Asthma prevalence and mortality in Sub Saharan Africa: the case of Uganda

Asthma is a very common disease affecting around 8.8 % of the global population. In Sub Saharan Africa (SSA), data on asthma are very limited and most patients with asthma will not be diagnosed or treated because of lack of resources. In this thesis we conducted studies to understand how many people suffer from asthma, asthma risk factors and the impact asthma had on the people in Uganda as an example of a Sub Saharan African country. We assessed 3416 persons and found 11.0% of them had asthma. Asthma was associated with smoking, family history of asthma and smoke from biomass (mostly wood fires) used for cooking and lighting indoors, history of TB, HIV infection and living in the cities.  Air pollution (particles) was 5.3 times the safety levels (132.1 μg/m3).  A follow-up study of 449 patients for 2-years documented 17 deaths. Calculated from this we estimate that the mortality is over 20 times higher than in developed high income countries. Only 14% of patients in this study had access to appropriate asthma medications, mainly because the medications were not available or patients could not afford them. The combination of socio economic problems and the low availability of medication makes asthma a disease with a high mortality in Sub Saharan countries surpassing the current mortality from HIV and TB combined. We conclude that asthma is common in Africa, probably because of a high prevalence of HIV, TB and air pollution. The high mortality observed seems due to lack of medication.

Proefschrift: http://hdl.handle.net/11370/02d876fe-281c-4252-8368-c0b02c41ccd8