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

M Isiagi; K J Okop; K Dikgomo; F M Bickton; J Rylance; E Akurut; J Gizamba; R N van Zyl-Smit

doi:10.7196/AJTCCM.2025.v31i3.2516

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

Afr J Thorac Crit Care Med. 2025 Sep 4;31(3):e2156. doi: 10.7196/AJTCCM.2025.v31i3.2516. eCollection 2025.

Authors

M Isiagi^{1

2}, K J Okop^{3

4}, K Dikgomo⁵, F M Bickton^{6

7}, J Rylance⁶, E Akurut⁸, J Gizamba⁹, R N van Zyl-Smit¹

Affiliations

¹ Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
² Global Surgery Division, Department of Surgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
³ Chronic Diseases Initiative for Africa (CDIA), Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
⁴ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
⁵ Department of Medical Practice, Medical School, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa.
⁶ Lung Health Group, Malawi-Liverpool-Wellcome Programme, Blantyre, Malawi.
⁷ Department of Rehabilitation Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi.
⁸ Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda.
⁹ Spatial Sciences Institute, University of Southern California, Los Angeles, Calif., USA.

Abstract

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.

Study synopsis: What the study adds. There is a paucity of recent studies in Africa that have addressed healthcare providers (HCPs)' knowledge of, attitudes to and beliefs about pulmonary rehabilitation (PR) or PR-related care activities. This study addresses that lack.Implications of the findings. The increasing recognition and acknowledgment of PR as a highly effective intervention for chronic obstructive respiratory disease and other chronic lung diseases across Africa is truly notable. It reflects the potential benefits that HCPs associate with implementing a comprehensive PR programme in African settings. Equipping all HCPs with the necessary skills to set up effective, locally accepted PR programmes will alleviate the burden of COPD in Africa.

Keywords: Africa; COPD; Pulmonary rehabilitation.