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  • br On Nov every year

    2019-05-30


    On Nov 25 every year, the International Day for the Elimination of Violence Against Women, and the 16 days of activism that follow it, help to draw the world\'s attention to the scourge of intimate partner violence and other forms of gender-based violence and their harmful effects on women\'s health, families, and communities. Related to this event, Dick Durevall and Annika Lindskog\'s report in is very timely. It not only provides key evidence about the positive association between intimate partner violence and HIV across sub-Saharan African countries but also moves intimate partner violence research forward in several important ways.
    Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. It is one of the most common non-communicable diseases, affecting 329 million people, and this number is likely to be an underestimate. The global economic cost of COPD is US$2·1 trillion. Yet it herpes simplex virus 2 remains almost unknown in Africa. The prevalence of COPD in sub-Saharan Africa has been poorly studied. A meta-analysis of nine cross-sectional studies (five from South Africa, two from Nigeria, one from Malawi, and one from Cape Verde) reported a prevalence ranging from 4·1% to 24·8%, depending on which diagnostic criterion was used. Of the nine studies, only one used population-based representative sampling and an internationally recognised case definition, whereas the other studies lacked robust designs and had inconsistent diagnostic criteria. Another meta-analysis of an additional four studies from Africa reported that the prevalence of COPD varied widely depending on whether spirometry was used or not. The eight studies that defined COPD on the basis of symptoms reported a mean prevalence of 4·0% (range 2·1–8·9), whereas the five that used spirometry reported a mean prevalence of 13·4% (9·4–22·1). One of the main reasons why COPD prevalence studies are rare is the general herpes simplex virus 2 lack of standardised epidemiological instruments and the need to do good quality post-bronchodilator spirometry, which requires considerable expertise and experience. Studies that use symptom-based questionnaires lack sufficient sensitivity and specificity. Moreover, considerable controversy exists about which spirometric criterion should be used to define COPD: a fixed post-bronchodilator FEV to FVC ratio of 0·7, or a FEV to FVC ratio less than the lower limit of normal. Each criterion has advantages and disadvantages, but the absence of an agreed standard has created confusion among epidemiologists wanting to study COPD prevalence. In , Frederik van Gemert and colleagues present results of a cross-sectional study of COPD prevalence in 588 people in the Masindi district of Uganda, with COPD defined by post-bronchodilator spirometry. This study is one of the first in sub-Saharan Africa to use a robust sampling strategy and an internationally accepted diagnostic method and criterion. The prevalence of COPD was 16·2%. The investigators also report that the prevalence of COPD did not differ between men and women, around 40% of patients with COPD were aged 30–40 years, 31% of men and 74% of women with COPD had never smoked, nearly all individuals with and without COPD had been exposed to biomass smoke. Smoke from biomass fuel is an important risk factor for COPD. From a global perspective, it might be more important than tobacco smoking. In the study by van Gemert and colleagues, 93% of the study population used biomass fuel for cooking, as in most African countries. Women spent 3–5 h cooking with prolonged exposure to biomass smoke, often in poorly ventilated kitchens. This behaviour could explain why COPD is as common in women as in men, despite less smoking among women. Exposure to biomass smoke since childhood also explains why 40% of people with COPD in Uganda were young (30–40 years). In high-income countries, COPD prevalence studies traditionally include adults older than 40 years, because 15–20 years of exposure to tobacco smoke is needed before COPD begins to manifest.