Non-communicable respiratory disease in Malawi: a systematic review and meta-analysis

• Published in: Malawi medical journal Vol. 32; no. 2
• Main Authors: Nightingale, Rebecca, Jary, Hannah, Meghji, Jamilah, Rylance, Sarah, Masiye, Jones, Chiumia, Hastings, Rylance, Jamie, Mortimer, Kevin, Lesoky, Maia
• Format: Journal Article
• Language: English
• Published: College of Medicine, University of Malawi and Medical Association of Malawi 28-11-2021
• Subjects: asthma; chronic lung disease; COPD; cough; Malawi; non-communicable disease
• ISSN: 1995-7262

Background Non-communicable respiratory diseases are important
contributors to morbidity and mortality in sub-Saharan African
countries such as Malawi. Aim To conduct a systematic review of the
available literature relating to chronic respiratory disease in Malawi.
Methods We conducted a systematic protocol-driven literature search of
key scientific databases including Scopus and Medline. Papers were
independently assessed for eligibility by two authors and included if
they reported objective measures (including self-reported standard
symptoms) of chronic respiratory disease and were conducted in Malawi.
A meta-analysis of available estimates was then conducted. We
re-analysed data from three of these studies in a secondary data
analysis to allow for between-study comparisons. Results Our search
identified 393 papers of which 17 (5 involving children and 12
involving adults) met the inclusion criteria. Wheeze was the symptom
most frequently reported in children in the community (12.1%), hospital
(11.2%) and HIV clinic (8.1%) settings. Cough was the symptom most
frequently reported by adults in the community (3-18%).
Spirometric abnormalities varied substantially between studies. For
example, in adults, airflow obstruction varied between 2.3% and 20% and
low forced vital capacity (FVC) varied between 2.7% and 52.8%.
Conclusion We identified a high burden of chronic respiratory symptoms
and abnormal spirometry (particularly low FVC) within paediatric and
adult populations in Malawi. The estimates for country-wide burden
related to this disease were limited by the heterogeneity of the
methods used to assess symptoms and spirometry. There is an urgent need
to develop a better understanding of the determinants and natural
history of non-communicable respiratory disease across the life-course
in Malawi.