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.
Highlights
Lung disease is a leading contributor to morbidity and mortality in sub Saharan Africa [1,2].Whilst respiratory infections such as tuberculosis (TB) are still a leading cause of morbidity and mortality in this region, their relative disease burdens are decreasing, with concurrent increases in non-communicable disease rates [3]
At a preliminary meeting of the ‘IMPALA’ International Partnership, representing expertise in asthma, chronic obstructive pulmonary disease (COPD), air quality, smoking and occupational lung disease, we identified existing validated tools, including the World Health Organization household energy use survey and questions on nutrition developed by experts from the Global Asthma Network
The development processes described above, in keeping with the literature on questionnaire design, validation, and cross-cultural adaptation [10,13] have allowed for the integration of contextual factors specific to sub Saharan Africa, providing a novel set of tools for the assessment of chronic lung disease and its risk factors
Summary
Lung disease is a leading contributor to morbidity and mortality in sub Saharan Africa [1,2]. Whilst respiratory infections such as tuberculosis (TB) are still a leading cause of morbidity and mortality in this region, their relative disease burdens are decreasing, with concurrent increases in non-communicable disease rates [3]. South Africa, with higher prevalences reported in urbanised areas [5] Drivers of these non-communicable lung diseases in sub Saharan Africa include poor indoor air quality (e.g., combustion of biomass fuel for lighting and cooking), outdoor air pollution (e.g., from motor vehicles), tobacco smoking, undernutrition [6] and high rates of acute infection [7]. Rapid urbanisation in countries across the region [8], and subsequent shifts in these environmental exposures at home and at work, will lead to changing patterns of chronic lung pathology [5]
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