Post-TB lung damage amongst Malawian adults

INTRODUCTION: Pulmonary tuberculosis (PTB) remains an important risk factor for chronic lung disease (CLD) in sub-Saharan Africa (sSA), but our understanding of the nature of post-TB lung damage, its evolution over time, and the associated morbidity remains limited. This information is needed to inform clinical care and health system approaches to the management of those surviving PTB disease. METHODS: A general review of the literature on CLDs in sSA, TB disease and epidemiology, and post-TB lung damage and its associated morbidity were completed, followed by a systematic review of the prevalence and pattern of post-TB structural lung pathology. Primary data presented in this thesis were drawn from two studies based in urban Blantyre, Malawi. The first was a cross-sectional survey of respiratory abnormalities amongst adults in the community which was completed as part of the Burden of Obstructive Lung Disease (BOLD) initiative. The second was a prospective cohort study of HIV-positive and negative adults completing treatment for PTB which aimed to describe a) the prevalence of respiratory pathology at TB treatment completion using symptoms, quality of life scores, spirometry and high-resolution CT imaging, ... (continues)