Chronic obstructive pulmonary disease in sub-Saharan Africa: a systematic review

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major global health problem. Although COPD is the sixth most common cause of mortality in low- and middle-income countries, most research comes from high-income countries. We set out to systematically review existing published research on COPD in sub-Saharan Africa to identify knowledge gaps and opportunities for further research. METHODS: A literature search of MEDLINE, EMBASE and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases, published reviews, reference lists from included publications and abstracts from major thoracic medicine conference proceedings within the previous 2 years was performed using a protocol-driven search strategy. Texts were screened for inclusion by two independent reviewers. Studies were included if they met the following criteria: 1) COPD was an outcome, and 2) the population included people from sub-Saharan Africa. There were no language restrictions. FINDINGS: Our search identified 688 studies: 41 were duplicates, 638 were excluded, and 9 met our inclusion criteria. Included studies were all cross-sectional, and included 3673 people from four sub-Saharan African countries. Estimates of COPD prevalence varied between 4% and 25%. Only one study used population-based representative sampling and an adequate case definition. Assessment of risk factors was limited. CONCLUSIONS: There is little existing research on COPD in sub-Saharan Africa. Prevalence estimates varied, reflecting the range of populations studied, inconsistent diagnostic criteria and variable methods and methodological quality. Population-representative studies using appropriate case definitions are needed to define the epidemiology of COPD in sub-Saharan Africa and to inform the development of prevention and management strategies for the future.