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Original research
COPD in Africa: risk factors, hospitalisation, readmission and associated outcomes—a systematic review and meta-analysis
  1. Chidiamara Maria Njoku1,
  2. John R Hurst2,
  3. Leigh Kinsman3,
  4. Saliu Balogun4,
  5. Kehinde Obamiro5
  1. 1 College of Health Sciences, Sport and Exercise Science, James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
  2. 2 Academic Unit of Respiratory Medicine, UCL Medical School, London, UK
  3. 3 School of Nursing and Midwifery, The University of Newcastle School of Nursing and Midwifery, Callaghan, New South Wales, Australia
  4. 4 National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
  5. 5 Centre for Rural Health, University of Tasmania School of Health Sciences, Launceston, Tasmania, Australia
  1. Correspondence to Chidiamara Maria Njoku, College of Health Sciences, Sport and Exercise Science, James Cook University Division of Tropical Health and Medicine, Townsville, QLD 4811, Australia; chidi.njoku{at}


Background This review aims to synthesise available evidence on the prevalence of chronic obstructive pulmonary disease (COPD), associated risk factors, hospitalisations and COPD readmissions in Africa.

Method Using the Met-Analyses and Systematic Reviews of Observational Studies guideline, electronic databases were searched from inception to 1 October 2021. The quality of studies was assessed using the Newcastle-Ottawa Scale. Evidence from retrieved articles was synthesised, and a random-effect model meta-analysis was conducted. The protocol was registered on PROSPERO.

Results Thirty-nine studies met the inclusion criteria, with 13 included in the meta-analysis. The prevalence of COPD varied between the Global Initiative for Chronic Obstructive Lung Disease (2%–24%), American Thoracic Society/European Respiratory Society (1%–17%) and Medical Research Council chronic bronchitis (2%–11%) criteria, respectively. Increasing age, wheezing and asthma were consistent risk factors for COPD from studies included in the narrative synthesis. Our meta-analysis indicated that prior tuberculosis ((OR 5.98, 95% CI 4.18 to 8.56), smoking (OR 2.80, 95% CI: 2.19 to 3.59) and use of biomass fuel (OR 1.52, 95% CI: 1.39 to 1.67)) were significant risk factors for COPD. Long-term oxygen therapy (HR 4.97, 95% CI (1.04 to 23.74)) and frequent hospitalisation (≥3 per year) (HR 11.48, 95% CI (1.31 to 100.79)) were risk factors associated with 30-day COPD readmission.

Conclusion This study not only highlights specific risk factors for COPD risk in Africa but also demonstrates the paucity and absence of research in several countries in a continent with substantial COPD-related mortality. Our findings contribute towards the development of evidence-based clinical guidelines for COPD in Africa.

PROSPERO registration number


  • long term oxygen therapy (LTOT)
  • tuberculosis
  • COPD exacerbations
  • COPD epidemiology

Data availability statement

No data are available. ‘Not applicable’.

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Data availability statement

No data are available. ‘Not applicable’.

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  • SB and KO contributed equally.

  • Contributors CMN, SB, and KO conceived and drafted the review. All authors have critically appraised and approved the final version for submission. CMN is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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