Pulmonary rehabilitation across Africa: A continental evaluation of healthcare providers’ awareness, availability and utilisation, and barriers to access

Background. In Africa, with a high burden of chronic obstructive pulmonary disease (COPD), access to medication and availability and use of pulmonary rehabilitation (PR) intervention, including awareness of its effectiveness, remain limited.Objectives. To evaluate the extent of clinical awareness and knowledge of and support for PR among healthcare providers, and to identify barriers to PR in Africa. Methods. A comprehensive electronic survey was conducted to assess healthcare providers (HCPs)’ beliefs about, knowledge, awareness and utilisation of, and access to PR in Africa, to inform strategies and policies for improved COPD prevention. The survey was adapted and validated for the African context through expert review and pilot testing with regional practitioners. It was then distributed to HCPs in clinical practice through the networks of the South African Thoracic Society and the Pan African Thoracic Society across Africa. Results. Data were received from 108 HCPs representing diverse disciplines across rural and urban locations in 23 African countries (response rate 56%). The median (interquartile range) age was 41.0 (37.0 - 48.5) years, with no significant differences between the locations. Almost all the HCPs (98%) acknowledged the necessity of PR for severe pulmonary disease, and 58% expressed the need to improve their knowledge and skills in this area. Significant barriers such as under-reporting of symptoms by patients (74%) and a lack of easy access to spirometry (53%) were reported, hindering access to and diagnosis and rehabilitation of patients with COPD. Conclusion. The substantial awareness and recognition of PR as an effective intervention for COPD and other chronic lung diseases across Africa is remarkable. It could indicate the feasible benefits that HCPs attach to implementing comprehensive PR in African settings. Equipping all HCPs with the requisite skills to implement an effective, locally acceptable PR programme will mitigate the burden of COPD in Africa.