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. 2017 Dec 7;12(12):e0188437.
doi: 10.1371/journal.pone.0188437. eCollection 2017.

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

Hastings T Banda  1 , Rachael Thomson  2 , Kevin Mortimer  2 , George A F Bello  1 , Grace B Mbera  1 , Rasmus Malmborg  3 , Brian Faragher  2 , S Bertel Squire  2
Affiliations

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

Hastings T Banda et al. PLoS One. .

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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Conflict of interest statement

Competing Interests: SBS, BF and RT are employed by the Liverpool School of Tropical Medicine (LSTM) which is a registered charitable, UK-based research and teaching institution. Its mission is to save lives in resource poor countries through research, education and capacity strengthening. LSTM, in collaboration with REACH Trust, Malawi, applied to LHL for funds to carry out the work described in this manuscript. RM works for LHL International which is a Norwegian Non-Governmental Organisation (NGO) that receives funding from NORAD and the ATLAS Alliance (an umbrella organisation consisting of Norwegian NGO's working with people with disabilities and the fight against TB). LHL International is a member of the ATLAS Alliance. Funding from the ATLAS Alliance comes from individual Norwegian citizens who have given non-earmarked donations. LHL International, using funding as described above, is the funder of this project and therefore also of this article. While RM had no decision on whether or not the article was to be written and published, he had both technical input and financial management responsibility for funding of the project, in addition to being involved in the actual writing and work linked to being an author of this article. HTB, GAFB, GBM are employed by the Research for Equity and Community Health Trust (REACH Trust) which is a registered charitable, local NGO based in Malawi. Its mission is to address the inequity in access to health services through research. REACH Trust in collaboration with LSTM, applied to LHL for funds to carry out the work described in this manuscript.

Figures

Fig 1
Fig 1. Flowchart illustrating process of selecting study participants.
Fig 2
Fig 2. Prevalence and overlap of respiratory symptoms of chronic cough, wheeze and shortness of breath amongst 3554 respondents.
Fig 3
Fig 3. Health passport possession and recorded respiratory diagnoses.
Fig 4
Fig 4. Chronic respiratory diagnoses recorded in health passports of 639 participants illustrating combinations and overlaps between diagnoses.
See this image and copyright information in PMC

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