Global partnerships for lung health

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Celebrating 15 years of Pan African Thoracic Society Methods in Epidemiological Clinical and Operations Research: Research capacity building changing African lives

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Establishing a new frontier in respiratory health in Africa

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The prevalence of and factors associated with tobacco smoking behavior among long-distance drivers in Lagos, Nigeria

Background: Factors associated with tobacco smoking are useful in designing tobacco control programs.Objectives: To estimate the prevalence of and factors associated with tobacco smoking among long-distance drivers.Methods: This was a cross-sectional study. Stratified cluster sampling approach was used to select drivers based on if they received annual health screening (AHS) or not (non AHS). We used a structured questionnaire to obtain information and weighted the resulting observations to derive population based estimates. Association between tobacco smoking and socio-demographic factors was explored in multivariate models.Results: 414 male drivers, mean age 43.6 (standard error 0.6) years. Population weighted prevalence of current smoking was 18.9% (95% CI: 14.3-23.4) of all drivers, 6.5% (95% CI: 2.6-10.4) of AHS drivers and 19.5 (95% CI: 14.7-24.2) of non AHS drivers (p<0.001). In multivariate models, having close friends that smoked (OR= 6.36, 95% CI= 2.49 - 16.20) cargo driving (OR= 2.58, 95% CI= 1.29 - 5.15) and lower education levels (OR for post-secondary education vs. primary education or less= 0.17, 95% CI= 0.04 - 0.81) were associated with current smoking.Conclusion: Prevalence of tobacco smoking is higher among non AHS compared to AHS drivers. Having close friends that smoked, cargo driving, and lower education levels were associated with current smoking.Keywords: Tobacco smoking behavior, long-distance drivers, Lagos, Nigeri

Nigerian doctors’ experiences of guideline-based asthma management: a qualitative study

Background The Global Initiative for Asthma (GINA) report sets out an updated evidence-based strategy for asthma management. Little is known about how this report is perceived and implemented in low-income and middle-income countries (LMICs) like Nigeria. We explored the experiences of asthma management as informed by the current GINA guideline among doctors in Lagos, Nigeria. Methods Using a qualitative research approach, in-depth interviews were conducted among doctors in Lagos, Nigeria to explore their experiences of asthma management in the context of the current GINA report. The thematic framework approach was used for data analysis. Results Eleven doctors aged 28-46 years (five general practitioners (GPs) and six family physicians (FPs) took part. Four overarching themes were identified: (i) knowledge of, and attitude towards the GINA strategy – whilst most doctors were aware of the existence of the GINA report, there was limited knowledge about its content including current recommendations for mild asthma treatment; (ii) asthma diagnosis and treatment – there was limited access to lung function testing facilities, and its role in asthma diagnosis was underappreciated; (iii) barriers to managing asthma according to GINA recommendations – these included complexity of the GINA report, unavailability and unaffordability of asthma medicines and poor patient adherence to medications, driven by socio-cultural factors; and (iv) enablers of GINA-recommended asthma management – improvement in asthma education for doctors and the general population and better access to diagnostic tests and medicines. Conclusions Whilst there was awareness of the existence of the GINA report, there was limited knowledge about its content and several barriers to its implementation were reported. Education about the GINA report, investment in diagnostic and treatment services and simplification of recommendations were identified as possible solutions

Nigerian doctors’ experiences of guideline-based asthma management: a qualitative study

# Background The Global Initiative for Asthma (GINA) report sets out an updated evidence-based strategy for asthma management. Little is known about how this report is perceived and implemented in low-income and middle-income countries (LMICs) like Nigeria. We explored the experiences of asthma management as informed by the current GINA guideline among doctors in Lagos, Nigeria. # Methods Using a qualitative research approach, in-depth interviews were conducted among doctors in Lagos, Nigeria to explore their experiences of asthma management in the context of the current GINA report. The thematic framework approach was used for data analysis. # Results Eleven doctors aged 28-46 years (five general practitioners (GPs) and six family physicians (FPs) took part. Four overarching themes were identified: (i) *knowledge of, and attitude towards the GINA strategy* -- whilst most doctors were aware of the existence of the GINA report, there was limited knowledge about its content including current recommendations for mild asthma treatment; (ii) *asthma diagnosis and treatment* -- there was limited access to lung function testing facilities, and its role in asthma diagnosis was underappreciated; (iii) *barriers to managing asthma according to GINA recommendations* -- these included complexity of the GINA report, unavailability and unaffordability of asthma medicines and poor patient adherence to medications, driven by socio-cultural factors; and (iv) *enablers of GINA-recommended asthma management* -- improvement in asthma education for doctors and the general population and better access to diagnostic tests and medicines. # Conclusions Whilst there was awareness of the existence of the GINA report, there was limited knowledge about its content and several barriers to its implementation were reported. Education about the GINA report, investment in diagnostic and treatment services and simplification of recommendations were identified as possible solutions

The prevalence of and factors associated with tobacco smoking behavior among long-distance drivers in Lagos, Nigeria.

Background: Factors associated with tobacco smoking are useful in designing tobacco control programs. Objectives: To estimate the prevalence of and factors associated with tobacco smoking among long-distance drivers. Methods: This was a cross-sectional study. Stratified cluster sampling approach was used to select drivers based on if they received annual health screening (AHS) or not (non AHS). We used a structured questionnaire to obtain information and weighted the resulting observations to derive population based estimates. Association between tobacco smoking and socio-demographic factors was explored in multivariate models. Results: 414 male drivers, mean age 43.6 (standard error 0.6) years. Population weighted prevalence of current smoking was 18.9% (95% CI: 14.3-23.4) of all drivers, 6.5% (95% CI: 2.6-10.4) of AHS drivers and 19.5 (95% CI: 14.7-24.2) of non AHS drivers (p<0.001). In multivariate models, having close friends that smoked (OR= 6.36, 95% CI= 2.49 - 16.20) cargo driving (OR= 2.58, 95% CI= 1.29 - 5.15) and lower education levels (OR for post-secondary education vs. primary education or less= 0.17, 95% CI= 0.04 - 0.81) were associated with current smoking. Conclusion: Prevalence of tobacco smoking is higher among non AHS compared to AHS drivers. Having close friends that smoked, cargo driving, and lower education levels were associated with current smoking

Estimating the prevalence of COPD in an African country:evidence from southern Nigeria

# BACKGROUND: Though several environmental and demographic factors would suggest a high burden of chronic obstructive pulmonary disease (COPD) in most African countries, there is insufficient country-level synthesis to guide public health policy. # METHODS: A systematic search of MEDLINE, EMBASE, Global Health and African Journals Online identified studies reporting the prevalence of COPD in Nigeria. We provided a detailed synthesis of study characteristics, and overall median and interquartile range (IQR) of COPD prevalence in Nigeria by case definitions (spirometry or non-spirometry). # RESULTS: Of 187 potential studies, eight studies (6 spirometry and 2 non-spirometry) including 4,234 Nigerians met the criteria. From spirometry assessment, which is relatively internally consistent, the median prevalence of COPD in Nigeria was 9.2% (interquartile range, IQR: 7.6–10.0), compared to a lower prevalence (5.1%, IQR: 2.2–15.4) from studies based on British Medical Research Council (BMRC) criteria or doctor’s diagnosis. The median prevalence of COPD was almost the same among rural (9.5%, IQR: 7.6–10.3) and urban dwellers (9.0%, IQR: 5.3–9.3) from spirometry studies. # CONCLUSIONS: A limited number of studies on COPD introduces imprecision in prevalence estimates and presents concerns on the level of response available across different parts of Nigeria, and indeed across many countries in sub-Saharan Africa

The reality of managing asthma in sub-Saharan Africa – Priorities and strategies for improving care

Asthma is the most common non-communicable disease in children and remains one of the most common throughout the life course. The great majority of the burden of this disease is seen in low-income and middle-income countries (LMICs), which have disproportionately high asthma-related mortality relative to asthma prevalence. This is particularly true for many countries in sub-Saharan Africa. Although inhaled asthma treatments (particularly those containing inhaled corticosteroids) markedly reduce asthma morbidity and mortality, a substantial proportion of the children, adolescents, and adults with asthma in LMICs do not get to benefit from these, due to poor availability and affordability. In this review, we consider the reality faced by clinicians managing asthma in the primary and secondary care in sub-Saharan Africa and suggest how we might go about making diagnosis and treatment decisions in a range of resource-constrained scenarios. We also provide recommendations for research and policy, to help bridge the gap between current practice in sub-Saharan Africa and Global Initiative for Asthma (GINA) recommended diagnostic processes and treatment for children, adolescents, and adults with asthma