FRESH AIR UGANDA SURVEY ON THE PREVALENCE AND BURDEN OF COPD AND ITS RISK FACTORS IN A RURAL AREA OF UGANDA

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1 1 FRESH AIR UGANDA SURVEY ON THE PREVALENCE AND BURDEN OF COPD AND ITS RISK FACTORS IN A RURAL AREA OF UGANDA Frederik van Gemert, general practitioner and researcher University Medical Centre Groningen, the Netherlands

2 FRESH AIR Uganda Survey 2 Research team: The Netherlands: Frederik van Gemert, Thys van de Molen, Niels Chavannes, Corina de Jong Uganda: Moses Kamya, Bruce Kirenga, Simon Luzige, Patrick Musinguzi, United Kingdom: Rupert Jones, Sian Williams Greece: Ioanna Tsiligianni Collaboration: International Primary Care Respiratory Group (IPCRG) University Medical Centre Groningen (UMCG), the Netherlands Leiden University Medical Centre (LUMC), the Netherlands University of Makerere, Uganda

3 COPD and Healthcare in Africa 3 High prevalence of TB, malaria, HIV/AIDS, and infections young children Non-communicable diseases receive insufficient attention COPD unfamiliar to public and physicians COPD 4 th leading cause of death; within 10 years the 3 rd (surpassing HIV/AIDS in Africa) Main risk factors: tobacco smoking, biomass fuel use, occupational exposure and (treated) TB Ait-Khaled et al, Int J Chron Obstruct Pulmon Dis 2007 Bousquet et al, Allergy 2007 Bischoff et al, Int J Environ Res Public Health 2009 UN meeting non communicable disease 2011 Buist et al, Int J Tuberc Lung Dis 2008

4 Biomass fuel use 4 Wood, dung, crop residues, grass 3 billion people and 90% of rural households in developing countries rely on biomass fuel use Causing extremely high levels of indoor air pollution Strongest associations in Africa: COPD, particularly women (nonsmoking) Acute respiratory infections in young WHO, Indoor Air Pollution 2007 Fullerton et al, Trans R. Soc Trop Med Hyg 2008 Torres-Duque et al, Proc Am Thorac Soc 2008 Salvi et al, Chest 2010 Kurmi et al, Eur Respir J 2012

5 FRESH AIR Uganda: objectives 5 1. Evaluation beliefs and attitudes of local communities towards respiratory symptoms and risk factors 2. Education and training of local healthcare workers in the knowledge of chronic respiratory diseases (CRDs) 3. Epidemiological study on prevalence COPD, and its risk factors 4. Evaluation burden of COPD 5. Measurement of direct exposure to biomass smoke (PM₂ˏ₅)

6 Survey setting in Masindi 6 district Random sampling of 300 men and 300 women above the age of 30 years Informed consent (n=620) Questionnaires Spirometry All participants with airflow obstruction underwent post-bd spirometry (n=317) Final number of participants: 588 National Bureau of Statistics Uganda FRESH AIR Ugana pilot-survey 2011

7 Demographic data subjects aged > 30 yrs 7 Male Female Subjects no. 49.5% (n=291) 50.5% (n=297) Age (years) ± ± BMI 22.2 ± ± 4.9 Smoking status Current smoker 34.4% (n=100) 7.4% (n=22) Former smoker 21.7% (n=63) 8.1% (n=24) Never smoker 42.9% (n=125) 75.1% (n=223) Passive smoker 1.0% (n=3) 9.4% (n=28) Biomass fuel use Indoor exposure 91.1% (n=265) 94.6% (n=281) Time per day 3.1 hours 5.2 hours Years

8 Subjects with COPD (FEV₁/FVC ratio < 0.7) 8 Subjects with COPD 12.4% (n=73) Male Female Subjects 56.2% (n=41) 43.8% (n=32) Age (yrs) 53.1 ± ± 15.3 Indoor biomass smoke Exposed 85.4% (n=35) 96.8% (n=31) Years 28.3 (95% CI ) 46.9 (95% CI ) Time (hrs) 2.93 (95% CI ) Under the age of (95% CI ) years: Male 17.1% Female 25.0%

9 9 Smoking status subjects with COPD (ratio < 0.7) 41.5% 50.0% 34.1% 24.4% 28.1% 9.1% 12.5%

10 Subjects with COPD (LLN) 10 Subjects with COPD 16.2% (n=95) Male Female Subjects 47.4% (n=45) 52.6% (n=50) Age (yrs) 45.8 ± ± 15.8 Indoor biomass smoke exposed 88.8% (n=40) 92.0% (n=46) years 22.2 (95% CI ) 36.2 (95% CI ) time (hrs) 3.36 (95% CI ) Under the age of (95% CI ) years: Male 35.6% Female 50.0%

11 Smoking status subjects with 11 COPD (LLN) 64.0% 44.4% 31.2% 22.2% 18.0% 8.0% 10.0% 2.2%

12 Summary FRESH AIR Uganda (preliminary results) 12 Prevalence COPD 12.5% FEV₁/FVC Ratio < % men smoke (mean age 45) 62.5% women never smoked 97% women exposed to indoor biomass smoke (mean 5.2 hrs/day) 25% women under age of 40 Lower Limits of Normal (LLN) Prevalence COPD 16.2% 44.1% men smoke (mean age 40) 74% women never smoked 92% women exposed to indoor biomass smoke (mean 5.6 hrs/day) 50% women under age of 40

13 13 Conclusion FRESH AIR Uganda (preliminary results) Prevalence of COPD in Uganda is high The rate of tobacco smoking is high, particularly among young men Biomass fuel use plays an important role in the development of COPD in rural areas of Uganda, particulary among young people

14 FRESH AIR Uganda is an official WHO-GARD demonstration project Now, a new world opens.. 14 FRESH AIR UGANDA is sponsored by University Medical Centre Groningen (UMCG), funded by the International Primary Care Respiratory Group (IPCRG), supported by an unrestricted grant from MundiPharma International Ltd