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

Abstract

Haules Robbins Zaniku,1,2 Emilia Connolly,3– 5 Moses Banda Aron,6,7 Beatrice Lydia Matanje,8 Myness Kasanda Ndambo,9 George Complex Talama,10 Fabien Munyaneza,11 Todd Ruderman,8 Jamie Rylance,12,13 Luckson Wandani Dullie,14 Rejani Lalitha,15 Ndaziona Peter Kwanjo Banda,16,* Adamson S Muula17,* 1Department of Physiotherapy, Ministry of Health, Neno District Health Office, Neno, Lilongwe, Malawi; 2Department of Epidemiology and Biostatistics, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi; 3Department of Partnerships and Policy, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi; 4Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA; 5Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45529, USA; 6Monitoring and Evaluation Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi; 7Snakebite Envenoming Department, Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; 8Clinical Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi; 9Department of Health Systems and Policy, Training and Research Unit of Excellence (TRUE), Kamuzu University of Health Sciences, Lilongwe, Malawi; 10Programs Directorate, Partners in Hope, Lilongwe, Malawi; 11Research Department, Partners in Health/Abwenzi Pa Za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi; 12Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; 13Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; 14Global Leadership Ecosystem, Partners in Health/Abwenzi Pa za Umoyo (PIH/APZU), Neno, Lilongwe, Malawi; 15Pulmonary Division, Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 16Department of Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences, Lilongwe, Malawi; 17Community and Environmental Health Department, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi*These authors contributed equally to this workCorrespondence: Haules Robbins Zaniku, Neno District Health Office, P.O. Box 52, Neno, Malawi, Tel [phone], Email [email protected]: 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

Keywords

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