Setting: Primary health centre in the highlands of Lesotho.
Background: There is limited information about the relative frequencies of common respiratory illnesses in resource-limited settings, particularly in sub-Saharan Africa.
Objective: To examine whether the distribution of respiratory illnesses in this region is unique due to the high prevalence of human immunodeficiency virus infection.
Design: In a prospective, cross-sectional study of adults and adolescents with cough or difficulty breathing recruited from the waiting areas of the health centre, the primary outcome was the respiratory diagnosis for each participant, which was based on history, physical examination, response to antibiotics and the results of chest radiography (CXR) and sputum examinations.
Results: Acute respiratory infections accounted for 65% of all diagnoses among 696 patients who were evaluated by a clinician and CXR. Pneumonia accounted for 10% of all diagnoses, and confirmed or probable tuberculosis (TB) accounted for 13%. Chronic respiratory conditions, including asthma, chronic obstructive pulmonary disease, silicosis and old TB, accounted for 14% of all diagnoses. Excluding 61 patients with an uninterpretable CXR, 36% (228) of the participants had significant pathology on CXR.
Conclusion: A high proportion of patients presenting to a primary health centre in Lesotho with routine respiratory complaints have serious respiratory illnesses.