Leiden University Scholarly Publications

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Brakema, E.A. (2022)

Tackling chronic respiratory disease in low-resource settings

Doctoral Thesis
Chronic respiratory disease (CRD) is a silent, ongoing pandemic. It disproportionally affects low-resource settings. Tobacco smoke and kitchen smoke (caused by the use of solid fuels and inefficient stoves) are major risk factors. Evidence-based solutions to CRD often fail to be effective, as they misalign with local needs and then fail to be implemented. This thesis focused on how lung health solutions can be implemented successfully by capitalising on the local needs.
Within the Horizon2020 FRESH AIR implementation research project, we first studied local settings in Kyrgyzstan, Uganda, Greece, and Vietnam. For example, we found that COPD in the highlands of Kyrgyzstan occurred three times more frequently than in the lowlands, partly due to higher levels of kitchen smoke. We discovered the high indirect burden of asthma and COPD, by their impact on work- and daily activities. We also found that many communities and their health workers mistook CRD for infectious disease like...Show moreChronic respiratory disease (CRD) is a silent, ongoing pandemic. It disproportionally affects low-resource settings. Tobacco smoke and kitchen smoke (caused by the use of solid fuels and inefficient stoves) are major risk factors. Evidence-based solutions to CRD often fail to be effective, as they misalign with local needs and then fail to be implemented. This thesis focused on how lung health solutions can be implemented successfully by capitalising on the local needs.
Within the Horizon2020 FRESH AIR implementation research project, we first studied local settings in Kyrgyzstan, Uganda, Greece, and Vietnam. For example, we found that COPD in the highlands of Kyrgyzstan occurred three times more frequently than in the lowlands, partly due to higher levels of kitchen smoke. We discovered the high indirect burden of asthma and COPD, by their impact on work- and daily activities. We also found that many communities and their health workers mistook CRD for infectious disease like tuberculosis. Based on these findings and on implementation literature, we then designed several practical tools addressing critical factors for implementation success of lung health interventions. These evidence-based tools can facilitate implementation success, thereby optimising the use of already scarce resources and benefitting health outcomes.
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COPD
Asthma
Chronic lung disease
Low-and middle-income country
Implementation
Household air pollution
Health belief
Uganda
Kyrgyzstan
Vietnam
Greece
All authors
Brakema, E.A.
Supervisor
Chavannes, N.H.
Co-supervisor
Kleij, R.M.J.J. van der; Crone, M.R.
Committee
Kiefte-de Jong, J.C.; Peet, P.G. van; Schayck, O.C.P. van; Khoo, E.M.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
Date
2022-05-19
ISBN (print)
9789463616935

Funding

Sponsorship
The studies presented in this thesis were funded by the European Commission Research and Innovation program Horizon 2020 (680997), and Healthy Lungs for Life. Financial support for printing of this thesis was kindly provided by the SBOH (employer of GP trainees in the Netherlands).