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Abstract Presentations 4. Nik Sherina Hanafi, Malaysia Breathing and feeling well through universal access to right care www.ed.ac.uk/usher/respire @RESPIREGlobal Chronic respiratory disease (CRD) surveys in low- and middle-income countries

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Breathing and feeling well through universal access to right care

Abstract Presentations

  • 4. Nik Sherina Hanafi, Malaysia
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7/4/2020 51

www.ed.ac.uk/usher/respire @RESPIREGlobal

Chronic respiratory disease (CRD) surveys in low- and middle-income countries (LMICs): A systematic scoping review of methodologies and

  • utcomes

Nik Sherina Hanafi1, Dhiraj Agarwal2, Soumya Chippagiri3, Evelyn A. Brakema4, Hilary Pinnock5, Ee Ming Khoo1, Aziz Sheikh5, Su-May Liew1, Chiu-Wan Ng1, Rita Isaac3, Karuthan Chinna1, Li Ping Wong1, Norita Hussein1, Ahmad Ihsan Abu Bakar1, Yong-Kek Pang,1Sanjay Juvekar2, on behalf of the RESPIRE Collaborators.

1Faculty of Medicine, University of Malaya, Malaysia, 2KEM Hospital Research Centre, Pune, India, 3Christian Medical College, Vellore, India

  • 4Dept. of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.

5NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh

IPCRG 2020: Hot Topic Clinical Practice Webinar, 4 July 2020

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www.ed.ac.uk/usher/respire @RESPIREGlobal

Introduction

  • CRDs - the leading causes of morbidity worldwide.
  • Little robust data on true prevalence of asthma and COPD in LMICs
  • Low rates of diagnosis

▪ awareness ▪ access to health care ▪ diagnostic capabilities ▪ questionnaire-based tools ▪ spirometry

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Background

  • RESPIRE Group
  • Four Country ChrOnic Respiratory Disease (4CCORD) study to estimate CRD burden in

adults in LMICs

  • Bangladesh, India, Malaysia and Pakistan
  • Scoping review
  • Aim: To identify strategies (definitions; questionnaires; study tools) used to conduct

surveys for CRDs in LMICs.

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Methods

  • Search strategy
  • Chronic respiratory

diseases

  • Prevalence
  • LMICs
  • Arksey and O’Malley’s1 six-step

framework.

  • Databases:

OVID Medline, EMBASE, ISI WoS, Global Health and WHO Global Index Medicus databases.

  • Limits: 1995 to 2018

Criterion Inclusion criteria Exclusion criteria Population ▪ General population ▪ Adults (typically 18 years) ▪ People with known CRDs Disease definitions ▪ Asthma, COPD or

  • ther CRD

▪ ‘chronic’ respiratory symptoms > three months

  • r recurred in

‘attacks’ ▪ Acute respiratory conditions Study design ▪ Population or community surveys ▪ RCTs ▪ Case control studies ▪ Systematic reviews

  • 1. Arksey H, O'Malley L. Int Jof Soc Res
  • Methodology. 2005 Feb 1;8(1):19-32
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Results

  • 281 articles
  • Study design:

cross-sectional surveys (n=260) cohort studies (n=11) secondary data analysis (n=10)

Figure 1: Study selection process Stage 1: Titles identified through database searching (n = 36,872) Titles excluded (n = 16,443) Titles after duplicates removed (n = 20,599) Stage 2: Title and abstract screened (n=4156) (n = 20,599) Stage 3: Full-text articles assessed for eligibility (n =729)

Screening

Full-text articles excluded (n = 448) Not prevalence study = 164 Not conducted in LMICs = 147 Abstracts = 46 Established diagnosis = 43 Non-English publications = 32 Not CRDs = 11 Non-adults = 4 Publication withdrawn = 1

Included

Studies included in analysis (n = 281) Eligibility Citations (title and abstract) excluded

Identification

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  • 70 countries
  • 132 from Asia; China, India and Turkey
  • Respondents: 50 to 512,891
  • Ten publications reported sample sizes of 100,000 or more.
  • Survey settings
  • house-to-house or community surveys (n=178)
  • worksites (n=48)
  • health care facilities (n=20)
  • telephone (n=7)
  • postal surveys (n=3)

Diagramme 1: Distribution of CRD Prevalence Studies in LMICs

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Questionnaires

  • ECRHS (n = 58)
  • ATS (n = 43)
  • IUATLD (n = 23)
  • MRC (n = 14)

Spirometry criteria for COPD

  • Fixed FEV1/FVC (n=59)
  • Fixed FEV1/FC and LLN (n=28)
  • LLN (n=3)
  • Burden/impact of CRD (n=33)
  • Phenotype (n=6)

50 100 150 200 CRD / SYMPTOM / LUNG FUNCTION LUNG FUNCTION SYMPTOMS CRD

Figure 2: Study outcomes

▪ Asthma ▪ COPD

20 40 60 80 100 120 RECORDS SPIROMETRY MEDICATION SYMPTOMS SELF-REPORT

Figure 3: Criteria to diagnosis asthma and COPD

COPD Asthma

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Conclusion:

  • There is substantial heterogeneity across the

definitions, methodologies, instruments and types of

  • utcomes in CRD prevalence studies
  • The impact of CRD on individuals/society was rarely

reported, highlighting a major gap in understanding the burden of CRD.

Acknowledgment:

  • NIHR Global Health Research Unit (RESPIRE), Usher Institute of Population

Health, Sciences and Informatics

  • Dr. Marshall Dozier, Academic Support Librarian, UoE
  • Dr. Ranita Shamsuddin, Librarian, UM
  • Shalini Selvaratnam
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7/4/2020 59

Thank you!

Any questions?

www.ed.ac.uk/usher/respire @RESPIREGlobal