Community prevalence of chronic respiratory symptoms in rural Malawi: Implications for policy

Background No community prevalence studies have been done on chronic respiratory symptoms of cough, wheezing and shortness of breath in adult rural populations in Malawi. Case detection rates of tuberculosis (TB) and chronic airways disease are low in resource-poor primary health care facilities. Objective To understand the prevalence of chronic respiratory symptoms and recorded diagnoses of TB in rural Malawian adults in order to improve case detection and management of these diseases. Methods A population proportional, cross-sectional study was conducted to determine the proportion of the population with chronic respiratory symptoms that had a diagnosis of tuberculosis or chronic airways disease in two rural communities in Malawi. Households were randomly selected using Google Earth Pro software. Smart phones loaded with Open Data Kit Essential software were used for data collection. Interviews were conducted with 15795 people aged 15 years and above to enquire about symptoms of chronic cough, wheeze and shortness of breath. Results Overall 3554 (22.5%) participants reported at least one of these respiratory symptoms. Cough was reported by 2933, of whom 1623 (55.3%) reported cough only and 1310 (44.7%) combined with wheeze and/or shortness of breath. Only 4.6% (164/3554) of participants with chronic respiratory symptoms had one or more of the following diagnoses in their health passports (patient held medical records): TB, asthma, bronchitis and chronic obstructive pulmonary disease) Conclusions The high prevalence of chronic respiratory symptoms coupled with limited recorded diagnoses in patient-held medical records in these rural communities suggests a high chronic respiratory disease burden and unmet health need

Prevalence and overlap of respiratory symptoms of chronic cough, wheeze and shortness of breath amongst 3554 respondents.

<p>Prevalence and overlap of respiratory symptoms of chronic cough, wheeze and shortness of breath amongst 3554 respondents.</p

Chronic respiratory diagnoses recorded in health passports of 639 participants illustrating combinations and overlaps between diagnoses.

<p>Chronic respiratory diagnoses recorded in health passports of 639 participants illustrating combinations and overlaps between diagnoses.</p

Number and type of care-seeking visit made by 3554 participants with chronic respiratory symptoms.

<p>Number and type of care-seeking visit made by 3554 participants with chronic respiratory symptoms.</p

Socio-demographic characteristics of survey participants.

<p>Socio-demographic characteristics of survey participants.</p

Health passport possession and recorded respiratory diagnoses.

<p>Health passport possession and recorded respiratory diagnoses.</p