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Under- and over-diagnosis of COPD: a global perspective
Ho T., Cusack R.P., Chaudhary N. et al.
Breathe, part of the European Respiratory Society (ERS)
(2019)
CC2
The article "Under- and over-diagnosis of COPD: a global perspective" reviews the worldwide variation in the prevalence of chronic obstructive pulmonary disease (COPD) and issues related to its misdiagnosis. It highlights that COPD is under-diagnosed due to factors such as limited access to spiromet
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ry and variable diagnostic criteria, especially in low- and middle-income countries. Conversely, over-diagnosis often results from reliance on non-standard criteria or inadequate spirometry use. The article discusses key risk factors, including age, gender, exposure to pollutants, and comorbidities, and emphasizes the need for standardized diagnostic practices to better address and manage COPD globally.
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Chronic Obstructive Pulmonary Disease (COPD) is now one of the top three causes of death worldwide and 90% of these deaths occur in low- and middle-income
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countries (LMICs).
More than 3 million people died of COPD in 2012 accounting for 6% of all deaths globally. COPD represents an important public health challenge that is both preventable and treatable. COPD is a major cause of chronic morbidity and mortality throughout the world; many people suffer from this disease for years and die prematurely from it or its complications. Globally, the COPD burden is projected to increase incoming decades because of continued exposure to COPD risk factors and aging of thepopulation.
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BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-
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income countries and remains under-recognised and poorly managed.
OBJECTIVES. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.
METHODS. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.
CONCLUSIONS. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.
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Asthma is the most common chronic disease in children, imposing a consistent burden on health system. In recent years, prevalence of asthma symptoms became globally increased in children and adolescents, particularly in Low-Middle
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Income Countries (LMICs). Host (genetics, atopy) and environmental factors (microbial exposure, exposure to passive smoking and air pollution), seemed to contribute to this trend. The increased prevalence observed in metropolitan areas with respect to rural ones and, overall, in industrialized countries, highlighted the role of air pollution in asthma inception. Asthma accounts for 1.1% of the overall global estimate of “Disability-adjusted life years” (DALYs)/100,000 for all causes. Mortality in children is low and it decreased across Europe over recent years. Children from LMICs particularly suffer a disproportionately higher burden in terms of morbidity and mortality. Global asthma-related costs are high and are usually are classified into direct, indirect and intangible costs. Direct costs account for 50–80% of the total costs. Asthma is one of the main causes of hospitalization which are particularly common in children aged < 5 years with a prevalence that has been increased during the last two decades, mostly in LMICs. Indirect costs are usually higher than in older patients, including both school and work-related losses. Intangible costs are unquantifiable, since they are related to impairment of quality of life, limitation of physical activities and study performance. The implementation of strategies aimed at early detect asthma thus providing access to the proper treatment has been shown to effectively reduce the burden of the disease.
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In 2014, the International Study of Asthma and Allergies in Childhood (ISAAC) reported that the highest prevalence of symptoms of severe asthma was found in the low- and middle-income
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countries (LMICs), including Nigeria. While exposure to biomass fuel use may be an important risk factor in the development of asthma, its association with asthma symptoms severity has not been well-established. The aim of this study is to extend the spectrum of environmental risk factors that may be contributing towards increasing asthma morbidity, especially asthma symptoms severity in rural schoolchildren in Nigeria and to examine possible asthma underdiagnosis among this population.
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Asthma is the most common non-communicable disease in children and remains one of the most common throughout the life course. The great majority of the burden of this disease is seen in low-income and middle-
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income countries (LMICs), which have disproportionately high asthma-related mortality relative to asthma prevalence. This is particularly true for many countries in sub-Saharan Africa. Although inhaled asthma treatments (particularly those containing inhaled corticosteroids) markedly reduce asthma morbidity and mortality, a substantial proportion of the children, adolescents, and adults with asthma in LMICs do not get to benefit from these, due to poor availability and affordability. In this review, we consider the reality faced by clinicians managing asthma in the primary and secondary care in sub-Saharan Africa and suggest how we might go about making diagnosis and treatment decisions in a range of resource-constrained scenarios. We also provide recommendations for research and policy, to help bridge the gap between current practice in sub-Saharan Africa and Global Initiative for Asthma (GINA) recommended diagnostic processes and treatment for children, adolescents, and adults with asthma.
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This purpose of this guide is to inform robust evaluations of the WHO training package – a package aimed at personnel whose primary role in health-care facilities is environmental cleaning, hereafter referred to as cleaners.
The WHO training package – Environmental cleaning and infection prev
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ention and control in health-care facilities in low- and middle-income countries – was designed to improve the competencies of cleaners through a practical, educational approach for adult learners in low- and middle-income countries and comprises two volumes: trainer’s guide and modules and resources (1,2). An associated OpenWHO online course describes the essential preparations for trainers to deliver the WHO training package.
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BMC Pregnancy Childbirth 2022 Apr 5;22(1):284. doi: 10.1186/s12884-022-04619-w. Adolescent reproductive health is still a challenge in Low and Middle Income Come
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Countries (LMICs). However, the reasons for the inability of most pregnant adolescent girls to access and utilize maternal and child health information (MCHI) are not well-documented. This is despite the policy guidelines promoting the provision of this necessary information to pregnant adolescents in order to prepare them for delivery. This provision is one of the strategies envisaged to improve their attendance of ANC visits and their maternal and child health.
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Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanz
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ania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania.
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Development Finance at a Turning Point: Effects and Policy Recommendations
Berensmann K., Laudage Teles S., Sommer C., et al.
German Institute of Development and Sustainability (IDOS)
(2023)
CC
Development finance is at a turning point, as the macroeconomic environment has changed profoundly and the financing gap for low- and middle-income countr
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ies has widened. The events that led to this new situation are the multiple crises that the global economy is facing, such as the climate crisis, the COVID-19 crisis and the war in Ukraine. As a
result, interest rates have risen sharply over the past year and are not expected to decline anytime soon. High interest rates further restrict low- and middle-income countries’ access to international financial markets by making borrowing more expensive. At the same time, debt
levels in several countries are rising to levels that are almost impossible to repay. Poorer countries find themselves in a trap where financing the Sustainable Development Goals (SDGs) becomes a distant goal for them.
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Achieving financial risk protection for the whole population requires significant financing for health. Health systems in low- and middle-income countries
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(LMIC) are plagued with persistent underfunding, and recent reductions in official development assistance have been registered. To create fiscal
space for health, the pursuit of efficiency gains and exploring innovative health financing for health seem attractive. This paper sought to synthesize available evidence on the nature of innovative health financing instruments, mechanisms and policies implemented in Africa. We further reviewed the factors that hinder or facilitate implementation, the lessons learnt on the structure, the development process and the implementation.
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Abrupt reductions in international HIV assistance in 2025 have deepened existing funding shortfalls. The OECD estimates that external health assistance is projected to drop by 30–40% in 2025 compared with 2023, causing immediate and even more severe disruption to health services in low- and
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middle-income countries.
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The document explains how Unitaid contributes to strengthening global pandemic prevention, preparedness, and response, particularly in low- and middle-income
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countries. It highlights lessons from the COVID-19 pandemic, including inequalities in access to health tools, and emphasizes the need for better coordination, stronger health systems, and increased investment in research and development. The text describes Unitaid’s role in improving access to diagnostics, treatments, and medical oxygen, supporting regional manufacturing, and working with global partners to ensure faster and more equitable responses to future health emergencies.
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The text is a report from a WHO meeting that focuses on strengthening research in the field of health emergency and disaster risk management (Health EDRM). It describes how experts from different regions discussed current challenges, progress, and future priorities in improving research to better pr
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epare for and respond to health emergencies and disasters. A central theme is the need for stronger collaboration between countries, institutions, and disciplines, as well as better use of evidence to support policies and decision-making. The report also outlines key actions, such as improving data sharing, developing practical guidance for policymakers, increasing research capacity—especially in low- and middle-income countries—and ensuring that research findings are effectively translated into real-world practice. Overall, the text emphasizes global cooperation and evidence-based strategies to enhance preparedness and resilience against health threats.
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Covid-19 has reinforced health and economic cases for investing in pandemic preparedness and response (PPR). The World Bank and World Health Organization (WHO) propose that low- and middle-income
g
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overnments and donor countries should invest $31.1 billion each year for PPR. We analyse, based on the projected economic growth of countries between 2022 and 2027, how likely it is that low- and middle-income country governments and donors can mobilize the estimated funding.
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Cancer is an emerging public health problem in sub-Saharan Africa due to population growth, ageing and westernisation of lifestyles. In this piece, we use data from Mozambique over a 50-year period to illustrate cancer epidemiological trends in low-income and
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middle-income countries to hypothesise potential circumstances and factors that could explain changes in cancer burden and to discuss surveillance weaknesses and potential improvements. This epidemiological transition deserves increasing policy attention.
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Mental Health Atlas 2024
recommended
The Mental Health Atlas 2024 is the seventh in a series that began in 2001, and draws on data from 144 countries to assess mental health policies, laws, information systems, financing, workforce and services. It shows little change in investment: m
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ental health accounts for only 2% of health budgets, unchanged since 2017. Spending disparities are wide, ranging from US$ 65 per person in high-income countries to US$ 0.04 in low-income countries. Workforce shortages remain critical, with a global median of just 13 workers per 100,000 people, and extreme shortages in low- and middle-income countries
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4 April 2020
This interim guidance on oxygen sources and distribution strategies for COVID-19 treatment has been adapted from WHO and UNICEF’s technical specifications and guidance for oxygen therapy devices, which is part of the WHO medical device technical series. This guidance is intended for
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health facility administrators, clinical decision-makers, procurement officers, planning officers, biomedical engineers, infrastructure engineers and policy-makers. It describes how to quantify oxygen demand, identify oxygen sources that are available, and select appropriate surge sources to best respond to COVID-19 patients’ needs, especially in low-and-middle income countries.
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The WHO Global Health Estimates show that nearly half a million deaths (493 471) occurred in the WHO European Region due to violence and injuries in 2016. This represents a decline of 29% from 2000. Injuries account for 5.3% of all deaths and 9.6 of all years of life lost. They are a leading cause o
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f death in people aged 15–29 years and the second leading cause of death for young people aged 5–14. The three leading causes of injury deaths are self-directed violence (141 089), falls (83 325) and road-traffic injuries (78 198). Inequalities in injury deaths exist in the Region, with mortality rates 2.4 times higher in males than in females and 1.5 times higher in middle-income compared to high-income countries.
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COVID-19 is having a catastrophic impact on the most vulnerable communities around the world and is threatening decades of progress in the fight against HIV, TB and malaria. The Global Fund works with partners, countries and communities to fight COV
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ID-19, adapt lifesaving HIV, TB and malaria programs, and reinforce fragile systems for health. Through our COVID-19 Response Mechanism (C19RM ), the Global Fund is now the primary channel for providing grant support to low- and middle-income countries for COVID-19 tests, treatments (including medical oxygen), personal protective equipment (PPE) and critical elements of health system strengthening.
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