Community prevalence of chronic respiratory symptoms in rural Malawi: Implications for policy.

Hastings T Banda,Grace B Mbera,Brian Faragher,Kevin Mortimer,Rasmus Malmborg,S Bertel Squire,Rachael Thomson,George A F Bello,Richard Van Zyl-Smit

doi:10.1371/journal.pone.0188437

Abstract

BackgroundNo 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.ObjectiveTo 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.MethodsA 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.ResultsOverall 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)ConclusionsThe 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.

Highlights

Both non-communicable chronic respiratory diseases and tuberculosis (TB), cause a major burden of disease and challenge to public health in developing countries and are on the increase globally [1,2,3,4]
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

Summary

Introduction

Both non-communicable chronic respiratory diseases (including chronic obstructive pulmonary disease [COPD], asthma, bronchiectasis) and tuberculosis (TB), cause a major burden of disease and challenge to public health in developing countries and are on the increase globally [1,2,3,4]. Chronic respiratory symptoms are common in the general population but weak primary health care systems in resource-poor countries are often unable to diagnose COPD, asthma, bronchiectasis [2],[7]. Factors contributing to low rates of diagnosis include limited access to, negative perceptions of quality of, and lack of diagnostic capability in, health care facilities by those with respiratory symptoms in rural populations. Case detection rates of tuberculosis (TB) and chronic airways disease are low in resource-poor primary health care facilities

Methods

Results

Conclusion