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Background: Small Airways Obstruction (SAO) is a common feature of obstructive lung diseases. There is limited research on SAO, its global prevalence and risk factors. Methods: Using data from 41 sites in the cross-sectional Burden of Obstructive Lung Disease study (N=26,448), we defined SAO as either: 1) mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FEF25-75) less than lower limit of normal (LLN), or 2) forced expiratory volume in three seconds to forced vital capacity ratio (FEV3/FVC) less than the LLN. We estimated the prevalence of pre- and post-bronchodilator SAO for each site. To identify risk factors for SAO, we performed multivariable regression analyses within each site, and pooled estimates using random effects meta-analysis. Findings: Prevalence of pre-bronchodilator SAO ranged from 5% (34/624) in Tartu (Estonia) to 34% (189/555) in Mysore (India) for FEF25-75, while for FEV3/FVC it ranged from 5% (31/667) in Riyadh (Saudi Arabia) to 31% (287/981) in Salzburg (Austria). Prevalence of post-bronchodilator SAO was universally lower. Risk factors associated with FEV3/FVC included increasing age, low body mass index, active and passive smoking, low level of education, working in a dusty job for more than 10 years, and previous tuberculosis. Results were similar for FEF25-75, except for increasing age, which was associated with reduced odds of SAO. Interpretation: Despite the wide geographical variation, SAO is common and more prevalent than chronic airflow obstruction worldwide. SAO shows the same risk factors as chronic airflow obstruction. However, further research is required to investigate whether it also associates with respiratory symptoms and lung function decline. Funding: National Heart and Lung Institute; Wellcome Trust (085790/Z/08/Z).

This protocol describes a systematic scoping review of chronic respiratory disease surveys in low/middle-income countries (LMICs) undertaken as part of the Four Country ChrOnic Respiratory Disease (4CCORD) study within the National Institute for Health Research Global Health Research Unit on Respiratory Health (RESPIRE). Understanding the prevalence and burden of chronic respiratory disease (CRD) underpins healthcare planning. We will systematically scope the literature to identify existing strategies (definitions/questionnaires/diagnostics/outcomes) used in surveys of CRDs in adults in low-resource settings. We will search MEDLINE, EMBASE, ISI WoS, Global Health and WHO Global Health Library [search terms: prevalence AND CRD (COPD, asthma) AND LMICs, from 1995], and two reviewers will independently extract data from selected studies onto a piloted customised data extraction form. We will convene a workshop of the multidisciplinary 4CCORD research team with representatives from the RESPIRE partners (Bangladesh, India, Malaysia, Pakistan and Edinburgh) at which the findings of the scoping review will be presented, discussed and interpreted. The findings will inform a future RESPIRE 4CCORD study, which will estimate CRD burden in adults in Asian LMICs.

Background There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. Methods A false positive diagnosis of COPD was considered when participants reported a doctor’s diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). Results Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of “chronic bronchitis” or “emphysema” (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. Conclusions False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.

Objectives We compared pregnancy identification methods and outcome capture across 31 Health Demographic Surveillance System (HDSS) sites in 14 countries in sub-Saharan Africa and Asia. Methods From 2009 to 2014, details on the sites and surveillance systems including frequency of update rounds, characteristics of enumerators and interviewers, acceptable respondents were collected and compared across sites. Results The 31 HDSS had a combined population of over 2,905,602 with 165,820 births for the period. Stillbirth rate ranged from 1.9 to 42.6 deaths per 1000 total births and the neonatal mortality rate from 2.6 to 41.6 per 1000 live births. Three quarters (75.3%) of recorded neonatal deaths occurred in the first week of life. The proportion of infant deaths that occurred in the neonatal period ranged from 8 to 83%, with a median of 53%. Sites that registered pregnancies upon locating a live baby in the routine household surveillance round had lower recorded mortality rates. Conclusions Increased attention and standardization of pregnancy surveillance and the time of birth will improve data collection and provide platforms for evaluations and availability of data for decision-making with implications for national planning. Electronic supplementary material The online version of this article (10.1007/s00038-019-01241-0) contains supplementary material, which is available to authorized users.

Population ageing is rapidly becoming a global issue and will have a major impact on health policies and programmes. The World Health Organization's Study on global AGEing and adult health (SAGE) aims to address the gap in reliable data and scientific knowledge on ageing and health in low- and middle-income countries. SAGE is a longitudinal study with nationally representative samples of persons aged 50+ years in China, Ghana, India, Mexico, Russia and South Africa, with a smaller sample of adults aged 18-49 years in each country for comparisons. Instruments are compatible with other large high-income country longitudinal ageing studies. Wave 1 was conducted during 2007-2010 and included a total of 34 124 respondents aged 50+ and 8340 aged 18-49. In four countries, a subsample consisting of 8160 respondents participated in Wave 1 and the 2002/04 World Health Survey (referred to as SAGE Wave 0). Wave 2 data collection will start in 2012/13, following up all Wave 1 respondents. Wave 3 is planned for 2014/15. SAGE is committed to the public release of study instruments, protocols and meta- and micro-data: access is provided upon completion of a Users Agreement available through WHO's SAGE website (www.who.int/healthinfo/systems/sage) and WHO's archive using the National Data Archive application (http://apps.who.int/healthinfo/systems/surveydata)

Women in a small coastal village in western India were asked to explain their preference for female sterili-zation over modern reversible contraceptive methods. Married women aged 19+ years were interviewed in six focus groups (n=60) and individually (n=15) regarding contraceptive methods and their use and side-effects. Women publicly denied contraceptive use but privately acknowledged limited use. They obtained contraceptive information from other village women and believed that modern reversible methods and vasectomy have high physical and social risks, and fertility goals could be achieved without their use. Women felt that reversible contraception is undesirable, socially unacceptable, and usually unnecessary, although the achievement of fertility goals is likely due to the use of female sterilization with abortion as a back-up method. Economic migration of village men may also play a role. Although women with high social capital can effectively disseminate correct knowledge, the impact on the uptake of reversible method is uncertain.