Randomized controlled trials on prevention, diagnosis and treatment of chronic obstructive pulmonary diseases in African countries - a systematic review

Eric Kroeber, Benjarong Nanuppakrankijkun, Etienne Ngeh, Anne Schrimpf, Mulugeta Tamire, Susanne Unverzagt

Keywords: COPD, randomized controlled trials, systematic review, Africa, low-resource settings

Globally, chronic obstructive pulmonary disease (COPD) currently marks the fourth leading cause of mortality. With a prevalence of over 25 million patients, COPD has become a major health problem in Africa. Major risk factor on the continent include smoking, biomass fuel exposure, dust in occupational setting as well as ageing populations. Research on prevention, education, diagnosis and treatment that is sensitive to local and regional availabilities and contexts is highly necessary due to the expected incidence rise.

Research questions:
To summarize all available evidence from randomized controlled trials (RCTs) on prevention, diagnosis and treatment of COPD patients conducted in African countries.

We conducted a systematic review based on a search in Medline, Central, CINAHL, regional electronic databases and registries until April 2021 for RCTs on patients suffering from non-communicable chronic lung diseases in African countries. We assessed the study quality using the Cochrane risk of bias tool. Results were narratively resumed. The inclusion criteria involved adult patients with a COPD diagnosis studies from all African countries. We extracted patient relevant outcomes including acute respiratory episodes and exacerbation rate. A protocol was registered on PROSPERO (CRD42020145057).

The search resulted in 1497 references. We included 16 studies on COPD from only three African countries (Tunisia, Egypt, South Africa). Seven studies with 922 patients were set intensive care units and 9 studies (498 patients) in outpatients including rehabilitative settings. Participants were primarily male (87 %). The studies interventions were very heterogenous.

The small amount of studies, set in only three countries shows the huge need for fostering of COPD research in African countries. Nevertheless, the number of studies are rising in recent years. Early tackling of the rising burden of non-communicable diseases like COPD needs to be a top health care priority on the continent.

Points for discussion:
1. What low resource research on COPD prevention and treatment is known from European settings and how can it be used in African contexts?

2. How can European general practice and family medicine networks support health care in low resource settings in order to jointly tackle the rising COPD burden?