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The prevalence and risk factors of chronic noncommunicable lung diseases in adults in rural and urban Sudan

Ahmed, Rana (2018) The prevalence and risk factors of chronic noncommunicable lung diseases in adults in rural and urban Sudan, Thesis (Doctoral), Liverpool School of Tropical Medicine.

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Non-communicable diseases (NCDs) are a major and increasing global health issue. They represent 71% (41million) of all global deaths including 3.9 million due to chronic respiratory diseases (CRDs) and chronic obstructive pulmonary disease (COPD) in particular. COPD is now the third most common cause of death globally; 90% of COPD deaths occur in Low and Middle-Income Countries (LMICs). Sub-Saharan Africa (SSA) and
Middle East and North Africa (MENA) countries report similar mortality rates from COPD of 18 per 100,000 population. However, the burden of COPD SSA is disputed and reports offer variable prevalence estimates, ranging from 4.1% to 22.2%. The work in this thesis set out to contribute new knowledge to this area by conducting a review of the literature about non-communicable lung disease in SSA and MENA and through population-based crosssectional studies (one urban and one rural) of the burden of non-communicable lung disease in adults in Sudan.
For the literature review, a broad review was undertaken to capture the breadth of work on non-communicable lung disease in SSA and MENA. The two cross-sectional studies were done to the same core Burden of Obstructive Lung Diseases (BOLD) protocol. The urban study was done in Khartoum state and sampled from the non-institutionalised population aged 40 years and above; the rural study was done in Gezira state and used the same sampling approach but with an extended age range – 18 and above. Alongside the rural study the potential role for digital data was explored for future studies of this nature. Review of the literature found that whilst research has been done in this area, it is limited in breadth and depth. The prevalence of chronic respiratory symptoms (mainly shortness of breath was 10.9% and 18.7% in the urban and rural study participants, respectively). The prevalence of post bronchodilator airflow obstruction was 10.3% and 14.8% in urban Sudan and 5.5% and 7.7% in rural Sudan using Lower Limit of Normal (LLN) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) definitions respectively. Older age was the main factor associated with airflow obstruction in both populations and helps to explain the difference in prevalence between the urban and rural studies as the latter included younger participants. Low Forced Vital Capacity (FVC) prevalence estimates were similar in the urban and rural studies - 58.1% vs 58% (Third National Health and Nutrition Examination Survey (NHANES) reference values), respectively. Pilot testing of digital compared to paper-based data capture found high levels of agreement between the two approaches suggesting that the former could be adopted in future work of this nature. Taken together, the work presented in this thesis highlights the limited breadth and depth of research on non-communicable lung disease in SSA and MENA to date and identifies a high burden of chronic respiratory symptoms and spirometric abnormalities (mainly low FVC) in adults in urban and rural Sudan. These findings suggest there is a substantial but underrecognised burden of non-communicable lung disease in Sudan and elsewhere in SSA and MENA that calls for greater attention from the research community alongside public health and health system strengthening for the prevention and control of these problems.

Item Type: Thesis (Doctoral)
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Lungs > WF 600 Lungs
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Depositing User: Lynn Roberts-Maloney
Date Deposited: 01 Aug 2019 14:32
Last Modified: 01 Aug 2020 01:02


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