Cohort profile: The Chikwawa lung health cohort; a population-based observational non-communicable respiratory disease study of adults in Malawi

Njoroge, Martin; Rylance, Sarah; Nightingale, Rebecca; Gordon, Stephen B.; Mortimer, Kevin; Burney, Peter; Rylance, Jamie; Obasi, Angela; Niessen, Louis; Devereux, Graham

doi:10.1371/journal.pone.0242226

Cited by 3 publications

(12 citation statements)

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“…In 2014 a community-based prevalence survey, nested within a cookstove intervention trial, was conducted in accordance with the Burden of Obstructive Lung Disease (BOLD) protocol [ 3 , 14 ]. Participants were randomly sampled from adults living in 50 villages in Chikwawa: [ 3 , 12 ] of the 3000 invited, 1481 participated. Non-participation was usually because of inability to make contact, non-participants were younger and more likely to be male [ 3 , 12 ].…”

Section: Methodsmentioning

confidence: 99%

“…We report the five year follow-up of a cohort of adult Malawians recruited in 2014. The Chikwawa lung health cohort has been described in detail elsewhere: Njoroge et al [3]. In 2014 a community-based prevalence survey, nested within a cookstove intervention trial, was conducted in accordance with the Burden of Obstructive Lung Disease (BOLD) protocol [3,14].…”

Section: Setting and Study Designmentioning

confidence: 99%

“…The Chikwawa lung health cohort has been described in detail elsewhere: Njoroge et al [3]. In 2014 a community-based prevalence survey, nested within a cookstove intervention trial, was conducted in accordance with the Burden of Obstructive Lung Disease (BOLD) protocol [3,14]. Participants were randomly sampled from adults living in 50 villages in Chikwawa: [3,12] of the 3000 invited, 1481 participated.…”

Section: Setting and Study Designmentioning

confidence: 99%

“…Asthma is the most common CRD, affecting 360 million people, it is the commonest chronic disease of childhood and remains a burden to individuals, their families, and healthcare systems [ 1 ]. In LMICs, population-based surveys have reported a high prevalence of respiratory symptoms [3] , [4] , [5] , obstructive and restrictive lung function [ 6 , 7 ], but low prevalence of diagnosed COPD [8] suggesting an unrecognised clinical need. International Guideline recommendations are that asthma and COPD require long term treatment and follow-up [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…We report here the findings of a cohort study in rural Malawi [3] in terms of annualised rate of change in lung function and associated impact on health-related quality of life (HRQoL) to investigate the natural history of abnormal lung function and its impact on HRQoL in a LMIC.…”

Section: Introductionmentioning

confidence: 99%

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Changing lung function and associated health-related quality-of-life: A five-year cohort study of Malawian adults

et al. 2021

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Background: In Sub-Saharan Africa cross-sectional studies report a high prevalence of abnormal lung function indicative of chronic respiratory disease. The natural history and health impact of this abnormal lung function in low-and middle-income countries is largely unknown. Methods: A cohort of 1481 adults representative of rural Chikwawa in Malawi were recruited in 2014 and followed-up in 2019. Respiratory symptoms and health-related quality of life (HRQoL) were quantified. Lung function was measured by spirometry. Findings: 1232 (83%) adults participated; spirometry was available for 1082 (73%). Mean (SD) age 49.5 (17.0) years, 278(23%) had ever smoked, and 724 (59%) were women. Forced expiratory volume in one second (FEV 1 ) declined by 53.4 ml/year (95% CI: 49.0, 57.8) and forced vital capacity (FVC) by 45.2 ml/year (95% CI: 39.2, 50.5) . Chronic airflow obstruction increased from 9.5% (7.6, 11.6%) in 2014 to 17.5% (15.3, 19.9%) in 2019. There was no change in diagnosed asthma or in spirometry consistent with asthma or restriction. Rate of FEV 1 decline was not associated with diagnosed Chronic obstructive pulmonary disease (COPD), asthma, or spirometry consistent with asthma, COPD, or restriction. HRQoL was adversely associated with respiratory symptoms (dyspnoea, wheeze, cough), previous tuberculosis, declining FEV 1 and spirometry consistent with asthma or restriction. These differences exceeded the minimally important difference. Interpretation: In this cohort, the increasing prevalence of COPD is associated with the high rate of FEV 1 decline and lung function deficits present before recruitment. Respiratory symptoms and sub-optimal lung function are independently associated with reduced HRQoL.

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Section: Methodsmentioning

confidence: 99%

Section: Setting and Study Designmentioning

confidence: 99%

Section: Setting and Study Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changing lung function and associated health-related quality-of-life: A five-year cohort study of Malawian adults

et al. 2021

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Factors associated with self-reported diagnosed asthma in urban and rural Malawi: Observations from a population-based study of non-communicable diseases

Amoah,

McLean,

Price

et al. 2024

PLOS Glob Public Health

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The growing burden of asthma in low- and middle-income countries has been linked to urbanisation and lifestyle changes. However, this burden has not been well characterised in adults. Therefore, we investigated the prevalence of self-reported diagnosed asthma and associated factors in urban and rural adults in Malawi, Southern Africa. Within a cross-sectional population-based survey to determine the burden and risk factors for non-communicable diseases (NCDs) in the city of Lilongwe and rural Karonga district, we collected information on self-reported previously diagnosed asthma and asthma-related symptoms using an interviewer-led questionnaire. Other data collected included: demographic characteristics, socioeconomic status indicators, NCD comorbidities, environmental exposures, and anthropometric measurements. We used multivariable logistic regression models to explore factors associated with self-reported asthma adjusting for variables associated with the outcome in univariable analysis. Findings were corrected for multiple comparisons using the Bonferroni method. We analysed data from 30,483 adult participants (54.6% urban,45.4% rural and 61.9% female). A prior asthma diagnosis was reported in 5.1% of urban and 4.5% of rural participants. In urban females, being obese (>30 kg/m2) compared to normal weight (18.5–24.9 kg/m2) was associated with greater odds of asthma (OR = 1.59, 95% CI [1.26–2.01], p<0.001), after adjusting for confounders. We observed associations between previously diagnosed heart disease and asthma in female participants which remained significant in rural females after Bonferroni correction (OR = 2.30,95%CI [1.32–4.02], p = 0.003). Among rural males, current smokers had reduced odds of diagnosed asthma (OR = 0.46,95%CI [0.27–0.79], p = 0.004) compared to those who had never smoked. In Malawi the prevalence of self-reported diagnosed asthma was greatest in females and urban dwellers. Notably, our findings indicate relationships between excess body weight as well as comorbidities and diagnosed asthma in females. Future investigations using longitudinally collected data and clinical measurements of asthma are needed to better understand these associations.

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Distinguishing pulmonary rehabilitation from chest physiotherapy in the African context

Bilungula

Orme

Bickton

et al. 2023

JPATS

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Chronic respiratory diseases (CRDs) are highly prevalent in low- and middle-income countries. In Africa, the burden of CRDs is set to worsen due to an increase in smoking prevalence and household air pollution. Chest physiotherapy (CP) and pulmonary rehabilitation (PR) are used to manage CRDs in Africa, but distinguishing between these terms is not clear common among health-care professionals (HCPs) and patients. Here, we provide clarity on the differences between PR and CP to facilitate a greater understanding of PR and remove barriers to research and implementation of PR across Africa. CP is a treatment aimed at clearing secretions within airways of the lungs, while PR, through exercise training, education and self-management, treats extrapulmonary or systemic impairments. We know that there is a need for PR among people living with CRDs in Africa. However, health professionals’ knowledge and training in PR remains insufficient. To implement PR services for people with CRDs in Africa, a strong understanding of what PR is, and its evidence base are needed. The development of PR in Africa will start by filling the gaps in knowledge, awareness, advocacy, and training.

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Cohort profile: The Chikwawa lung health cohort; a population-based observational non-communicable respiratory disease study of adults in Malawi

Cited by 3 publications

References 38 publications

Changing lung function and associated health-related quality-of-life: A five-year cohort study of Malawian adults

Changing lung function and associated health-related quality-of-life: A five-year cohort study of Malawian adults

Factors associated with self-reported diagnosed asthma in urban and rural Malawi: Observations from a population-based study of non-communicable diseases

Distinguishing pulmonary rehabilitation from chest physiotherapy in the African context

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