The epidemiology of respiratory disease in Zimbabwe

Adeline Salim and Stephen Gordon, Liverpool School of Tropical Medicine, UK; Tapiwa Bwakura, Department of Medicine, Harare, Zimbabwe; and Narcisius Dzvanga, Department of Medicine, Bulawayo, Zimbabwe. Correspondence to: Dr Stephen Gordon, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK. Email: [email protected] Introduction As in much of sub-Saharan Africa, respiratory diseases are one of the main causes of presentation to primary care and admission to hospitals in Zimbabwe. The advent of the HIV/AIDS pandemic has been accompanied by an increase in case-notification rates of tuberculosis and other respiratory opportunistic infections for the past two decades, but other respiratory presentations are also an important health burden. This review will look at the burden of infectious and non-infectious respiratory diseases in Zimbabwean children and adults and discuss what needs to be done to improve the situation. We searched the published literature using PubMed with This review of the burden of respiratory diseases in children and adult Zimbabweans is based on limited available literature and highlights a need for more descriptive epidemiological studies. In children, the commonest reported causes of respiratory mortality were acute pyogenic pneumonia, Pneumocystis carinii pneumonia, and tuberculosis, with different patterns of diseases evident between HIV-positive and HIV-negative children. Asthma and other atopic conditions are common but under-reported due to a predominance of publication on HIV-related subjects. In adults, exposure to indoor air pollution due to burning of biomass fuels is probably associated with acute respiratory infections, asthma, chronic obstructive pulmonary disease, lung cancer, and nasopharyngeal and laryngeal cancers in Zimbabwe as in other regions. These conditions also have other common risk factors including malnutrition and tobacco smoking but the prevalence rates of these conditions and their associations with risk factors are not known. In adults with chronic cough, tuberculosis is the most common diagnosis among HIV infected adults but lower respiratory tract infections and asthma were more common among HIV-negative patients. Factors associated with tobacco smoking in Zimbabwe are discussed. terms including the general terms ‘Zimbabwe and lung diseases’, as well as specific diseases, e.g. ‘Zimbabwe and tuberculosis’, ‘Zimbabwe and asthma’, etc. Further publications were identified from references cited in