard 3, Pre- and post-bronchodilator spirometry should be performed in individuals (>6 years) to support diagnosis before treatment is commenced if there is diagnostic uncertainty; Standard 4, Individuals with an acute exacerbation of asthma and clinical signs of hypoxaemia or increased work of breathing should be given supplementary oxygen to maintain saturation at 94-98%; Standard 5, Inhaled short-acting beta-2 agonists (SABAs) should be used as an emergency reliever in individuals with asthma via an appropriate spacer device for metered-dose inhalers; Standard 6, Short-course oral corticosteroids should be administered in appropriate doses to individuals having moderate to severe acute asthma exacerbations (minimum 3-5 days); Standard 7, Individuals having a severe asthma exacerbation should receive emergency care, including oxygen therapy, systemic corticosteroids, inhaled bronchodilators (e.g., salbutamol with or without ipratropium bromide) and a single dose of intravenous magnesium sulphate should be considered; Standard 8, All individuals with asthma should receive education about asthma and a personalised action plan; Standard 9, Inhaled medications (excluding dry-powder devices) should be administered via an appropriate spacer device in both adults and children. Children aged 0-3 years will require the spacer to be coupled to a face mask; Standard 10, Children aged <5 years with asthma should receive a SABA as-needed at step 1 and an inhaled corticosteroid (ICS) to cover periods of wheezing due to respiratory viral infections, and SABA as-needed and daily ICS from step 2 upwards; Standard 11, Children aged 6-11 years with asthma should receive an ICS taken whenever an inhaled SABA is used; Standard 12, All adolescents aged 12-18 years and adults with asthma should receive a combination inhaler (ICS and rapid onset of action long-acting beta-agonist [LABA] such as budesonide-formoterol), where available, to be used either as-needed (for mild asthma) or as both maintenance and reliever therapy, for moderate to severe asthma; Standard 13, Inhaled SABA alone for the management of patients aged >12 years is not recommended as it is associated with increased risk of morbidity and mortality. It should only be used where there is no access to ICS.The following standards (14-18) are for settings where there is no access to inhaled medicines. Standard 14, Patients without access to corticosteroids should be provided with a single short course of emergency oral prednisolone; Standard 15, Oral SABA for symptomatic relief should be used only if no inhaled SABA is available. Adjust to the individual's lowest beneficial dose to minimise adverse effects; Standard 16, Oral leukotriene receptor antagonists (LTRA) can be used as a preventive medication and is preferable to the use of long-term oral systemic corticosteroids; Standard 17, In exceptional circumstances, when there is a high risk of mortality from exacerbations, low-dose oral prednisolone daily or on alternate days may be considered on a case-by-case basis; Standard 18. Oral theophylline should be restricted for use in situations where it is the only bronchodilator treatment option available.CONCLUSION: These first consensus-based clinical standards for asthma management in LMICs are intended to help clinicians provide the most effective care for people in resource-limited settings.
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Affiliation(s)
- S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield
| | - M Stolbrink
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - E M Khoo
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Edinburgh, Scotland, UK
| | - I T Sunte
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - J I Awuru
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - M Cohen
- Hospital Centro Médico, Guatemala City, Guatemala, Mexico, Asociación Latinoamericana de Tórax, Montevideo, Uruguay
| | - D C Lam
- Department of Medicine, University of Hong Kong, Hong Kong, Asian Pacific Society of Respirology, Hong Kong, China
| | - A Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Tradate, Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como
| | - D Visca
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Department of Medicine, University of Hong Kong, Hong Kong
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri, Tradate, Italy
| | - A C Ayuk
- College of Medicine, University of Nigeria, Enugu, Nigeria
| | - J A Buendia
- Affiliation Departamento de Farmacologia y Tóxicologia, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - B I Awokola
- Medical Research Council, The Gambia at the London School of Tropical Medicine, The Gambia
| | | | - S Muteti-Fana
- Department of Primary Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - M Lao-Araya
- Division of Allergy and Clinical Immunology, Chian Mai University, Chiang Mai, Thailand
| | - P Chiarella
- Health Sciences School, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - H Badellino
- Head Pediatric Respiratory Medicine Department, Clinica Regional del Este, San Francisco, Argentina
| | - S W Somwe
- Paediatrics and Child Health, University of Lusaka, Lusaka, Zambia
| | - M P Anand
- Department of Respiratory Medicine, JSS Medical College, Mysore, India
| | - J R Garcí-Corzo
- Department of Pediatrics, Universidad Industrial de Santander, Santander, Colombia
| | - A Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - M E Soto-Martinez
- Department of Pediatrics, Universidad de Costa Rica, San Jose, Costa Rica
| | - B H M Ngahane
- Douala General Hospital, University of Douala, Douala, Cameroon
| | - M Florin
- Institute of Pneumology M. Nasta, Bucharest, Romania
| | - K Voyi
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - K Tabbah
- College of Medicine, Ajman University, Ajman, United Arab Emirates
| | - B Bakki
- University of Maiduguri Teaching Hospital, Maiduguri
| | - A Alexander
- Deparment of Medicine, University of Abuja, Abuja
| | - B L Garba
- Department of Paediatrics, Usmanu Danfodiyo, University Teaching Hospital, Sokoto, Nigeria
| | - E M Salvador
- Deparment of Biological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - G B Fischer
- University of Medical Sciences, Porto Alegre, RS, Brazil
| | - A G Falade
- Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Zorica ŽivkoviĆ
- Dragiša Mišovic, Childrens Hsopital for Lung Disease and TB, Belgrade, Serbia
| | - S J Romero-Tapia
- Health Sciences, Academic Division, Juarez Autononous, University of Tabasco, Villahermosa, Mexico
| | - G E Erhabor
- Department of Medicine, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria
| | - H Zar
- Department of Paediatrics & Child Health & SA MRC Unit on Children & Adolescent Health, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - B Gemicioglu
- Department of Pulmonary Diseases, Istanbul University, Cerrahpasa, Turkey
| | - H V Brandão
- State University of Feira de Santana, Feira de Santana, BA, Brazil
| | - X Kurhasani
- UBT Higher Education Institution, Prishtina, Kosovo
| | | | - V Singh
- MJ Rajasthan Hospital, Jaipur, India
| | | | - S T Kudagammana
- Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - M R Masjedi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - J N Velásquez
- Medical School, Santander Industrial, Bucaramanga, Colombia
| | - A Jain
- Department of Community Medicine, Kasturba Medical College, Mangalore
| | | | - L F M Valdeavellano
- Asociación Latinoamericana de Tórax, Montevideo, Uruguay, Francisco Morroguín University, Guatemala City, Guatemala
| | - R M Gómez
- Faculty of Health Sciences, Catholic University of Salta, Salta, Argentina
| | - E Mesonjesi
- Department of Allergy and Clinical Immunology, University Hospital Centre "Mother Teresa", Tirana, Albania
| | | | - A E Ndikum
- The University of Yaounde 1, Yaounde, Cameroon
| | | | - B K Reddy
- Shishuka Children's Speciality Hospital, Bangalore, India
| | - O Yusuf
- The Allergy and Asthma Institute, Islamabad, Pakistan
| | - S Taright-Mahi
- Medecin Faculty, Mustapha Universitary Hospital Algiers, Algeria
| | - J V Mérida-Palacio
- Centrode Investigación de Enfermedades Alérgicas y Respiratorias SC, Mexico DF, Mexico
| | - S K Kabra
- Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - E Nkhama
- Levy Mwanawasa Medical University, School of Public Health and Environmental Sciences, Lusaka, Zambia
| | - N R Filho
- Federal University of Parana, Curitiba, PA, Brazil
| | - V B Zhjegi
- Social Medicine, Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - K Mortimer
- University of Cambridge, Cambridge, Imperial College, London, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - S Rylance
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - R R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
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Rylance S, Bateman ED, Boulet L, Cohen M, El Sony A, Halpin DMG, Khoo EM, Marks GB, Masekela R, Mikkelsen B, Mortimer KJ, Chakaya Muhwa J, Nunes da Cunha I, Šajnić A, Salvi S, Slama S, Winders T, Yorgancioglu A, Zar HJ. Key messages and partnerships to raise awareness and improve outcomes for people with asthma and COPD in low- and middle-income countries. Int J Tuberc Lung Dis 2022; 26:1106-1108. [PMID: 36447314 DOI: 10.5588/ijtld.22.0544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- S Rylance
- Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
| | - E D Bateman
- Global Initiative for Asthma (GINA), Fontana, WI, USA, University of Cape Town Lung Institute, Cape Town, South Africa
| | - L Boulet
- Global Initiative for Asthma (GINA), Fontana, WI, USA, Laval University, Quebec City, QC, Canada
| | - M Cohen
- Forum of International Respiratory Societies, Lausanne, Switzerland, Asociacion Latinoamericana de Torax, Montevideo, Uruguay, Hospital Centro Medico, Guatemala City, Guatemala
| | - A El Sony
- International Union Against Tuberculosis and Lung Disease, Paris, France, Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - D M G Halpin
- Global Initiative for Obstructive Lung Disease (GOLD), Fontana, WI, USA, University of Exeter Medical School, Exeter, UK
| | - E M Khoo
- International Primary Care Respiratory Group (IPCRG), Edinburgh, UK, Department of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - G B Marks
- International Union Against Tuberculosis and Lung Disease, Paris, France, University of New South Wales, Sydney, NSW, Australia
| | - R Masekela
- International Union Against Tuberculosis and Lung Disease, Paris, France, Global Asthma Network (GAN), Auckland, New Zealand, Pan African Thoracic Society, Congella, South Africa, Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa
| | - B Mikkelsen
- Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
| | - K J Mortimer
- Global Initiative for Asthma (GINA), Fontana, WI, USA, International Union Against Tuberculosis and Lung Disease, Paris, France, Global Initiative for Obstructive Lung Disease (GOLD), Fontana, WI, USA, Global Asthma Network (GAN), Auckland, New Zealand, Aintree University Hospital, Liverpool, UK
| | - J Chakaya Muhwa
- International Union Against Tuberculosis and Lung Disease, Paris, France, Kenyatta University, Nairobi, Kenya
| | | | - A Šajnić
- International Coalition of Respiratory Nurses, University Hospital Centre Zagreb, Croatia
| | - S Salvi
- Global Initiative for Obstructive Lung Disease (GOLD), Fontana, WI, USA, Pulmocare Research and Education Foundation, Pune, India
| | - S Slama
- Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
| | - T Winders
- Global Allergy and Airways Patient Platform, Vienna, Austria
| | - A Yorgancioglu
- Global Initiative for Asthma (GINA), Fontana, WI, USA, Celal Bayar University, Manisa, Turkey
| | - H J Zar
- Forum of International Respiratory Societies, Lausanne, Switzerland, Pan African Thoracic Society, Congella, South Africa, SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Stolbrink M, Chinouya MJ, Jayasooriya S, Nightingale R, Evans-Hill L, Allan K, Allen H, Balen J, Beacon T, Bissell K, Chakaya J, Chiang CY, Cohen M, Devereux G, El Sony A, Halpin DMG, Hurst JR, Kiprop C, Lawson A, Macé C, Makhanu A, Makokha P, Masekela R, Meme H, Khoo EM, Nantanda R, Pasternak S, Perrin C, Reddel H, Rylance S, Schweikert P, Were C, Williams S, Winders T, Yorgancioglu A, Marks GB, Mortimer K. Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries. Int J Tuberc Lung Dis 2022; 26:1023-1032. [PMID: 36281039 PMCID: PMC9621306 DOI: 10.5588/ijtld.22.0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution.CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.
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Affiliation(s)
- M Stolbrink
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Stellenbosch University, Tygerberg, South Africa
| | - M J Chinouya
- Education Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Jayasooriya
- Academic Unit of Primary Care, University of Sheffield, Sheffield, UK
| | - R Nightingale
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, IcFEM Dreamland Mission Hospital, Kimilili, Kenya
| | | | - K Allan
- Healthcare Consultant, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia
| | - H Allen
- Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia
| | - J Balen
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Beacon
- Medical Aid International, Bedford, UK
| | - K Bissell
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - J Chakaya
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya
| | - C-Y Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - M Cohen
- Asociación Latinoamericana del Tórax, Forum of International Respiratory Societies, Guatemala
| | - G Devereux
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A El Sony
- The Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum Sudan
| | - D M G Halpin
- University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - J R Hurst
- UCL Respiratory, University College London, London, UK
| | - C Kiprop
- IcFEM Dreamland Mission Hospital, Kimilili, Kenya
| | | | - C Macé
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - A Makhanu
- IcFEM Dreamland Mission Hospital, Kimilili, Kenya
| | - P Makokha
- IcFEM Dreamland Mission Hospital, Kimilili, Kenya
| | - R Masekela
- Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - H Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - E M Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Larbert, Scotland, UK
| | - R Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - C Perrin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - H Reddel
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia, Global Initiative for Asthma (GINA), Fontana, WI, USA
| | - S Rylance
- Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland
| | | | - C Were
- GlaxoSmithKline, Brentford, UK
| | - S Williams
- International Primary Care Respiratory Group, Larbert, Scotland, UK
| | - T Winders
- Global Allergy & Airways Patient Platform, Vienna, Austria
| | - A Yorgancioglu
- Department of Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey, Global Alliance Against Chronic Respiratory Diseases, Geneva, Switzerland
| | - G B Marks
- International Union Against Tuberculosis and Lung Disease, Paris, France, University of New South Wales, Sydney, NSW, Australia
| | - K Mortimer
- International Union Against Tuberculosis and Lung Disease, Paris, France, University of Cambridge, Cambridge, UK
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Rylance S, Masekela R, Banda NPK, Mortimer K. Determinants of lung health across the life course in sub-Saharan Africa. Int J Tuberc Lung Dis 2020; 24:892-901. [PMID: 33156755 DOI: 10.5588/ijtld.20.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
LUNG HEALTH ACROSS THE life course is influenced by factors affecting airway and alveolar development and growth during antenatal and perinatal periods, throughout childhood and adolescence, and into adulthood. Lung function trajectories are set in early life and childhood deficits may predispose to non-communicable respiratory diseases, such as asthma and chronic obstructive pulmonary disease, in later years. Potential risk factors are common in many sub-Saharan African (sSA) countries; adverse antenatal environments cause in utero growth restriction and prematurity; HIV and respiratory infections, including TB are common; exposure to air pollution is widespread, including household air pollution from biomass fuel use, traffic-related pollution in rapidly expanding cities, and tobacco smoke exposure. Multiple disadvantages experienced in early life require an integrated approach that addresses reproductive, maternal and child health. Public health strategies need to tackle multiple risk factors, emphasising Universal Health Coverage, to maximise lung health in the world´s poorest, most vulnerable populations. This review explores potential determinants of lung health across the life course. Due to the extensive topic and wide range of related literature, we prioritised more recent citations, especially those from sSA, focusing on risk factors for which there is most information, and which are most prevalent in the region.
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Affiliation(s)
- S Rylance
- Lung Health Group, Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Masekela
- Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa
| | - N P K Banda
- Department of Medicine, University of Malawi College of Medicine, University of Malawi, Blantyre, Malawi
| | - K Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Katangwe-Chirwa T, Molyneux E, Rylance S, Kennedy N, Chagaluka G. Tricuspid endocarditis, in a 12 year old girl with a previously normal heart. Malawi Med J 2012; 24:81-3. [PMID: 23638283 PMCID: PMC3623021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- T Katangwe-Chirwa
- College of Medicine, University of Malawi, Paediatric and Child Health Department
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van den Heuvel M, Blencowe H, Mittermayer K, Rylance S, Couperus A, Heikens GT, Bandsma RHJ. Introduction of bubble CPAP in a teaching hospital in Malawi. ACTA ACUST UNITED AC 2011; 31:59-65. [PMID: 21262111 DOI: 10.1179/1465328110y.0000000001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) is relatively inexpensive and can be easily taught; it therefore has the potential to be the optimal respiratory support device for neonates in developing countries. OBJECTIVE The possibility of implementing bubble CPAP in a teaching hospital with a large neonatology unit but very limited resources was investigated. METHODS A CPAP system was developed consisting of a compressor, oxygen concentrator, water bottle to control the pressure and binasal prongs. Neonates with birthweights between 1 and 2·5 kg with persistent respiratory distress 4 hours after birth were eligible for bubble CPAP. RESULTS In the 7-week introduction period from 11 March until 27 April 2008, 11 neonates were treated with CPAP. Five of these neonates met the inclusion criteria and six neonates did not meet these criteria. Of the five neonates who received CPAP and met the inclusion criteria, three survived. The six infants who did not meet the inclusion criteria included three preterm infants with apnoea (all died), two with birthweights <1 kg (both died) and a firstborn twin (1.2 kg) who survived. No major complications of CPAP occurred. Bubble CPAP could be used independently by nurses after a short training period. CONCLUSION Successful long-term implementation of CPAP depends on the availability of sufficient trained nursing staff.
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