Barriers to Understanding the Epidemiology of Noncommunicable Lung Disease in Sub-Saharan Africa

There is growing concern about the current and future burden of
noncommunicable lung disease (NCLD) in sub-Saharan Africa
(sSA) (1). This is largely driven by recent data documenting the rise
of several putative risk factors for NCLD in sSA, including uptake
of tobacco and related products (2), exposure to worsening outdoor
air pollution from vehicle and industrial emissions (3), and
sustained indoor air pollution from the use of biomass fuels for
cooking and heating (4). However, empirical evidence of the
burden of NCLD, especially spirometry-based general population
data, is lacking (Figure 1) (5, 6). This is not entirely surprising,
given the limited pulmonary care expertise and clinical capacity in
the region (7, 8). Further, most countries in sSA do not routinely
collect health data or have vital registration systems (9, 10). As a
result, with few exceptions, existing estimates of mortality and
morbidity related to NCLD in sSA have been derived from
infrequent national or scattered hospital and local surveys,
demographic surveillance sites, and extrapolation from statistical
models (9, 10). The few attempts to systematically review the
burden of NCLD in sSA have primarily assessed chronic obstructive
pulmonary disease and have been hampered by heterogeneity in
study methods, sample selection, and diagnostic criteria (5, 6, 11, 12)