Prevalence and Associated Factors of Chronic Obstructive Pulmonary Disease Among Adults in Neno District, Malawi: A Cross-Sectional Analytical Study

Abstract

Introduction

Chronic obstructive pulmonary disease (COPD) continues to pose a global public health challenge. However, literature is scarce on the burden of COPD in Malawi. We assessed the prevalence and risk factors for COPD among adults in Neno, Malawi.

Methodology

We conducted a population-based analytical cross-sectional study in Neno District between December 2021 and November 2022. Using a multi-stage sampling technique, we included 525 adults aged≥40 years. All participants underwent spirometry according to the American Thoracic Society (ATS) guidelines and were interviewed using the IMPALA questionnaire. For this study, we utilized the definition of COPD as a post-bronchodilator FEV1/FVC <0.70. We collected data using Kobo collect, exported to Microsoft Excel, and analysed using R software. We used descriptive statistics and logistic regression analysis; a p-value of <0.05 was considered statistically significant.

Results

Out of 525 participants, 510 participants were included in the final analysis. Fifty-eight percent of the participants were females (n=296), and 62.2% (n=317) were between 40 and 49 years with a median (IQR) age of 46 (40–86). For patient characteristics, 15.1% (n=77) were current smokers, and 4.1% (n=21) had a history of pulmonary tuberculosis (PTB). Cough was the most commonly reported respiratory symptom (n=249, 48.8%). The prevalence of COPD was 10.0% (n=51) and higher (15.0%) among males compared to females (6.4%). Factors significantly associated with COPD were age 60 years and above (adjusted odds ratio [aOR] = 3.27, 95% CI: 1.48–7.34, p<0.004), ever smoked (aOR = 6.17, 95% CI:1.89–18.7, p<0.002), current smoker (aOR = 17.6, 95% CI: 8.47–38.4, p<0.001), and previous PTB (aOR = 4.42, 95% CI: 1.16–15.5, p<0.023).

Conclusion

The cross-sectional prevalence of COPD in rural Malawi is high, especially among males. Factors significantly associated were older age (60 years and above), cigarette smoking, and previous PTB. Longitudinal studies are needed to better understand disease etiology and progression in this setting.

Keywords:

• chronic obstructive pulmonary disease
• prevalence
• spirometry
• associated factors
• Malawi

Abbreviations

COPD, chronic obstructive pulmonary disease; ATS, American Thoracic Society; PTB, pulmonary tuberculosis; CRDs, chronic respiratory diseases; LMICs, low-income and middle-income countries; BOLD, The Burden of Obstructive Pulmonary Disease; GOLD, The Global Initiative for Chronic Obstructive Lung Disease; NCDs, Non-communicable diseases; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; PIH/APZU, Partners In Health/Abwenzi Pa za Umoyo; T/As, Traditional Authorities; GVHs, Group Village Heads; BMI, Body mass index; Interquartile range (IQR); KUHeS, Kamuzu University of Health Sciences.

Data Sharing Statement

The data presented in this study are available on request from the corresponding author.

Ethical Approval and Informed Consent

The protocol was approved by the Neno District Health Research Committee and College of Medicine Research and Ethics Committee (COMREC) (P.08/20/3110). Written informed consent was obtained from study participants. The study was conducted in accordance with the Declaration of Helsinki.

Acknowledgments

We would like to thank MoH and PIH/APZU leadership for their support during this study’s implementation. We would also like to thank all the participants who participated in this study. We would like to greatly appreciate Asante Makuta, NCD BRITE coordinator, and Dr. Amrei Braun, R4GH, who provided administrative support during the implementation of the study. We also thank the data collectors Lucius Horacio and Hajra Bwanali.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Mr Haules Zaniku reports grants from Researchers for Global Health and grants from NCD BRITE Consortium, during the conduct of the study. Dr Emilia Connolly reports personal fees from Cincinnati Children’s Hospital Medical Centerital Medical Center, outside the submitted work and is seconded to the national Ministry of Health in Malawi with working through this institution. This work is not part of the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This study was supported by the association Researchers for Global Health (www.researchersforglobalhealth.org) and the NCD BRITE Consortium. The NCD-Brite Consortium is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under grant number 5U24HL136791, and the NIH-NCI Grant number CA210285-Planning for a National Non-Communicable Disease Center of Research Excellence in Malawi. The content in this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All the other funders had no role in the research’s design, analysis, or reporting. The ACEPHEM Project also funded Adamson Muula at the Kamuzu University of Health Sciences (KUHeS).