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Burden of fungal asthma in Africa: A systematic review and meta-analysis

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  • Richard Kwizera
  • Joseph Musaazi
  • David B Meya
  • William Worodria
  • Freddie Bwanga
  • Henry Kajumbula
  • Stephen J Fowler
  • Bruce J Kirenga
  • Robin Gore
  • David W Denning

Abstract

Background: Asthma is one of the neglected diseases in Africa with a high prevalence. Allergic fungal diseases have been reported to complicate asthma progression and treatment outcomes. However, data about fungal asthma and its associated complications are limited in Africa. We aimed to estimate the burden of fungal asthma among adults and children in Africa using a systematic review. Methods: We first engaged the Institute for Health Metrics and Evaluation (IHME) to highlight the trend in morbidity and mortality attributed to asthma in Africa. We then searched PubMed, HINARI and Google Scholar for all studies of any design focusing on fungal asthma in any African country. Languages were restricted to English and French, but not year of publication. We estimated the weighted prevalence of allergic fungal infections among asthmatics with a 95% CI and pooled the results using a random effects model. This study is registered with PROSPERO, number CRD42019117319. Results: The IHME data showed that there has been a gradual increase in morbidity and mortality due to asthma in African adults with a prevalence of 4%. Our search retrieved 5233 citations. We retained 20 studies that met our selection criteria. These were from 13 African countries published between 1967 and 2018. There were eight cross-sectional studies and twelve review articles. The average asthma prevalence in Africa was 6% from these studies. The prevalence of fungal sensitisation was relatively high (3–52%) in the asthmatic population with an average of 28% and a pooled estimate of 23.3%, mostly due to Aspergillus species. Prevalence of Allergic bronchopulmonary apsergillosis was estimated at 1.6–21.2%. Diagnosis of fungal allergy was mostly made by skin prick tests. There was no data on the use of medication to manage fungal asthma. None of the studies evaluated the association between fungal allergy and asthma severity. Data were lacking in children. Conclusion: There is a high prevalence of fungal sensitization among Africans with asthma. Fungal asthma is a significant problem in Africa but there remains a paucity of data on the epidemiology and associated complications. There is urgent need for national epidemiological studies to estimate the actual burden of fungal asthma in Africa.

Suggested Citation

  • Richard Kwizera & Joseph Musaazi & David B Meya & William Worodria & Freddie Bwanga & Henry Kajumbula & Stephen J Fowler & Bruce J Kirenga & Robin Gore & David W Denning, 2019. "Burden of fungal asthma in Africa: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-17, May.
    • Handle: RePEc:plo:pone00:0216568
    DOI: 10.1371/journal.pone.0216568
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    1. Kabengele Benoit Obel & Kayembe Jean Marie Ntumba & Kayembe Patrick Kalambayi & Akilimali Pierre Zalagile & kaba Didine Kinkodi & Kashongwe Zacharie Munogolo, 2017. "Prevalence and determinants of asthma in adults in Kinshasa," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-13, May.
    2. Reginald Quansah & Maritta S Jaakkola & Timo T Hugg & Sirpa A M Heikkinen & Jouni J K Jaakkola, 2012. "Residential Dampness and Molds and the Risk of Developing Asthma: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-9, November.
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    1. Abike O. Olajide-Ibiejugba & Vusumuzi Nkosi & Funzani Takalani-Rathogwa & Joyce Shirinde & Janine Wichmann & Robin J. Green & Kuku Voyi, 2021. "Allergy and Household Living Conditions among Adolescents Living near Gold Mine Tailing Dumps in the Gauteng and North West Provinces of South Africa," IJERPH, MDPI, vol. 19(1), pages 1-13, December.

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