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

Int J Chron Obstruct Pulmon Dis. 2024 Feb 5:19:389-401. doi: 10.2147/COPD.S444378. eCollection 2024.

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: Malawi; associated factors; chronic obstructive pulmonary disease; prevalence; spirometry.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Forced Expiratory Volume
  • Humans
  • Malawi / epidemiology
  • Male
  • Prevalence
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / epidemiology
  • Risk Factors
  • Spirometry / methods
  • Tuberculosis, Pulmonary* / diagnosis
  • Tuberculosis, Pulmonary* / epidemiology

Grants and 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).