Academic journal article Bulletin of the World Health Organization

Chronic Respiratory Diseases in Developing Countries: The Burden and Strategies for Prevention and Management. (Theme Papers)

Academic journal article Bulletin of the World Health Organization

Chronic Respiratory Diseases in Developing Countries: The Burden and Strategies for Prevention and Management. (Theme Papers)

Article excerpt

Voir page 977 le resume en francais. En la pagina 977 figura un resumen en espanol.

Introduction

Chronic respiratory diseases represent a public health challenge in both industrialized and developing countries because of their frequency (1) and economic impact. In developing countries, where poverty and noncommunicable respiratory disease have long been linked (2, 3), most patients have poor access to health care; this is even true of the poorest minorities in industrialized countries. In developing countries, however, an additional problem is that health planners have limited resources (4). The burden and trend of chronic respiratory diseases and their economic impact are highlighted in this paper, and practical strategies for improving patient management in developing countries are suggested.

Prevalence and distribution of chronic respiratory disease

Chronic obstructive pulmonary disease

In 1990, the WHO/World Bank global burden of disease study (5, 6) estimated the global prevalence of chronic obstructive pulmonary disease (COPD) to be 9.33 per 1000 people for men and 7.33 per 1000 for women. The prevalence was higher in industrialized countries, except for China -- although this has been disputed (7) -- and was already high in sub-Saharan Africa (4.41 per 1000 for men and 2.49 per 1000 for women). The lowest prevalence was in the Middle Eastern Crescent (2.69 per 1000 for men and 2.83 per 1000 for women) (6).

In middle-income countries, such as Algeria, COPD and asthma are emerging as public health problems (4; Table 1). However, the prevalence of COPD is probably underestimated, since it is not usually diagnosed until it is clinically apparent and moderately advanced. COPD affects men more frequently than women, usually appears after 45 years of age, and increases in frequency with age. Tobacco smoking is the single most important factor in the genesis of COPD and is responsible for more than 75% of cases worldwide (8-I0), but other environmental risk factors are also known. A number of studies in Africa, for example, have shown that COPD is associated with workplace pollution (11-14), and indoor air pollution from biomass fuel appears to contribute to COPD in women in developing countries (15-17). In addition, COPD is associated with acute respiratory, infections in children (18, 19) and low socioeconomic status (3). Substantial impairment of lung function is also often found in patients cured of tuberculosis, but with extensive residual fibrosis (20).

The rate of tobacco consumption is increasing throughout the developing world. Between 1985 and 1990, for example, the rates rose by 3.4%, and were predicted to rise by 2.7% between 1995 and 2000 (21). Africa is likely to be particularly hard hit, because of an ageing population and because tobacco use is rising faster there than in any other country. Consumption increased by 2.4% between 1985 and 1990 and was predicted to rise by 3.2% between 1995 and 2000 (22). If nothing is done to stop this rate of growth, Africa will have one of the world's highest levels of tobacco consumption (23). Rising tobacco consumption is due in part to aggressive marketing campaigns by international tobacco companies, which are effective in men and boys (24). Because smoking rates are low in women in Africa and Asia, they are likely to be targeted next by the tobacco industry (25).

Some of the expected trends in COPD prevalence can be explained by changes in life expectancy at birth, which varies widely between countries, and the age structure of the population (with COPD being most frequent in people over 65 years of age). In China, for example, the life expectancy for men in 1998 was 68 years, but only 49 years for men in Africa. The corresponding figures for women were 72 and 51, respectively (21). The age structure of the population also differs between countries (26). In 1995, 44% of the population in Africa was under 5 years of age, compared to only 26% of the population in China; and the proportion of the population over 65 years old was 3% in Africa, 7% in China, 8% in the USA, and 14% in Europe. …

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