The burden of non-communicable lung disease in urban Malawi

Background Non-communicable diseases (NCD) account for a growing burden of morbidity and mortality in sub-Saharan Africa. Chronic lung disease is an important contributor to the NCD epidemic in this region but reliable burden of disease estimates are lacking. Aims and Objectives: We conducted a Burden of Obstructive Lung Disease (BOLD) study as part of the Blantyre Health Study in Malawi to assess the burden of non-communicable lung disease and other NCDs in this setting. Methods: We used GPS-enabled PDAs to collect data from all consenting adults (n=16079) living in the Chilomoni area of Blantyre. We took a population representative gender stratified random sample of 1000 adults aged 40 and above and visited them at home to conduct questionnaires and post bronchodilator spirometry to BOLD protocol requirements. Results: Full questionnaire and spirometry data were obtained from 600 participants of whom 413 (165 Male and 248 female) had post bronchodilator spirometry that met BOLD quality standards. Of these 5.9% of men and 9.3% of women had LLN Modified Stage 1 or higher COPD. 8% and 25% of men and 1% and 3% of women were current and ever smokers respectively. Use of biomass fuel or kerosene for cooking was universal. Age (OR 1.5/10yrs), female gender (OR 4.3) and current smoking (OR 3.74) were associated with an increased risk of COPD. Conclusions: Chronic lung disease is an important NCD in urban Malawi. Exposure to tobacco smoke is common in men; exposure to dirty burning fuels for cooking is universal amongst women. Targeted public health strategies are needed to tackle the prevention and management of non communicable chronic lung disease in Malawi and the sub Saharan African region.