10 Mera: African Journal of Respiratory Medicine March 2009 Review Article The burden of respiratory disease in Nigeria M O Akanbi, C O Ukoli, G E Erhabor, F O Akanbi, and S B Gordon Introduction Respiratory disease is a major cause of mortality and morbidity worldwide. In most developing countries including Nigeria, the burden of respiratory disease is largely unknown; however the burden of infectious and non-infectious respiratory disease appears to be on the increase. This article aims to review current available literature on infectious and non-infectious respiratory disease among Nigerians with a view to identifying ma- jor causes of morbidity and mortality, and highlighting where gaps in knowledge exist that require new studies for their elucidation. Nigeria is a nation of over 130 million diverse people occupying a land mass of 923 766 km 2 . It is the fourth largest exporter of crude oil. Despite the huge gains made over the years from petroleum, the nation’s people are largely impoverished. With a GDP of US$1116 in 2007, Nigeria ranked 165 in the world (South Africa ranked 57 and Malawi 177). 1 The percentage of persons living on less than 1US$ per day is 71. 2 The under-5 mortality rate was 197/1000 live births in 2007 which is still a far cry from the Millennium Development Goal target of <70/1000 by 2015. 2 Methodology A literature search was carried out using the Pubmed website and the search term ‘Nigeria’, with 16 799 hits. The search was redefined as ‘Nigeria and Lung’ (202 hits). Abstracts of these studies were read and articles that addressed the epidemiology or determinants of respiratory disease in Nigeria were reviewed. Where no relevant studies were available on Pubmed, information on the disease of interest was obtained using the ‘Google scholar’ search engine or grey literature. Distribution of disease Distribution of infectious respiratory diseases in adults Tuberculosis The World Health Organization (WHO) estimates that Nigeria has the fifth highest burden of tuberculosis (TB) M O Akanbi and C O Ukoli, Department of Medicine, JUTH, Jos, Nigeria; G E Erhabor, Department of Medicine, Obafemi Awolowo University, Ife-Ife, Nigeria; F O Akanbi, Evangel Hospital Jos; and S B Gordon, Liverpool School of Tropical Medicine, University of Liverpool, UK. Correspondence to: M O Akanbi, Department of Medicine, Jos University Teaching Hospital, PM Bag 2076, Jos, Plateau State Nigeria. Email: maxwell_ akanbi@yahoo.com in the world (see Figure 1). It is estimated that 395 000 cases of TB occurred in Nigeria in 2007 (283 cases per 100 000 population). 3 The Nations’ DOTS programme, which is estimated to have a coverage of 65%, has a case detection rate of 35% for smear-positive TB (the target is 70%). Despite this low case detection rate, the reported incidence of TB has been on the increase during the last 10 years as shown in Figure 2. A survey carried out at TB referral centers in Abuja, North Central Nigeria in 2003 showed that of 1391 patients seen during the year, 21.3% were smear posi- tive. The highest incidence of smear positive TB was found in the 21- to 30-year age group with no gender difference. 4 Due to a paucity of facilities for sputum culture and sensitivity, there is a paucity of data on prevalence of smear-negative TB. A 10-year review of sputum samples sent to the University College Hospital, Ibadan, Nigeria on suspicion of TB, showed that 6.9% of smear-negative sputum samples were culture positive. 5 The burden of multidrug resistant (MDR) and exten- sive drug resistant (XDR) TB is largely unknown due to the absence of a national survey. The urgent need for a national survey on the prevalence of MDR TB has been recognised and preparations for the survey are in progress. Pneumonia Acute lower respiratory tract infection is a common cause of hospital admission in Nigeria; however no Figure 1 Burden of TB in Africa. WHO Africa region (AFR): rank based on estimated number of incident cases (all forms) in 2006. HBC, high-burden countries