Systematic scoping review protocol of methodologies of chronic respiratory disease surveys in low/middle-income countries

www.nature.com/npjpcrm PROTOCOL OPEN Systematic scoping review protocol of methodologies of chronic respiratory disease surveys in low/middle-income countries Dhiraj Agarwal 1, Nik Sherina Hanafi 2, Soumya Chippagiri3, Evelyn A. Brakema 4, Hilary Pinnock5, Ee Ming Khoo 2, Aziz Sheikh5, Su-May Liew2, Chiu-Wan Ng2, Rita Isaac3, Karuthan Chinna2, Wong Li Ping 2, Norita Binti Hussein2, Sanjay Juvekar 1 and the RESPIRE Collaborators This protocol describes a systematic scoping review of chronic respiratory disease surveys in low/middle-income countries (LMICs) undertaken as part of the Four Country ChrOnic Respiratory Disease (4CCORD) study within the National Institute for Health Research Global Health Research Unit on Respiratory Health (RESPIRE). Understanding the prevalence and burden of chronic respiratory disease (CRD) underpins healthcare planning. We will systematically scope the literature to identify existing strategies (definitions/questionnaires/diagnostics/outcomes) used in surveys of CRDs in adults in low-resource settings. We will search MEDLINE, EMBASE, ISI WoS, Global Health and WHO Global Health Library [search terms: prevalence AND CRD (COPD, asthma) AND LMICs, from 1995], and two reviewers will independently extract data from selected studies onto a piloted customised data extraction form. We will convene a workshop of the multidisciplinary 4CCORD research team with representatives from the RESPIRE partners (Bangladesh, India, Malaysia, Pakistan and Edinburgh) at which the findings of the scoping review will be presented, discussed and interpreted. The findings will inform a future RESPIRE 4CCORD study, which will estimate CRD burden in adults in Asian LMICs. npj Primary Care Respiratory Medicine (2019)29:17 ; https://doi.org/10.1038/s41533-019-0129-7 BACKGROUND Chronic respiratory diseases (CRDs), especially asthma and chronic obstructive pulmonary disease (COPD), are common public health problems across the world, with the Global Burden of Disease estimating that CRDs now account for 30% of total deaths.1 Although morbidity and mortality are particularly high in low- and middle-income countries (LMICs), there are very little robust data on the true prevalence of asthma and COPD in these countries.2,3 Chronic respiratory symptoms are common in the general population,1 but the clinicians in primary healthcare systems in resource-poor countries lack the skills and support to diagnose the underlying disease condition.4–8 Factors contributing to low rates of diagnosis include limited awareness of respiratory long-term conditions,4–10 limited access to healthcare and lack of diagnostic capability in these countries.11 Determining the prevalence of asthma and COPD remains a challenge because of the poor sensitivity and specificity of the widely used questionnaire-based research tools,3,12 while objective testing with spirometry may be a challenge in community-based epidemiological surveys.11 With notable exceptions, such as the Burden of Lung Disease (BOLD),13 surveys of the prevalence of CRDs conducted in LMICs often have major limitations (such as relying on patient-reported 1 disease or symptom questionnaires), and report very varied estimates of prevalence.2,14–39 In addition, many existing surveys focus on one condition (e.g. the BOLD study detects COPD,13 the International Study of Asthma and Allergies in Childhood (ISAAC) detects symptoms of asthma and allergy in children40) and rarely look for the broad range of less common causes of CRD (such as interstitial lung disease, bronchiectasis, lung cancer and complications post tuberculosis) or attempt to identify the phenotypes of asthma and COPD, which are increasingly regarded as important to understanding and managing the conditions.41 Effective health policies related to CRD can only be developed if we know the true burden of asthma, COPD and other CRDs in the community. Funded by the National Institute for Health Research (NIHR), RESPIRE is a Global Health Research Unit focusing on respiratory health in Asia (https://www.ed.ac.uk/usher/respire). Prior to undertaking a comprehensive Four Country ChrOnic Respiratory Disease study (4CCORD) in the partner countries of RESPIRE, we sought to systematically scope the literature to identify existing strategies—that is, definitions, questionnaires, study tools and diagnostics protocols—that have been used to conduct surveys for CRDs in LMICs. Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India; 2Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3RUHSA Department, Christian Medical College, Vellore, India; 4Department of Public Health and Primary care, Leiden University Medical Centre, Leiden, The Netherlands and 5NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK Correspondence: Sanjay Juvekar () A list of consortium members appears before the Acknowledgements. These authors contributed equally: Dhiraj Agarwal, Nik Sherina Hanafi Received: 3 March 2019 Accepted: 12 April 2019 Published in partnership with Primary Care Respiratory Society UK D. Agarwal et al. 2 Table 1. Inclusion and exclusion criteria Criterion Definition Population Populations of adults (typically of over 18 years, but we will accept different thresholds, for example, reflecting the age of the majority in different countries). Surveys that also screened children will be included if the procedure for adults is described Screening procedure Surveys employing random sampling with the aim of determining the prevalence of asthma,50 COPD51 or other CRD8 in the adult population. The survey procedures may include questionnaires, clinical examination, spirometry and/or other tests. We are also interested in the prevalence of chronic respiratory symptoms, and in surveys that detected phenotypes Disease definitions We will include studies that use definitions of CRD from globally recognised guidelines: asthma,50 COPD 51 or other CRD8 We define ‘chronic’ respiratory symptoms as symptoms (such as cough, wheezing and shortness of breath) that have persisted for more than 3 months, or recurred in ‘attacks’ Burden of disease We are interested in the population-level surveys of the burden of CRD; this includes symptom burden, use of healthcare resources or societal burden (e.g. absenteeism, loss of earnings) Phenotypes We are interested in population-level surveys that have attempted to detect phenotypes of asthma,50 COPD51 or the overlap between these conditions53 in the context of low-resource settings Setting Normally LMICs. Our, focus is surveys undertaken in low-resource contexts, which we anticipate will normally be countries classified by the Organisation for Economic Cooperation and Development as being ‘LMIC’ at the time of the survey. We may, however, include surveys developed in higher-income cou (...truncated)