Abstract
ObjectiveTo determine the prevalence of chronic respiratory diseases in urban and rural Uganda and to identify risk factors for these diseases.MethodsThe population-based, cross-sectional study included adults aged 35 years or older. All participants were evaluated by spirometry according to standard guidelines and completed questionnaires on respiratory symptoms, functional status and demographic characteristics. The presence of four chronic respiratory conditions was monitored: chronic obstructive pulmonary disease (COPD), asthma, chronic bronchitis and a restrictive spirometry pattern.FindingsIn total, 1502 participants (average age: 46.9 years) had acceptable, reproducible spirometry results: 837 (56%) in rural Nakaseke and 665 (44%) in urban Kampala. Overall, 46.5% (698/1502) were male. The age-adjusted prevalence of any chronic respiratory condition was 20.2%. The age-adjusted prevalence of COPD was significantly greater in rural than urban participants (6.1 versus 1.5%, respectively; P < 0.001), whereas asthma was significantly more prevalent in urban participants: 9.7% versus 4.4% in rural participants (P < 0.001). The age-adjusted prevalence of chronic bronchitis was similar in rural and urban participants (3.5 versus 2.2%, respectively; P = 0.62), as was that of a restrictive spirometry pattern (10.9 versus 9.4%; P = 0.82). For COPD, the population attributable risk was 51.5% for rural residence, 19.5% for tobacco smoking, 16.0% for a body mass index < 18.5 kg/m2 and 13.0% for a history of treatment for pulmonary tuberculosis.ConclusionThe prevalence of chronic respiratory disease was high in both rural and urban Uganda. Place of residence was the most important risk factor for COPD and asthma.
Highlights
Chronic respiratory disease affects one billion people worldwide and is a leading cause of death.[1]
Previous studies have examined the prevalence of chronic obstructive pulmonary disease (COPD) in either rural or urban settings,[8,9,10] but none has investigated how the pattern of chronic respiratory disease varies across different residential settings, with the aim of evaluating the impact of the urban environment
COPD has been closely linked to household air pollution in rural areas in low- and middle-income countries and the disease burden is expected to increase in urban areas with the growing prevalence of tobacco smoking.[2]
Summary
Chronic respiratory disease affects one billion people worldwide and is a leading cause of death.[1]. The associated morbidity and mortality principally occur in lowand middle-income countries, where the disease burden is expected to rise as rapid economic gains lead to increases in longevity, industrialization and tobacco consumption.[1,2,3] In addition to its impact on individuals, this epidemiological transition has substantial direct and indirect economic implications.[4]. Previous studies have examined the prevalence of COPD in either rural or urban settings,[8,9,10] but none has investigated how the pattern of chronic respiratory disease varies across different residential settings, with the aim of evaluating the impact of the urban environment. COPD has been closely linked to household air pollution in rural areas in low- and middle-income countries and the disease burden is expected to increase in urban areas with the growing prevalence of tobacco smoking.[2]
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