PATS & ReSoK Congress
7-10 June 2023

ABSTRACTBOOK
Poster Presentations

ABSTRACTPOSTER PRESENTATION

Lower plasma nitric oxide and pulmonary function parameters in
Nigerian children with sickle cell anaemia compared to non-sickle cellchildrenDr Oyebimpe.A Adeniyi¹, Adefehinti. Olufemi¹ ², Kuti. Bankole Peter¹ ²
Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria¹
Department of Paediatrics and Child health, Obafemi Awolowo University, Ile-Ife, Nigeria²

Introduction
Advancements in health care have led to increased chances of survival of children with sickle cell anaemia(SCA) with consequent prolonged morbidities including lung diseases. This study sets out to determine theprevalence of pulmonary function abnormalities and plasma nitric oxide (NO) levels (a biomarker of lungdisease) in children with SCA in steady state and that of their non- SCA counterparts at a Nigerian tertiary
health facility.
Methods
Children aged 6-15 years with SCA (87) and Hb AA (87) were consecutively recruited and characterised overa seven-month period at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Theirpulmonary function parameters [FEV1%, FVC% and PEFR (L/sec)] were assessed using Spirolab III
spirometer (Medical International Research, Srl Italy) and interpreted based on ATS/ERS guidelines. Their
plasma NO assayed via Enzyme-linked immunosorbent assay method (biosource, San Diego, USA) andcompared.
Results
and 2.3% for SCA, and Hb AA respectively. The pattern was possible restrictive (50.6%), obstructive (3.4%)
and mixed ventilatory patterns (5.8%). Pulmonary function parameters and plasma NO [166.9 (126.0 –275.1) vs. 460.0 (378.6 – 562.0 micromoles/litre);p<0.001] were lower in SCA compared to the AA. However,no correlation exists between pulmonary function and plasma NO levels.
Conclusion
There are more spirometric and biomarker evidences of lung diseases in children and adolescents with SCA
than Hb AA. Routine pulmonary function assessment in children with SCA will facilitate early detection andprompt management of lung diseases in these children.

ABSTRACTPOSTER PRESENTATION

Inf-γ and Il-2 Asses the Therapeuthic Response in Anti-tuberculosis
Patients at Jamot Hospital Yaounde, Cameroon
Mrs Membangbi Alexandra Emmanuelle¹, Jacky Njiki Bikoï¹, Esther Del-Florence Moni Ndedi¹,
Marie Joseph Nkodo Mindimi², Donatien Serge Mbaga¹, Elsa Nguiffo Makue¹,
André Chris Mikangue Mbongue¹, Martha Mesembe³, George Ikomey Mondinde³,
Eric Walter Perfura-Yone², Sara Honorine Riwom Essama¹
Department of Microbiology, The University of Yaoundé 1, Yaoundé Cameroon¹
Pneumology Department, Jamot Hospital of Yaoundé, Yaoundé, Cameroon²
Center for Study and Control of Communicable Diseases, The University of Yaoundé 1, Yaoundé Cameroon³

Introduction
Tuberculosis (TB) is one of the top lethal infectious diseases worldwide. In recent years, interferon-γ (INF-γ)
release assays (IGRAs) have been established as routine tests for diagnosing TB infection. However,produced INF-γ assessment failled to distinguish active TB (ATB) from latent TB infection (LTBI), especially
in TB epidemic areas. In addition to IFN-γ, interleukin-2 (IL-2), another cytokine secreted by activated T cells,
is also involved in immune response against Mycobacterium tuberculosis. The aim of the study was toassess the capacity of IFN-γ and IL2 in the follow-up of patients on anti-tuberculosis treatment
Methods
We conducted a cross-sectional study in the Pulmonological Departments of the Jamot Hospital in Yaoundé
between May and August 2021. After signed the informed consent, the sociodemographic data as well as 5mL of blood were collected in the crook of the elbow of each participant. Sixty-one subjects were selected(n= 61) and divided into 4 groups as followed: group 1: resistant tuberculosis (n=13), group 2: active
tuberculosis (n=19), group 3: cured tuberculosis (n=16) and group 4: presumed healthy persons (n=13). The
cytokines of interest were determined using indirect Enzyme-linked Immuno-Sorbent Assay (ELISA)
according to the manufacturer's recommendations. P-values < 0.05 were interpreted as statisticallysigniﬁcant. All statistical calculations were performed using SPSS version 22.0
Results
The results showed that men were more 14/61 infected (31,8%) with a high presence in active and resistant
TB groups. The mean age was 41.3±13.1 years with a 95% CI = [38.2-44.7], the age group with the highest
infection rate was ranged between 31 and 40 years. The IL-2 and INF-γ means were respectively 327.6±160.6
pg/mL and 26.6±13.0 pg/mL in active tuberculosis patients, 251.1±30.9 pg/mL and 21.4±9.2 pg/mL inpatients with resistant tuberculosis, while it was 149.3±93.3 pg/mL and 17.9±9.4 pg/mL in cured patients,
15.1±8.4 pg/mL and 5.3±2.6 pg/mL in participants presumed healthy (p <0.0001). Signiﬁcant differences in
IFN-γ and IL-2 rates were observed between the different groups.
Conclusion
Monitoring the serum levels of INF-γ and IL-2 would be useful to evaluate thetherapeutic response of anti-tuberculosis patients, particularly in the both cytokines
association case, that could improve the accuracy of routine examinations.

ABSTRACTPOSTER PRESENTATION

Prevalence and Determinants of Respiratory Symptoms Among
Commercial Taxi Drivers in Douala Cameroon
Mr Atongno Humphrey Ashu¹ ², Ngu Sandra², Ojong Pimi Queen², Eyong Mbu², Kange Lifafa³,
Ngang Peter², Mbatchou Bertrand⁴ ⁵, Assob Jules² ⁵
Douala General Hospital¹
Univeristy of Buea²
Alpha Higher Institute of biomedical and Technological Sciences Douala³
Douala General Hospital⁴
University of Douala⁵

Introduction
Respiratory disorders are among the top causes of morbidity and mortality worldwide .Exposure to air
pollutants leads to inﬂammation and changes in lung function (Damayanti et al, 2019). Occupational taxi
drivers with long exposures to traﬃc related air pollution are more susceptible to the effects(Tall et al,2018).There are reports of high prevalence of respiratory symptoms among occupational workers(Lawin etal, 2018). This study was aimed to determine the prevalence and determinants of respiratory symptoms
among commercial taxi drivers(CTDs) in Douala
Methods
Our study was a community based cross-sectional study; data was collected using Kobo tool collect from
June to July 2022 in Douala with 282 CTDs gotten using convenient sampling technique. SPSS version 21
was used for data analysis considering CI of 95% and 5% margin of error. Descriptive and inferential
statistics (Chi-square test and logistic regression) were used to determine the association between
variables. Administrative authorization was gotten from the Delegation of Public Health and Ethical
Clearance from the University of Douala.
Results
The study participants had a mean age of 42.49 (SD 9.14), years of driving 12.01 (SD 8.24), working days per
week 5.99 (SD 0.72), working hours per day10.38 (SD 1.99). Cough 42(21%), Phlegm 27(13.5%), Shortness ofbreath 14(7.0%), Eye irritation 50(25%), Nasal discharges 70(35%), Chest pain 19(9.5%), Wheezing 12(6%),
Sore throat 24(12%). Logistic regression shows that years of driving (p=0.003), smoking (p=0.038) andhealth history (p=0.002) were the associated with respiratory symptoms, with ever smoked cigarette being
the most predictive determinant (COR=5.75 CI=2.35-14.06 p=0.001)
Conclusion
Respiratory symptoms were reported among the CTDs. Driving experience, consulted for a respiratory
problem, daily working hours and ever smoked cigarette were associated with the respiratory symptoms.
CTDs should limit their exposure time to traﬃc related air pollutants and go for screening of respiratory
problems.

ABSTRACTPOSTER PRESENTATION

How overcrowding affects the transmission of TB in African counties(case study, Nairobi Kenya)
Ms Sophy Badia¹
Rhodes chest clinic in Nairobi¹

Introduction
There has been an increasing number of Tb patients in slums areas. A study published in the International
Journal of Tuberculosis and Lung Disease in 2017 found that overcrowding was signiﬁcantly associatedwith TB infection in households in Kampala, Uganda.
The purpose of this study was to establish the extent to which overcrowding increases the chances of TB
transmission.
Methods
Two methods were used in collecting data ,this included Questionnaires and oral questions .Questionnaires
were mainly used where the respondents were not willing to orally disclose their area of residence while oral
questions were administered to patients who visited Rhodes chest clinic and different hospitals within
Nairobi .An outreach was conducted in Mthurwa market ,( which is generally a crowded area ) using
questionnaires , in the month of early February for a week with 70 participants.
in the second week of January 2023, 80 patients were screened for TB.
In the month of January 2023 , 645 patients were tested positive for TB at Rhodes chest clinic .
Results
Out of 70 participants who participated in mthurwa market Tb testing , in the month of early February 2023,
15 of them were positive after samples tested through gene expert and x-rays was conﬁrmed .This translates
to about 21.4% which is generally high given that the samples were taken at random .
while conducting oral questions after screening at the triage center at Rhodes chest clinic Nairobi Kenya inthe second week of January 2023, 15 out of 80 respondents who tested positive live in slum areas 645
patients tested for TB in Rhodes chest clinic in the month of January 2023 , 65 patients were positive
conﬁrmed cases . Out of the 65 who were positive 60 were slums dwellers . And their sample test was done
through gene expert and x-rays
Conclusion
Following the data provided, there is a strong relationship between overcrowding and the spread of TB. Its
evident that most of the TB cases occur among people who live in slums areas which are overcrowded .

ABSTRACTPOSTER PRESENTATION

Automation of active TB case ﬁnding in Electronic Medical Record inincreasing TB case identiﬁcation in Matata hospital, Homabay County
Mr Korir Brian¹, Felix Ochieng¹, Sally Keino², Fredrick Raywe³
Clinical Oﬃcer, Matata Hospital¹
Nursing Oﬃcer, Matata Hospital²
Program Oﬃcer, CoAg Project³

Introduction
80% of those who seek care with symptoms of TB are not usually diagnosed at initial contact within thehealth facility (prev. survey 2016). Additionally, 42% of people with respiratory symptoms initially seek care
at private clinics, laboratories and retail chemists (PPA, 2016). TB diagnosis is made after 4 – 5 hospital
visits (many times a patient has visited a local nearby private facility and other public health facilities several
times before the diagnosis is made, mostly at a public health facility). Homabay County is a high burdened TB
zone. The county notiﬁed 1989 and 2155 new TB cases in the year 2020 and 2021 respectively (TIBU),
However Matata hospital notiﬁed 40 cases (67%) TB cases in the year 2020. We sought to assess the impactof the automation of TB screening questions in the electronic medical record (EMR) in the outpatient
department.
Methods
This was a retrospective analysis of 6 months of ACF data from July to December 2020, comparing thefacility’s Outpatient workload and the number screened for TB. Non standardized way of screening was used
before automation of ACF questions in the electronic medical record in the OPD. The Clinicians still skippedthe process sending patients to the pharmacy without ﬁrst screening them for TB. Restrictions were done to
make TB screening mandatory.
Capacity building was done to facility staff through CMEs and OJTs on the TB module. For symptomaticpatients, EMR prompted request for Gene Xpert and AFBs Microscopy automatically to the laboratory which
improved identiﬁcation and linkage towards TB diagnosis and treatment.
Results
There was a 117% (70/60) ACF achievement in 2021 compared to 67 % (40/60) in 2020 . Across all the month
the increment was signiﬁcant with January 2021 when the intervention was introduced, reporting the highest
increment (From zero to 7 TB cases)
Conclusion
Automation and making ACF questions a mandatory module in the EMR leads to increased case notiﬁcationand therefore reduce public health burden of TB in facilities using EMR.
Supportive system contributes to the success of implementation of Active Case Finding.

ABSTRACTPOSTER PRESENTATION

Sputum quality as a predictor of bacteriologically-conﬁrmed TB bysmear and culture in Nairobi county
Ms Robi Chacha¹, Asiko Ongaya¹, Paul Mwangi¹, Jeremiah Ndeto¹, Pascah Bulia¹, Dorcas Wanjiru¹,
Geoffrey Okallo¹, Janice Endsley², Evans Amukoye¹
Kenya Medical Research Institite- KEMRI¹
University of Texas Medical Branch- UTMB²Introduction
Globally tuberculosis (TB) is a major public health problem and among the leading causes of death from asingle infectious pathogen. The quality of sputum sample is an important factor in the diagnosis of TB
through smear and culture. This study aimed to investigate whether sputum quality, deﬁned as mucoid,salivary, or mucosalivary, could predict the yield of bacteriologically-conﬁrmed TB by smear and culture in
Nairobi County, Kenya.
Methods
This cross-sectional study included 440 TB participants recruited from three health facilities in Nairobi
County; Mbagathi hospital, Rhodes TB clinic and AIDs Health Foundation-Mathare. Sputum samples fromconsented participants were collected. The sputum quality was recorded, ZN microscopy and Lowenstein
Jansen culture were performed to determine the presence of Mycobacterium tuberculosis.
Results
Of the 440 243(55.22%) were mucoid with 176(72.42%) ZN positive and 67(27.57%) ZN negative;
173(71.19%) were culture positive and 70/243(28.81%)culture negative. 144(32.72%) were muco-salivary
with 102/144(70.83%) ZN positive and 42(29.17%) ZN negative; 90(62.50%)culture positive and 54(37.50%)
culture negative. Salivary samples were 51(11.56%) with 28(54.90%) ZN positive, 23(45.10%) ZN negative;
30(58.82%)culture positive,21(41.18%) culture Negative. Pearson chi2 (2) = 6.2456; p=0.044
Conclusion
The study ﬁndings suggest that the quality of sputum samples is a predictor of the yield of bacteriologicallyconﬁrmed TB, both by smear and culture. Therefore, it is important to ensure that sputum samples are ofgood quality, and efforts should be made to collect and process mucoid and muco-salivary sputum samples
whenever possible. This can be achieved through the implementation of proper sputum collection
techniques and training of healthcare workers on sputum collection and handling.

ABSTRACTPOSTER PRESENTATION“We have a human right to breath fresh air”: Health inequalities andthe Social Determinants of Asthma
Dr Martha Chinouya¹, Prof Kevin Mortimer², Dr Sepeedeh Saleh³
Liverpool School of Tropical Medicine¹
University of Cambridge²
University of Liverpool³

Introduction
Is there anything more fundamental to life than the function of breathing fresh air? This is a pertinent
question as we are reminded by Rosamund Adoo Kissi-Debrah the mother of 9-year-old Ella Kissi-Debrah, ablack girl who died from Asthma having lived 25 metres from a busy London road. Ella’s death was the ﬁrst to
be attributed to air pollution in the UK. Asthma is therefore part of a metaphor for the ‘right to health/life’ –determining at times, who lives healthily and who dies. Its diverse and complex patterning of risks across theglobe follows footprints of class, race, region, education, and gender, amongst other social factors. Existingdata suggest that there are 300 million people living with asthma globally: a number which has increased by
50% over each passing decade. This is an important challenge for respiratory health in Africa, but one towhich the answers are far from simple.
Methods
This presentation, informed by ‘rights-based’ approaches, will critically review the evidence with asubsequent discussion around how the Social Determinants of Health (SDH) can inﬂuence experiences ofliving with asthma and accessing health care including a diagnosis. According to the WHO, SDH are “the nonmedical factors that inﬂuence health outcomes.” These include conditions in which people are born, grow,
live, and age and the wider forces such as globalisation, systems, policies, laws, norms, and politics.
Results
Whilst there is diversity of risks globally, in sub-Saharan Africa, factors contributing to the development ofasthma include household air pollution from solid fuel use, traﬃc and industrial pollution exposures, andprenatal maternal nutrition. Reported rates of asthma are high in higher income countries with recent
increases noted in low- and middle-income country settings where paucity of data often masks the true
extent of suffering. Inequities in access to asthma diagnosis and management are thus another area wherewider determinants of health – including wider health systems factors as well as social, political, andeconomic factors – shape individuals’ experiences of asthma.
Conclusion
The presentation contributes to ongoing debates on how the Social Determinants of Health affect children’s
chances of developing asthma, and the health of those living with the illness. Multi-sectoral approaches are
required to tackle these complex challenges, and we discuss how those in leadership positions in various
contexts may act as resources for social change, advocacy, and education, equipping us all to meet thisglobal challenge.

ABSTRACTPOSTER PRESENTATION

Using creative activities to sensitise communities in Nairobi to lung
health and air pollution research
Prof Cindy M Gray¹, Howard Abwao², Matthew Hahn³, Patricia Mboya², Hellen Meme⁴, Louis Netter⁵,
Bob Omondi², Fred Orina⁴, Melaneia Warwick⁶, Jana Wendler⁷, Jana Wendler⁵
School of Social and Political Sciences, University of Glasgow, UK¹
Zindua Creative Organization, Kenya²
Freelance Theatre for Development Specialist, UK³
Kenya Medical Research Institute, Kenya⁴
Faculty of Creative and Cultural Industries, University of Portsmouth, Uk⁵
Kleos Consulting, Uk⁶
Playfuel Games CIC; Berlin School of Public Engagement and Open Science, Germany⁷

Introduction
Air pollution is a global health priority. It reduces life expectancy and increases risk of respiratory andcardiovascular disease. In Kenya, people living in informal settlements experience greater air pollution
exposure than those living in more aﬄuent areas. Sources include industrial emissions, waste burning andcooking. This project aimed to develop creative sensitisation activities to support recruitment to the
Tupumue (‘let’s breathe’ in Kiswahili) study, which compared lung health and air pollution exposure among
school children in two communities in Nairobi.
Methods
The project took place in a large informal settlement (Mukuru) and a neighbouring more aﬄuent area
(Buruburu). Researchers and arts practitioners worked with 27 community artists and local residents(Tupumue champions) in two co-creation workshops in December 2019 and February 2020 to develop
inclusive, culturally-relevant creative sensitisation activities. These were delivered in schools andcommunity locations by the champions from February 2020 to August 2021. The champions were also
trained in data collection (observation ﬁeldnotes/photographs, interviewing) to assess attendees’
engagement and learning.
Results
The sensitisation activities included street games, a music video and visual arts illustrating different
aspects of lung health, and a puppet show, dramatizing Tupumue data collection to address any
uncertainties about the study. The activities were initially delivered in eight of the 14 Tupumue ﬁeldwork
schools and 28 community settings. Following a COVID-enforced suspension (April-December 2020), thechampions installed 10 large-scale, stencilled murals near the schools. From April 2021, smaller teams (5-8champions) resumed delivery of adapted COVID-compliant sensitisation activities to 1552 pupils in 33
classes at the remaining six schools. Observations suggested most children were highly engaged in theactivities. Many of the 24 pupils interviewed said they knew more about lung health, and most wanted to takepart in Tupumue. However, interviews with 36 adults and children about the murals demonstrated mixed
understanding of the messaging.
Conclusion
The sensitisation campaign was highly successful. It supported recruitment of 2403 children to the
Tupumue study (Mukuru N=1296; Buruburu N=1107). The champions gained new skills in designing,delivering and evaluating creative sensitisation activities, and have established a community-basedorganisation (ZICO) to support future work in this area.

ABSTRACTPOSTER PRESENTATION

Sputum Culture Conversion rates in relation to HIV status after 6
months of Tuberculosis treatment in Nairobi Kenya
Ms Dorcas Ihuthia¹, Robi Chacha¹, Pascah Bulia¹, Jeremiah Ndeto¹, Geoffrey Okallo¹, Paul Mwangi¹,
Janice Endsley², Evans Amukoye¹, Asiko Ongaya¹
Kenya Medical Research Institute¹
University of Texas Medical Branch, Galveston, Texas USA²

Introduction
In 2021, 10.6 million people fell ill with Tuberculosis (TB) worldwide, an increase of 4.5% from 10.1 million in
2020. Decreased reported new TB cases in 2020 and 2021 indicate that the number of people with
undiagnosed and untreated TB has increased mainly because of TB services disruptions caused by the
COVID-19 pandemic. TB diagnosis involves clinical evaluation, including chest radiography andbacteriological tests. Bacteriological diagnosis depends on smear microscopic examination and bacterial
cultures, which has been the traditional method for many decades. Lowenstein–Jensen (LJ) based mycobacteriological culture and recently introduced TB molecular diagnostic technique with eﬃcient turnaroundtime and speciﬁcity is also used for the diagnosis of active TB in clinical settings. The objective of this study
was to determine sputum culture conversion rates in relation to HIV status after the intensive phase of TB
treatment.
Methods
A total of 289 sputum samples from positive TB cases from three health facilities in Nairobi; AIDS Healthcare
Foundation, Rhodes TB clinic, and Mbagathi hospital were collected, processed, and cultured on Lowenstein
Jensen for 12 weeks.
Results
Of the 289 TB patients, 231(79.9%) were HIV non-infected, and 58 (20.1%) were HIV infected. Of the 231
patients, 43(18.6%) had negative culture results, and 188(81.4%) had positive culture results at the baselineof TB treatment. Of the 188(81.4%) patients who had positive culture results, 184(97.9%) had negative
culture results and 4(2.1%)had positive culture results on completion of TB treatment. Of the 58 patients,
16(27.6%) had negative culture results, and 42(72.4%) had positive culture results at the baseline of TB
treatment. Of the 42 (72.4%) who had positive smear results, 39(92.9%) had negative culture results and3(7.1%) had positive culture results on completion of TB treatment. The sputum culture conversion rate after
the completion of TB treatment for HIV non-infected was 97.9% and 92.9% for the HIV-infected.
Conclusion
Sputum culture conversion is strongly inﬂuenced by adherence to TB treatment. Patients’ demographics
should be analyzed to support the above ﬁndings.

ABSTRACTPOSTER PRESENTATION

Malaria, COVID-19 and hyper-inﬂammation in a paediatric patient
Dr Anne Irungu¹, Dr Christine Karanja-Chege², Dr Doris Kinuthia²
Gertrude's Children's Hospital Kenya¹
Gertrude's Children's Hospital and Kenyatta University Medical School, Kenya²

Introduction
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has been associated with an inﬂammatory condition in children ,multi-system inﬂammatory
syndrome in children (MIS-C) .We describe a unique case of malaria and COVID-19 with persistent hyperinﬂammation.
Methods
Descriptive case report.
Results
An 8 year old female was admitted with acute onset fever and gastrointestinal(GI) symptoms.On admission
she was sick-looking and febrile. Saturating 99% on room air,tachypnoea of 34 breaths/minute, bronchialbreath sounds bilaterally. Tachycardia at 114 beats/minute and hypotension 80/40mmhg .She had a tender
hepatomegaly, 4cm below the right sub-costal margin and epigastric tenderness. The rest of the systemic
exam was unremarkable. Her initial work-up showed : Mild iron deﬁciency ,Thrombocytopenia ,Malaria
antigen positive and falciparum parasitemia of 100,000/µL,high C-reactive protein (CRP) - 163.27mg/L (010) and Pro-calcitonin (PCT) - 57.18ng/ml (0.0-0.05). deranged urea, creatinine and electrolytes,,microscopic haematuria,low albumin 21.78g/L (35-50)and low Vitamin D -19ng/ml(30-100).She wasmanaged initially in the intensive care unit (ICU).A renal ultrasound showed parenchymal disease and on
Chest X-ray (CXR) Bilateral opaciﬁcation, pneumonia/pneumonitis features that later progressed to a rightpleural effusion and an enlarged left ventricular outline.She was transferred to the general ward on day 7. She
still had febrile episodes ,diﬃculty weaning off low ﬂow oxygen and the CRP and PCT markers were
high.Cardiac echo-cardiogram showed a small pericardial effusion, mild pulmonary hypertension withnormal anatomy and function.She still had persistent features of pneumonia/pneumonitis on her CXR. A
suspicion of COVID MIS-C was made .The sputum multi-plex test was negative for all antigens tested
including SARS-CoV-2, COVID IgM and IgG test were positive, Ferritin-782.19ng/ml (7-84) and lactate
dehydrogenase -(LDH)1332 (0-305) were high.A 3 day pulse dose of methylprednisolone was given withresolution of her symptoms. Results for auto-immune markers showed ; low C3,C4 complement levels, Antinuclear antibodies (ANA) weakly positive, Anti-double stranded DNA antibodies (Anti-dsDNA) negative. On
follow-up 2 weeks later she’s progressing well with no residual symptoms, good exercise tolerance andnormal renal function.
Conclusion
Respiratory and GI symptoms in an older child with hypotensive shock in a highly endemic malaria zone
should warrant diagnostics for MIS-C.

ABSTRACTPOSTER PRESENTATION

Spirometry reference values for healthy children and adolescents in
Tanzania
Dr Julieth Lalashowi¹, Olena Ivanova² ³, Elimina Siyame⁴, Willyhelmina Olomi¹, Rebekka Wenzel²,
Abhishek Bakuli², Michael Hoelscher² ³, Nyanda Elias Ntinginya¹, Issa Sabi¹, Andrea Rachow² ³
Mbeya Medical Research Centre, National Institute for Medical Research (NIMR)¹
Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich,Germany²
German Centre for Infection Research (DZIF), Partner Site Munich, Germany³
Mbeya Medical Research Centre, National Institute for Medical Research (NIMR),Assistant Medical Oﬃcers training
school (Mbeya), Ministry of Health, Tanzania⁴

Introduction
The interpretation of spirometry test results is usually based on comparisons of data measured in an
individual with predicted values based on healthy subjects, preferably from the same population or area.
However, these data are scarce in African countries, especially in children. We aimed to collect lung function
data from healthy Tanzanian children and adolescents to establish spirometry reference values for thisspeciﬁc population.
Methods
This cross-sectional study enrolled 300 healthy children and adolescents aged 5 to 17 years in Mbeya,
Tanzania. We collected demographics and behavioural information using structured questionnaire, andperformed anthropometric measurements. Lung function test was assessed using a handheld spirometer(EasyOne®ndd Medical Technologies, Inc) with individual-use ﬁltered one-way single-use mouthpieces. The
predictive Tanzanian equations for FVC, FEV1 and FVC/FEV1 ratio were constructed by using different
regression models and correlation coeﬃcients for the spirometry parameters with age, height and weightcomputed for each sex
Results
Out of the 300 participants who were enrolled, 285 produced valid spirometry results according to theAmerican Thoracic Society (ATS)/ European Respiratory Society (ERS) acceptability criteria. In those who
produced valid results, 143 (50.1%) were females and the mean age was 12.5 (SD 2.2) years. The Mean FVC
and FEV1 were 2.3L (0.6) and 2.0L (0.5) respectively. Height was covariate for the prediction of FVC in bothmales and females, while the inﬂuence of age differed by sex for FEV1.
Conclusion
This study provides ﬁrst data on lung function in healthy Tanzanian children and adolescents. The analysis
and comparison of the obtained equations with GLI and references obtained from other African populations
are currently ongoing. The pending analysis will reveal the applicability of the GLI equation in our setting.

ABSTRACTPOSTER PRESENTATION

Assessment of the effect of Computer Aided Detection (CAD4TB)
enabled chest x-ray (CXR) on screening for Tuberculosis cases inMathare North Health Centre
Ms Caroline Macharia¹ ², Dennis Oira², Felix Oloo³
Nairobi County Department of Health¹
Centre for Health Solutions-Kenya (CHS) TB Accelerated Response and Care II²
Maseno University, Department of Health, Siaya County³

Introduction
With over 95% tuberculosis (TB) cases and deaths occurring in developing countries, there is need for
substantially improved case detection to ﬁnd the “missing millions” and accelerate action to achieve thesustainable development goals to end TB by 2030. CXR with CAD software for TB has been recommended forsystematic screening for TB disease in the most recent WHO TB Screening Guidelines. In 2021, 10.6 million
people were presumed to have TB globally with only 6.4 million being diagnosed with TB in the same year. In
the same period, Kenya reported 77,854 drug-sensitive TB (DSTB) cases, indicating a case detection gap of
48%. Following the WHO 2021 guidance on systematic screening for TB with CAD software enabled digitalchest X-rays (DCXR), Kenya rolled out these new technologies in eight facilities. We set out to evaluate theoutcome of CAD- DCXR TB screening on patients seeking care in Mathare North Health Centre, Nairobi
County.
Methods
This was a cross-sectional screening of all eligible patients above 15 years of age between September 2022
and January 2023. patients were screened using a Delft Light portable digital X-ray with Computer Aided
Detection Software (CAD4TB) version 7. It gave a probabilistic score for TB ranging from 0 (low probability)
to 99 (high probability). GeneXpert MTB/RIF Ultra was used for bacteriologic conﬁrmation of results above
set threshold. Bacteriological negative results were clinically evaluated and this aided in clinical diagnosis.
Results
1025 were screened for TB using CAD4TB v7 enabled DCXR. OPD and CCC clients screened were 345(33.7%) and 676 (66.0%) of whom, majority were females (63.6%). CAD scores >60 for and 40-59 was50(14.4%) and 31(9%). Out of those who scored >60, 46 (92%) received bacteriological testing, 23 (46%)
were positive while 12 (24 %) were clinically diagnosed. CAD scores of >60 and 40-59 for HIV positive
patients were 23 (3.4%) and 30 (4.4%) respectively. Out of those who scored >60, 22(73%) received
bacteriological testing. 2(6.6%) were positive while 2 (6.6%) were clinically diagnosed.
Conclusion
Our ﬁndings demonstrate CAD-DCXR as a useful TB screening tool for all clients in our setting

ABSTRACTPOSTER PRESENTATION

Rare cause of Bilateral Vocal Cord Paralysis and Diaphragm
Dysfunction
Dr Sindiswa Makate¹, Diane Gray², Marco Zampoli², Aneesa Vanker², Shaazia Peer³, Alvin Ndondo⁴,
Gill Riordan⁴, Seyrum Wordoi¹, Joy Eze¹
Division of Paediatric Pulmonology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s
Hospital, University of Cape Town, South Africa¹
Division of Paediatric Pulmonology, Department of Paediatrics and Child health, University of Cape Town, South Africa²
Division of Otolaryngology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town,
South Africa³
Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s
Hospital, University of Cape Town, South Africa⁴

Introduction
Bilateral Vocal Cord Paralysis (BVCP) is a differential diagnosis of congenital stridor. The cause ofcongenital BVCP is usually idiopathic, due to associated neurological abnormalities or chromosomal
abnormalities.
Methods
We present a case of a term neonate with respiratory distress at birth and biphasic stridor.
Results
The neonate had respiratory distress from birth requiring CPAP. From day 3 of life noted to havedesaturations on feeding, increased work of breathing, biphasic stridor and unable to wean off CPAP. He wastransferred for assessment on D14 of life. He had no dysmorphic features, but stridor and paradoxical
breathing pattern was noted, with respiratory acidosis and a raised lactate. Echo revealed biventricular
hypertrophy without outﬂow obstruction and normal ECG. Bedside ultrasound of the diaphragm conﬁrmed
bilateral palsy. Bronchoscopy showed reduced movement of the larynx and no movement of the vocal cords
during spontaneous respiration. Child required tracheostomy for prolonged ventilation. CT Brain was done
which was normal, myopathy excluded clinically with a normal CK.
Noted to have persistently raised lactate, metabolic investigations showed a serum lactate pyruvate ratio of
69.23 (7 times the upper limit of normal). MRI of the brain and spine showed diffuse abnormal signal of thehemispheric subcortical and deep white matter without any basal ganglia or brainstem abnormality. There
was cervical myelopathy with expansion of the cervical central spinal canal. Features in keeping with aleukoencephalopathy or mitochondrial cytopathy. Muscle biopsy showed features suggestive of a
mitochondrial abnormality. Mitochondrial DNA sequencing results to follow. The patient is currently onhome ventilation awaiting a feeding gastrostomy.
Conclusion
Metabolic disorders should also be considered in the workup for congenital vocal cord paralysis, withmitochondrial disorders a rare but important diagnosis.

ABSTRACTPOSTER PRESENTATION

Improving TB case ﬁnding through strengthening the use of Chest
X-rays as a TB screening tool for presumptive cases. A case of Kamiti
prison hospital, Nairobi
Mrs Peninah Makena Michuki¹, Elizabeth Mueni², Daniel Nono³, Dr Gitonga⁴
Kamiti Prison Hospital¹
Nairobi City County²
LVCT³
Kenya Prisons⁴

Introduction
The Kenya national prevalence survey 2016 showed that Kenya’s tuberculosis (TB) burden is 426 per
100,000, previously estimated by WHO at 233 per 100,000. It further showed that a chest x-ray (CXR) was avital screening tool for tuberculosis. During the survey, 88% of cases diagnosed had abnormal chest x-rays,
and 52% did not have a cough for more than two weeks. Prisoners are a high-risk group for TB disease; Kamiti
prison hospital is one of the four prison facilities in Nairobi serving the inmates and the community. In 2020,
TB case ﬁnding at Kamiti dropped by 67% to 46 notiﬁed patients from 141 in 2019. We aimed to improve caseﬁnding through the use of chest X-rays as a screening tool in Kamiti prison
Methods
We retrospectively reviewed data from TB4 and the presumptive registers reported in January to December
2021.The presumptive TB cases that were identiﬁed were through symptom screening. CXR was further
used for triaging a proportion of presumptive cases before subjecting the clients with suggestive CXRs togene expert for further analysis.
Results
In 2021, there were 435 persons presumed to have TB, 284 (65%) had CXR done. Eighteen percent of thosewith CXR had abnormal CXRs, and 27 (52%) were bacteriologically positive by GeneXpert. Further 25 (25%)
were clinically diagnosed using symptom and the chest x-ray only. Out of the 151 without CXR, 40 (26%)
yielded a positive result on Xpert.
Conclusion
This study demonstrates the importance of CXR as a triaging tool with high yield from Xpert for those triaged
with CXR, 52% versus 26%. This could potentially lead to savings on number of Xpert tests needed todiagnose one bacteriologically positive TB case. An increase in clinical diagnosis was also noted with allwith abnormal CXR and negative Xpert put on treatment. Use of CXR in triaging has a potential for TB overdiagnosis and caution should be applied with clinical team discussions before making a decision to start
treatment.

ABSTRACTPOSTER PRESENTATION

Surveillance of Common Respiratory Viruses in Senegal During theCovid-19 Pandemic: Focus on Respiratory Syncytial Virus (RSV)Mr Jallow Mamadou Malado¹, Marie Pedepa Mendy¹, Mamadou Aliou Barry¹, Sara Sy¹,
Ndiendé Koba Ndiaye¹, Modeste Name Faye¹, Déborah Goudiaby¹, Ndongo Dia¹
Pôle de virologie, Institute Pasteur, Dakar, Senegal¹

Introduction
In many countries, different public health measures have been implemented during the COVID-19 pandemic
to counter the transmission of SARS-CoV-2. These measures, in particular physical distancing and the use ofmasks, might have contributed to containing the circulation of other respiratory viruses, including RSV.
However, similar data in tropical and resource-limited countries are limited. So here, we investigated theepidemiology and seasonality of RSV infection to determine the possible impact of such interventions in
reducing the spread of Respiratory Syncytial Virus (RSV).
Methods
From January 2020 to December 2021, nasopharyngeal and throat swab samples are collected fromconsenting patients with ILI or SARI presenting to the various healthcare sentinel sites across the country.
An enrollment form is used to collect data from enrolled eligible patients including patient demographics,
medical history, clinical signs and symptoms, comorbidities, recent travel history, treatment, clinical course,
and outcome. Respiratory samples are tested for RSV and other respiratory pathogens using RT-qPCR.
Results
During the study period, 4160 samples were received of which 3728 (89.6 %) ILI cases and 432 (10.4 %) SARI
cases, and the most frequently observed symptoms were cough (92.4%) and fever (68.9%). Children ≤ 5years accounted for 35.6 % (1483/4160) of all participants, whereas the elderly patients represented 16.5 %(688/4160). RSV was detected in 224 (5.4 %) cases with 28 (12.5 %) found in co-infection with at least one
another respiratory virus. The most common co-infecting viruses were with inﬂuenza viruses (11.6%;
26/224), rhinoviruses (11.2%; 25/224), adenovirus (4 %; 9/224) and SARS-COV2 (3.6 %; 8/224). RSV infection
were more identiﬁed in SARI (10.6 %; 46/432) compared to ILI (4.8 %; 178/3728) patients. RSV detection
rates in the different age groups varied signiﬁcantly with children under 5 years group accounting for 68.3%(153/224) of positive patients. Globally, we observed a shift in the seasonality of RSV during the Covid-19
pandemic (systematic increase in RSV infections between September-November each year), which usually
circulates during the rainy season (June-September).
Conclusion
Overall, results obtained in this study suggest that the spread of the pandemic SARS-CoV-2 virus has
signiﬁcantly affected the temporal trend of RSV in Senegal, highlighting that the detection of other common
respiratory pathogen(s) should not be ignored during the COVID-19 pandemic.

ABSTRACTPOSTER PRESENTATIONTime to appropriate care-seeking for Covid – 19 symptoms
Dr Ekat Martin Herbas¹, Ossibi ibara Bienvenu Rolland¹, Adoua Doukaga Tatia¹,
Aloumba gilius Axel²
Centre Hospitalier Universitaire de Brazzaville¹

Introduction
in sub-Saharan Africa, the symptoms of covid-19 are similar to those of several pathologies frequently
encountered in this region, which can confuse the diagnosis both for the patient and for health structureswith limited resources. We studied self-reported time to care-seeking from the onset of covid-19 symptoms
Methods
This was a cross-sectional study. Patient’ﬁles who attended at the medical emergencies Unit of Brazzaville
University Hospital, for symptoms suggestive of Covid - 19 between May 2020 and February 2022, werecollected. The diagnosis of Covid-19 was conﬁrmed by RT-PCR or antigen test. Delay, between the rise of
Covid- 19 symptoms and the attendance at the medical emergencies Unit, was recovered from the history ofthe disease reported by the patients themselves, and a certain consistency was observed. When the patient
had reported duration of 'about one week' in the delay we noted '7 days' and 'about 2 weeks' corresponded to'14 days' taking this into account we used the Weibull regression model accelerated failure-time metric to
identify potential risk factors which were subsequently presented as a time ratio (TR).
Results
102 patients were included, 57 (55.88%) were women, the median age was 64 years (Interquartile Range(IQR): 56 – 71), history of hypertension and diabetes was found respectively in 51 (50%) and 27 (26.47%)
patients. 13 (12.75%) were vaccinated against Covid – 19. The median time to care-seeking was 7 days (IIQ:
5 – 7). Being vaccinated (adjusted Time Ratio (aTR): 1.69 (95% CI: 1.09 – 2.6) p=0.02) and having a cough(aTR: 1.74 (95% CI: 1.2 – 2.52) p=0.03) was associated with a longer time to care-seeking. On the other hand,being Hypertensive (aTR: 0.68 (95% CI: 0.51 – 0.9) p= 0.006), asthenic (aTR: 0.46 (95% CI: 0.23 – 0.91) p=0.03) and having respiratory distress (aTR: 0.48 (95% CI: 0.26 – 0.89) p=0.03) were associated with a fastertime to care-seeking.
Conclusion
vaccine increases time to care seeking, especially when it is associeted with the classic signs of COVID-19
such as cough. To limit the under-notiﬁcation of cases in sub-Saharan Africa, Covid 19 testing must be
generalized

ABSTRACTPOSTER PRESENTATION

Proﬁle and factors associated with survival of patients that received
physiotherapy during admission in the intensive care unit (ICU) in
Kano, Nigeria
Dr Jibril Mohammed¹, Idris Tijjani Shu’aibu², Jibril Mohammed Nuhu³,
Abdulwali Sabo Abdurrahman⁴, Abubakar Tijjani Salihu⁵, Jibril Sagir Idris⁶
Department of Physiotherapy, Bayero University, Kano¹
Medical Services Department, Diagnostic and Treatment Centre, Kano, Central Bank of Nigeria²
Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria³
Department of Community Medicine, Faculty of Clinical Sciences, Federal University, Dutse, Nigeria⁴
Department of Physiotherapy, Monash University, Melborne, Australia⁵
Department of Physiotherapy, Aminu Kano Teaching Hospital, Kano, Nigeria⁶

Introduction
The intensive care unit (ICU) is a specially equipped ward where critically ill patients are admitted for closemonitoring and special care in order to increase their chances of survival. Mortality rate in ICUs are high andare inﬂuenced by several factors. The objective of this study was to report the proﬁle and factors associatedwith survival of ICU patients who received physiotherapy in a Nigerian tertiary hospital.
Methods
A 5-year retrospective survey of patients admitted between January 2016 and December 2020 in the ICU ofAminu Kano Teaching Hospital Kano, was conducted. An audit of the ICU register and patients’ hospital ﬁles
was conducted. Sociodemographic and clinical variables such as mechanical ventilation use, typephysiotherapy interventions and status at discharge were recorded. Descriptive and inferential statistics
was utilized in analyzing the data obtained using SPSS v24 software.
Results
A total of 191 cases were included after screening 397 patients’ records. The mean age of the included cases
was 39.7(SD=13.63) years, majority of whom were males (69.1%). The cause of admission was mainly
surgical conditions following traumatic assault (68.1%). About 46.1% of the patients received mechanicalventilation, whilst 87.4% received a combination of exercise and chest physiotherapy techniques as part oftheir treatment interventions. The study also found that ICU related mortality rate was 39.7%. Following
regression analyses, the results indicated that mechanical ventilation was a signiﬁcant predictor of survival.
Speciﬁcally, ICU patients that were not mechanically ventilated were 3.37 times more likely to survive
compared to those that were ventilated (AOR=3.37, p value < 0.001).
Conclusion
It was concluded that among ICU patients amenable to physiotherapy, mortality rate is high, andadministration of mechanical ventilation was the major determinant of ICU-related mortality.

ABSTRACTPOSTER PRESENTATION

Fortuitous Discovery of a Double Superior Vena Cava
Dr Gourti Mouad¹, Maidi Elmehdi¹, Ammor Fatimzahra¹, Makloul Mouhsine¹
Medical University of Agadir, Medical Center of Agadir, Morroco¹

Introduction
In this Work , we presented adult patient who incidentally diagnosed with double Superior vena cava and a
description of the clinical evolution and abnormalities found in the chest-Xray and Ct-imaging .
Methods
A case report of fortuitous discovery of A double vena cava in patient who were operated for an implanted
venous chamber .
Results
Fortuitous discovery of a double superior vena cava on an implanted venous chamber performed on alymphoma in a 65-year-old patient. the patient was operated before for a biopsy of a cervical adenopathy
under local anaesthesia having revealed a lymphoma for which the patient was programmed for achemotherapy. the thoracic radiography face immediately after surgery of Implanted venous chamber
performed on Sub-clavien vein revealed that the catheter is parasternal left and the thoracic Tdm realized
immediately revealed a double superior vena cava with a low localization of the catheter which required a
withdrawal of 5 cm on a good caliber of the vena cava varied.
Conclusion
Duplication of superior vena cava is a rare anomaly. The incidence of double SVC in general population is
0.3% whereas in patients with congenital heart disease it varies between 10-11%. This abnormality can haveclinical importance if especially the one on the left side drains into the left atrium.

ABSTRACTPOSTER PRESENTATION

Unusual Metastatic Sites for Lung Cancer: About 4 Cases
Dr Gourti Mouad¹, Maidi Elmehdi¹
Medical university of Agadir¹

Introduction
Lung cancer is a malignant tumor developed in depend of lung cells. Incrimina+on of smoking is never deny
but gene+c and professional exposi+ng is also incriminated. Diagnosis conﬁrma+on is cytological. Liver,brain and bones represent the common metasta+c localiza+ons. Prognosis depends in +me of diagnosis
and treatment.
Methods
we report in our retrospective study all cases of unusual localizations of lung cancer metastasis seen in thesurgery department of the Agadir regional hospital . 4 cases reported of cutaneous, scalp and ocular
metastasis with histological evidence by surgery under local or general anesthesia.
All patients of our study are male, and the mean age is 43 years. The mean dura+on of symptoms was 2.5
months. Histological types were: adenocarcinoma 75% and epidermoide carcinoma in 25 %. 2 Patients had
more than one metastasis (two different sites). There were cutaneous metastases in 1 case, scalp 1 caseand ocular 2 cases. Metastasis had revealed lung cancer in 2 cases. The histological diagnosis of lungcancer was conﬁrmed by local biopsy 1 case, ocular biopsy 1 case and after thoracoscopy 1 case.
Chemotherapy was given in all cases . The median survival was 5years .
Results
we report in our retrospective study all cases of unusual localizations of lung cancer metastasis seen in thesurgery department of the Agadir regional hospital . 4 cases reported of cutaneous, scalp and ocular
metastasis with histological evidence by surgery under local or general anesthesia.
All patients of our study are male, and the mean age is 43 years. The mean dura+on of symptoms was 2.5
months. Histological types were: adenocarcinoma 75% and epidermoide carcinoma in 25 %. 2 Patients had
more than one metastasis (two different sites). There were cutaneous metastases in 1 case, scalp 1 caseand ocular 2 cases. Metastasis had revealed lung cancer in 2 cases. The histological diagnosis of lungcancer was conﬁrmed by local biopsy 1 case, ocular biopsy 1 case and after thoracoscopy 1 case.
Chemotherapy was given in all cases . The median survival was 5years .
Conclusion
Lung cancer is one of the most frequent cancer. Stage is often advanced at the time of diagnosis . Metastasis
is one important prognosis factor for lung cancer.

ABSTRACTPOSTER PRESENTATION

Role of Pulmonary Rehabilitation on the Health-Related Quality of Lifein People affected with Post TB Lung Diseases in Tanzania
Dr Kassim Msaji¹
KIDH¹

Introduction
Post TB lung disease (PTLD) is a growing health problem accounting for over 40% in Tanzania andelsewhere. Yet, there is no clear programmatic intervention to address the problem. We assessed the role of
Pulmonary-rehabilitation (PR) on the health-Related Quality of Life (HRQoL) in individuals with PTLD
Methods
This cohort study recruited and followed patients with PTLD who were participating in a community-based
PR for 12 weeks. Patients received community-based PR intervention comprised of physical exercise andhealth education, with or without pharmacotherapy, which was done 4 times in a week.
Results
From October 2021 through March 2022, 85 PTLD patients were recruited including 58 (68%) who had valid
baseline spirometry results. Of these 58 patients, 30 (52%) had abnormal spirometry results such as,
restrictive (n = 6), obstructive (n = 10) and mixed (n = 14). In total, 19 (22%) of 85 PTLD patients completed 12
weeks follow up of community pulmonary rehabilitation (n = 15) alone and pharmacotherapy (n = 4). The
mean (SD) STGRQ score signiﬁcantly decreased from 46.2 (19.7) at baseline to 18.4 (11.1) at week 12 (p<0.001) whereas the median (Interquartile rage; IQR) mMRC dyspnea scale improved from 1 (1 – 2) atbaseline to 1 (0 – 1) at week 12 (p = 0. 013).
Conclusion
Pulmonary rehabilitation with or without pharmacotherapy intervention improved the health-related qualityof life, as measured by STGRQ and mMRC dyspnea scale.

ABSTRACTPOSTER PRESENTATION

Evaluating a mobile health tool to guide management of acuterespiratory illnesses in young children in Uganda
Dr Rebecca Nantanda¹, Irene Najjingo¹, James W Stout², Joyce Nakatumba-Nabende³,
Chodrine Mutebi³, Jane Edelson⁴, Stephanie Farquhar⁵, Margaret Rosenfeld⁶, Laura E Ellington⁶Makerere University Lung Institute¹
Department of Pediatrics, University of Washington, Seattle WA²
Department of Computer Science, Makerere University School of Computing and Information Technology, Kampala,
Uganda³
Institute of Translational Health Sciences, University of Washington, Seattle, Wa⁴
Department of Health Systems and Population Health, University of Washington, Seattle, Wa⁵
Department of Pediatrics, University of Washington, Seattle WA and Seattle Children’s Research Institute, Seattle, Wa⁶

Introduction
Acute lower respiratory illnesses (ALRI) are a leading cause of death in young children. Despite evidencebased guidelines, ALRI case management remains challenging, and guideline adherence is low. We created
ALRITE (Acute Lower Respiratory Illness Treatment Evaluation), a point-of-care, Integrated Management ofChildhood Illnesses (IMCI)-based mobile health application to guide ALRI diagnosis/management in
Uganda.
Methods
Pilot feasibility study following ALRITE deployment in two primary care Ugandan health centers. Medical
doctors and clinical oﬃcers caring for children in the outpatient department were eligible to participate in the
study. We conducted training on use of ALRITE and ALRI management and provided ALRITE-enabled tablets
for clinicians to use during clinical consultations for three months. ALRITE use was not required, andclinicians were encouraged to override the ALRITE diagnosis if they disagreed. We collected ALRITE use
data, clinical information, and implementation outcome measures (adoption, acceptability, and feasibility).
Results
All eligible clinicians (N=7) enrolled in the study. One month after enrollment, 5 were actively using ALRITE(adoption 63%); and by 6 weeks had dropped to 2 (28.6%). ALRITE was initiated for 159/1139 pediatricencounters; 4 encounters were not completed. Primary ALRITE diagnosis included 37(24%) severe
pneumonia or very severe disease, 32(21%) pneumonia, 82(53%) cough/cold/no pneumonia, and 6(%) nosigns of respiratory Illness; ALRITE additionally diagnosed 4(3%) with wheezing illness. Algorithm errors
included 1) no primary diagnosis (once); 2) multiple primary diagnoses (twice); 3) overdiagnosis of severe
disease (twice). The concordance of the primary diagnosis between ALRITE and clinician was 70%. Forty
percent of discordance occurred due to clinicians marking IMCI danger sign, likely inappropriately, in a childwith less severe disease. Facilitators of ALRITE use included clinician stories of positive patient outcomes,
clinicians’ perception of improved guideline adherence, and ease of use. Barriers included usability, time
constraints, knowledge gaps, and inadequate staﬃng.
Conclusion
We have demonstrated the feasibility of the ALRITE mobile health tool in Ugandan health centers. The next
steps include addressing discordance and improving user experience and functionality by modifying ALRITE
and implementation approach to address the barriers. Results will inform a larger trial evaluating ALRITE’s
impact on clinical care.

ABSTRACTPOSTER PRESENTATION

The inﬂuence of maternal allergy or atopy on child wheezing and lungfunction at two years in a South African birth cohort study
Dr Evelyn Ng'ang'a¹, Michael Levin², Nicola Marozva³ ⁴, Carvern Jacobs³ ⁴, Maresa Botha³ ⁴,
Heather J Zar³ ⁴, Diane M Gray³ ⁴
Nairobi Hospital¹
Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa²
Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town³
South African MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa⁴

Introduction
Knowledge on early life determinants of respiratory disease in children is important for directing
interventions to strengthen lung health
Methods
Mother and child pairs enrolled in the Drakenstein Child Health Study, a South African birth cohort were
followed from birth for 2 years for wheezing episodes and lung function measurements. Active surveillance
for wheezing episodes and for lower respiratory tract illness (LRTI) was done. Recurrent wheeze was deﬁned
as x2 wheeze episodes. A subset of mothers had self-reported allergies and atopy blood tests (total IgE,
phadiatop and ascaris IgE). Correlations were explored between maternal allergy or atopy with children’s
wheeze characteristics and lung function tests (tidal breathing, exhaled nitric oxide and multiple breath
washout) in children at 6 weeks and annually.
Results
Amongst 1137 mothers and 1143 children enrolled, 611 (54%) mothers had allergy testing, median (IQR) age
25 years (21.8, 30.7); 201 (33%) mothers smoked, 113(18%) were living with HIV and 42 (7%) had selfreported allergy. 613 (54%) infants included: term-born (519, 85%), male (323, 53%), median (IQR) birthweight 3 (2.69, 3.42) kgs and one HIV infected infant (0.2%). 234/613 (38%) children had at x1 wheezing
episode through 2 years, of whom 89(15%) had recurrent wheeze; there were 404 LRTI episodes in 209/613(33%) children. Risk factors for recurrent wheezing included maternal asthma (OR 4.36; 95%CI 2.03,12.49;
p<0.001) or previous LRTI (OR 2.12; 95%CI:0.44, 10.07; p<0.05). Children whose mothers had self-reported
hay-fever had a higher FeNO (2.05ppb, 95% CI 0.03, 4.13, p=0.05). Males had higher tidal volume (4.36ml,
95% CI 3.05, 5.67; p = 0.01), higher FRC (11.53, 95% CI: 7.84 ,15.23; p = 0.01), higher resistance (2.08, 95% CI:
0.59 - 3.56; p = 0.01), and 3% lower tPTEF/tE (0.97, 95% CI 0.93,1.00; p = 0.05). A positive phadiatop was
associated with 6% change in tPTEF/tE (1.06, 95%CI 1.01, 1.11; p=0.03). Maternal total IgE and Ascaris
sensitization had no effect on wheeze or lung function.
Conclusion
Maternal allergy and atopy inﬂuence childhood wheezing and impact healthy lung growth.

ABSTRACTPOSTER PRESENTATION

Integrating Quality Improvement to Increase Tuberculosis Active Case
Finding in Giribe Dispensary
Mrs Josephine Mbinya Ngangi¹, Peter Omware², Stella Omullo³
CIHEB MOH¹
Ministry of health²
Centre for health solution³

Introduction
Giribe dispensary is a health facility in Migori county which began implementing active case ﬁnding(ACF)
since 2019 which is the systematic identiﬁcation of presumptive TB cases from a predetermined target
group or population, while quality improvement is the formal approach to the analysis of practiceperformance and efforts to improve performance. The facility has catchment population of 10,188 with an
expected annual target for notiﬁed TB cases at 43 cases per year which up to the end of 2021 had not beenachieved. In January 2022 The facility formed a work improvement team and Using a ﬁsh bone the following
root causes were identiﬁed knowledge gaps amongst clinicians on active case ﬁnding, poor contact
management and weak community facility
Objectives
i. To increase TB case ﬁnding by 50% by December 2022.
Methodology
This is a retrospective study comparing data collected from the facility TB patient register and contact
management from 2019 to 2021 before integrating quality improvement and 2022 after. The number of TB
cases diagnosed was then analyzed.
Strategies employed were:
1. ACME to sensitize facility staffs on active case and contact management register.
2. Regular on job training and mentorship on screening and TB management.
3. Monthly tracking of indicators on the TB dash boards after QI meetings.
4. Sensitizing the community health volunteers on screening, contact tracing and community facility
referrals of suspects.
Results
In 2019 when the facility began implementing active case ﬁnding only 12 cases of TB were notiﬁed and in2020 decreased to 8 (25%) cases, in 2021 8 cases. In 2022 with the above strategies following integrating
quality improvement in active case ﬁnding the facility notiﬁed 39 (488 %) cases.
It was only in 2022 3 (7.7 %) TB cases were diagnosed from referral from the community who were allpediatrics due to improved contact management
Conclusion
Integrating quality improvement in active case ﬁnding aids in identifying problems, solutions and tracking
down progress essential in scaling up number of TB cases diagnosed

ABSTRACTPOSTER PRESENTATION

Treatment intervention strategies for asthma and chronic obstructive
pulmonary disease in Malawi – economic evaluation based on a
ﬁve-year population cohort
Dr Martin Njoroge¹, Dr Jamie Rylance², Dr Angela Obasi², Prof Louis W Niessen²,
Prof Graham Devereux²
Centre for Reviews and Dissemination, University of York¹
Liverpool School of Tropical Medicine, Liverpool, UK²

Introduction
Asthma and chronic obstructive pulmonary disease (COPD) are the most common chronic respiratory
diseases. 90% of the deaths from COPD are in populations living in low- and middle- income settings(LMICs). This study evaluates the long-term costs and effects of possible interventions in Malawi andusefulness in similar settings
Methods
A six-stage Markov model having four mutually exclusive disease states for patients with asthma or COPD in
addition to a death state, and a healthy general population state was developed to conduct a costeffectiveness analysis over a patient’s lifetime. Patients entered the model at the age of 35 from the general
population state. We evaluated the use of anticipatory ‘emergency packs’ of antibiotics and corticosteroids
at home for COPD and inhaled beclomethasone and salbutamol for asthma. Estimation of stage-speciﬁc
probabilities, utilities and costs was based on Malawian cohort studies and lifetables. A discount rate of 3%
was applied to costs. Probabilistic sensitivity analysis was used.
Results
The COPD intervention dominated usual care in the people with mild COPD while the incremental costeffectiveness ratios (ICERs) were US$ 72, US$ 102, and US$ 242 in people with mild asthma,
moderate/severe asthma, and moderate/severe COPD respectively. The asthma intervention resulted in alife-years gain of 1.62 years and 1.29 years in the patients with mild asthma and moderate/severe asthma
respectively while the COPD intervention resulted in a life-years gain of 3.49 years and 3.90 years in patientswith mild COPD and moderate/severe COPD respectively. Uncertainty primarily originated from data on
treatment cost especially in people with moderate/severe COPD.
Conclusion
The COPD intervention was dominant in people with mild COPD while the in the people with moderate/severe
COPD and people with asthma the ICER ranged from US$ 72 to US$ 241. The COPD intervention resulted inlarger life expectancy gains compared to the asthma intervention. In the univariate sensitivity analyses, thecost of managing moderate/severe COPD had the highest impact on the uncertainty in the model. This study
describes the structure of an asthma and COPD dynamic prevalence model that accounts for disease natural
occurrence and history until death with input parameters drawn cohort studies conducted in Malawi.

ABSTRACTPOSTER PRESENTATION

Challenges of unsupervised sputum samples collection for
Mycobacterium tuberculosis analysis
Ms Martha Njoroge¹, Cheryl Kerama², Erick Nyadimo², Valentine Mibei², Ann Waweru²,
David Horne³, Jane Ong’ang’o²
CRDR-KEMRI¹
Centre for Respiratory Diseases Research, Kenya Medical Research Institute (CRDR-KEMRI), Past Government Chemist,
Opposite Diabetes Clinic. Nairobi-Kenya²
University of Washington, Division of Pulmonary and Critical Care and Sleep Medicine. Seattle-Washington, USA³

Introduction
In the wake of the COVID -19 pandemic, tuberculosis (TB) is the second leading cause of death from aninfectious disease worldwide. Kenya listed 30th among the high burden TB states, despite the effort made by
the government on early diagnosis and treatment. WHO recommends collection of two sputum samples fortuberculosis (TB) diagnosis, with one being a morning sputum sample (MS) collected at home without
supervision while spot samples (SS) are collected at site under supervision of a well-trained personnel.
Quality of sputum produced can inﬂuence the processing of the samples and results reported by laboratory
personnel. This study aims to assess the challenges limiting eﬃciency and effectiveness of unsupervised
early morning sputum sample collection.
Methods
A cluster-based cross-section study was conducted between April 2022 to December 2022 in Nairobi
County. Spot sputum sample from community-based TB suspects were collected at the mobile ﬁeld sites(MFS) by well trained personnel. The participants were provided with sputum containers for unsupervised
early morning sputum sample collection.
Results
The common challenges encountered in the unsupervised morning sample collection were; no turnout ofparticipants in delivering morning samples to the MFS site due to family or work commitments, sub-standard
sputum quality(poor cough technique and eating prior to production) that increased contamination rates,
inadequate sample quantity collected, Sample rejections due to false information by participants (due tostigma), untimely return of the morning samples inﬂuenced by the nature of occupation of the participants
and improper storage and transportation conditions from participants’ homes to the MFS.
Conclusion
Spot samples collected at site under supervision yielded high turnout and were of good quality compared tomorning samples collected at home without supervision. Introduction of a tracking log sheet helped in
tracing and reminding the participants about the time of sample collection and delivery. Supervision is key
for eﬃcient and reliable sputum sample collection in diagnosis of TB. Future studies can consider having
participants have well trained community health volunteers (CHVs) supervise the sputum production to
reduce contamination rates to promote high sputum quality.

ABSTRACTPOSTER PRESENTATION

Assessment Of Lung Function And Oxygen Saturation In Children With
Sickle Cell Anaemia At Alex Ekwueme Federal University Teaching
Hospital, Abakaliki, Ebonyi State, Nigeria
Dr Nnenna Ugo Nweke¹, Joy Nkiru Eze²
Alex Ekwueme Federal UniversityTeaching Hospital Abakaliki Ebonyi State Nigeria¹
University Of Nigeria Teaching Hospital Ituku Enugu State Nigeria²

Introduction
Pulmonary complications of sickle cell anaemia (SCA) start early in childhood and translate into adultchronic lung disease. Routine assessment and monitoring of lung function are important to optimize lung
health in sufferers. We aimed to assess the lung function values measured by spirometry, and oxygen
saturation measured with a pulse oximeter in children with SCA and to compare them with those of children
without SCA.
Methods
This was a comparative cross-sectional study of children with SCA aged 6 to 18 years old attending clinics at
the Sickle Cell Institute of a tertiary health facility in Abakaliki, and children without SCA (HbAA) matched forage and sex drawn from public (government-owned) schools from June 2021 to December 2021. We
measured the forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio,
and peak expiratory ﬂow rate (PEFR) using SCHILLER SPIROVIT; and oxygen saturation (SpO2) with aportable pulse oximeter. Mean FEV1, FVC, FEV1/FVC, and SpO2 were compared between groups (SCA andnon-SCA) using the Student's t-test; and across age groups using the Analysis of Variance (ANOVA). The
relationship between the SpO2 and lung function parameters was tested using Pearson’s correlation.
Results
In all, 262 children (131 with SCA and 131 without SCA (HbAA)) were enrolled. The mean (SD) FEV1 (1.72 ±0.54litres), FVC(1.94± 0.63 litres), and PEFR (259.63+-92,67L/Min) in children with SCA were signiﬁcantly
lower than those without SCA (2.68 ± 0.75 litres),(2.52± 0.83 litres) and (329.80±105.94L/Min) respectively;
p <0.001. Their mean FEV1/FVC was not signiﬁcantly different. Restrictive impairment was predominant inboth groups (SCA 38.93% and non-SCA (10.8%). Only 4.2% of children with SCA and 1.6% of those without
SCA had obstructive impairment. None of the participants had mixed abnormalities. Oxygen saturation(SpO2) was comparable in both groups. No signiﬁcant correlation was observed between SPO2 andspirometric parameters.
Conclusion
Conclusions: Sickle cell anaemia is associated with poor lung function. Lung function impairment did not
impact signiﬁcantly the oxygen saturation during a steady state. Optimization of lung health in affectedchildren is advocated to forestall the progression to chronic lung disease in futureABSTRACTPOSTER PRESENTATION

Scaling up Tb case ﬁnding by use of presumptive Tb register – a casein Tisinye health centre, Migori county
Mr George Obonyo¹, David Nyamohanga², Robert Timase², Nancy Mwita², Stella Omullo³
Migori county government,USAID, CHMT,National Tb and leprosy programT,CHS TB ARC II¹
MOH-Migori county govt²
CHS TB ARC II³

Introduction
Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the leading causesof death worldwide. Approximately 10million people developed tuberculosis globally in 2020 (WHO TB
Global report 2021). Case identiﬁcation of clients with TB infections through the use presumptive registers inscreening all RTIs is a key intervention as a primary model of breaking the community transmission chain
hence useful in the eradication of the disease. Through an effective and eﬃcient presumptive screening
approach, Tisinye health Centre realized the highest number of bacteriologically conﬁrmed cases in one
month.
Methods
Analytical screening approach; by the use of presumptive register was done, with skills gained in a training
supported by CHS TB ARC II project. RTI patients who presented at Tisinye health centre OPD department
were line listed on the presumptive register and subjected to smear tests and 12 patients were conﬁrmed
with TB in that month.
Results
The facility was able to identify 12 TB cases through presumptive register screening. This intervention madethe facility improve on its TB case identiﬁcation from 2 in July to 12 in August 2022. The highest number everachieved
Conclusion
An effective and eﬃcient use of presumptive registers approach has a big potential in bridging the TB cases
identiﬁcation gap.

ABSTRACTPOSTER PRESENTATION

Impact of computer aided detection (CAD4tb) chest x-ray on TB casedetection among people living with HIV (PLHIV) in Madiany Hospital
Dr Felix Oloo¹, Ruth Oruenjo², Richard Kiplimo², Oira N. Denis², Keziah Gichanga²,
Wycliffe Onyango² ³, Brenda Mungai²
Maseno University and Siaya County Department of Health¹
Centre for Health Solutions-Kenya (CHS) TB Accelerated Response and Care II²
Department of Health, Siaya County³

Introduction
Tuberculosis (TB) is currently second to COVID-19 as a leading cause of death from a single infectious agent,claiming a life every 22 seconds. Globally, TB caused 187 000 deaths among PLHIV in 2021. Kenya’s TB-HIV
co-infection rate was 24% in 2021. PLHIV are 18 times more likely to develop TB disease compared to those
without the virus. TB screening was carried out at every clinical encounter. Following the WHO 2021
guidance on systematic screening for TB with computer aided detection (CAD) software enabled digitalchest X-rays (DCXR), Kenya rolled out these new technologies in eight facilities. We set out to evaluate theoutcome of CAD-DXCR TB screening among PLHIVs on care at Madiany Hospital, Siaya County.
Methods
This was a cross-sectional prospective screening of all eligible clients >15 years of age booked for routine
HIV clinic visits between July 2022 and January 2023. Clients were screened using a Delft Light portable
digital X-ray with Computer Aided Detection Software (CAD4TB) version 7. CAD4TBv7 gave a probabilistic
score for pulmonary TB ranging from 0 (low probability) to 99 (high probability). Bacteriologic conﬁrmation
for above the set threshold score was by use of GeneXpert MTB/RIF Ultra and in some instances by
microscopy. Clinical Oﬃcer CXR interpretation and clinical evaluation of patients aided in clinical diagnosisof bacteriological negative results. Clients <15 years of age, those currently on TB treatment, pregnant andthose who declined were excluded from CXR screening.
Results
920 eligible clients were screened for TB using CAD4TB v7 enabled DCXR. Out of these, 346(37.6%) weremales with a median age of 45 (IQR: 36,54). These clients had a median period of 9 years IQR (6,12) on ART.
The average CAD score was 5 (IQR: 3,12). The CAD scores 40-59 and >60 was 2.8% and 4.2%. Out of thosewith CAD score >60 (N=39), 35(90%) received bacteriological testing and 25(64.1%) were positive. Clinicaldiagnosis was 14. Males were at a 22% higher risk of TB-HIV co-infection compared to females (RR=1.22;
95% CI, 0.70-2.12).
Conclusion
Regression analysis showed that PLHIVs with CAD scores >60 were 16 times more likely to have TB as
compared with those with scores <40.

ABSTRACTPOSTER PRESENTATION

Optimization of smear microscopy to enhance afb detection. A casestudy of Tisinye health centre. Migori County.
Mr Evans Ondieki¹, Boniface Onyango Olalo¹, John Nyakundi Mageto¹, Paul Silah²
County Government of Migori¹
Tukicheki²

Introduction
Sputum microscopy has been the primary method of diagnosis of pulmonary TB in low and middle income
countries as well as a method of choice for treatment following up for both bacteriologically and molecularconﬁrmed cases due to its simplicity and cost effectiveness. However it's sensitivity is compromised incases of low bacterial load. Large number of samples for microscopy sometimes do contribute to the low
sensitivity of the test. Therefore a need to optimize smear microscopy to enable more cases detection in
peripheral facilities with limited resources and enhance TB treatment following up as well.
Methods
The convectional AFB staining technique involves heating the underside of sputum smear ﬂooded with cold
ZN stain. This time long technique has been used for a long time. However in a case of many slides
insuﬃcient heating of the smears do occur. To avoid this A pre-heated hot ZN stain is ﬂooded on the smears
thereby eliminating the need to heat the smears to enhance staining. This is done by heating the working ZN
Stain till it boils before being used.
Results
After using this method of enhancement of stain by heating, the Laboratory was able to achieve a the highest
number of bacteriologically conﬁrmed cases ever achieved in a single month totaling to 12 cases equivalent
to 300% of it's target on the month of August 2022.
Conclusion
If embraced and adopted, the use of boiled carbol futchin stain can be a game changer that may see ZN
become a universally accessible test that can potentially save thousand of lives globally from TB death.

ABSTRACTPOSTER PRESENTATION

Indoor air pollution, knowledge of sources and Respiratory Symptoms
among Women in Kano State
Mrs Aishat Shittu¹, Gloria Vincent Akpabio¹
Bayero University Kano¹

Introduction
Indoor air pollution (IAP) in many households occurs due to the burning of solid fuels used for meal
preparations. It has been identiﬁed to be one of the ten most important risk factors for the global burden of
disease. There are growing indications that indoor air pollution resulting from using biomass fuel for cooking
is a major threat that seriously affects both children and the elderly alike. This study assessed air pollution
and investigated the knowledge of sources of air pollution and respiratory symptoms among women in
Kano.
Methods
One hundred and thirty-three mothers were recruited in a cross-sectional study. Purposive sampling wasused to recruit participants. Knowledge of sources of indoor air pollution and respiratory symptoms wasassessed using a structured questionnaire. Air pollution was measured using air quality meter. Dataobtained was summarized using frequency and percentages, statistical package for Social Sciences (SPSS)
version 20
Results
The mean age of mothers was 33 years. The majority have secondary school education (56.4%), cooking fuelpredominantly used was charcoal (47.4%), a combination of kerosene, ﬁrewood, and charcoal (18.0%),
ﬁrewood alone (13%), and the least is kerosene alone (2%). The majority of them cook between 3-4 hrs perday. PM2.5 reported within the hazardous was 25.6%, pollution from C02(39.8%), and TV02 (51.1%). The
humidity level was low in all cooking areas. Sources of knowledge of air pollution are mosquito coil(88.7%),
ﬁrewood (86.5%), cigarette smoke (85%), and charcoal (81.2%) constitute major sources. Symptoms
commonly reported was cough(36.8%) , phlegm(66.7%), shortness of breath(44.7%)
Conclusion
Air pollution is present, participants have knowledge of sources and respiratory symptoms are present
among the womenABSTRACTPOSTER PRESENTATION

Pattern, correlates of respiratory symptoms and Lung function among
Shisha Smokers in Kano, Nigeria
Mrs Aishat Shittu¹, Abdulshakur Lawan Fagge¹, Farida Garba Sumaila¹
Bayero University Kano¹

Introduction
Water-form tobacco smoking (Shisha) has increased among youth in the last several years, despite evidence
that it has similar or even worst health effects. It may be partially due to the misconception that waterpipe
smoking (WPS) is safer than cigarette smoking. This study determined the pattern and correlates of
respiratory symptoms and lung function among shisha smokers
Methods
This study is a cross-sectional study. One Hundred and Thirty Five participants who smoke shisha arerecruited. 111(82.2%) were males and 24(17.8%) were females. They were recruited from various shisha
joints in Kano using convenient sampling. Respiratory symptoms were assessed using a respiratory
symptoms questionnaire (ATS-DLD-78), portable spirometer (MSO4) was used to assess lung function. Data
were summarized using frequency and percentage and inferential statistics of Correlation were used to test
the relationships, with alpha level P<0.05.
Results
The majority are single youth (99.3%), and the mean age is 23.21 years. Respiratory symptoms reported
during active hours were Phlegm (38.5%), shortness of breath(30.4%), wheezes(26.7%), and cough(17.8%).
A moderate positive correlation existed between wheezes and FEV1 (r=.383; p=.000) and a weak positive
correlation between cough with phlegm (r=.229; p=.008) and breathlessness with FEV1 (r=.175; p=.042). A
weak negative correlation was noted between wheezes (r=.150; p=.083), phlegm production with chest
illness (r=.217; p=.012), and FEV1. Also, a weak positive correlation between wheezes occasionally apartfrom cold (r=.299; p=.000), breathlessness (r=.191; p=.026), and FVC, while a weak negative correlation
between phlegm production (r=-.172; p=.045), cough (r=-.180; p=.037), wheezes with cold (r=-.207; p=.016)
and FVC.
Conclusion
The respiratory symptoms are present in Shisha smokers and these symptoms may affect their lung function

ABSTRACTPOSTER PRESENTATION

The availability, cost, and affordability of essential medicines forasthma and COPD in low- and middle-income countries: A systematic
review
Dr Marie Stolbrink¹ ², Helen Thomson³, Ruth M. Hadﬁeld⁴, Obianuju B. Ozoh⁵, Rebecca Nantanda⁶,
Shamanthi Jayasooriya⁷, Brian Allwood², David M.G. Halpin⁸, Sundeep Salvi⁹,
Maria Montes de Oca¹⁰, Maria Montes de Oca¹¹
Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom¹
Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa²
King’s College Hospital, London, United Kingdom³
Australian Institute of Health Innovation, Macquarie University, Australia⁴
Department of Medicine, College of Medicine, University of Lagos, Nigeria⁵
Makerere University Lung Institute, College of Health Sciences, Kampala, Uganda⁶
Academic Unit of Primary Care, University of Sheﬃeld, United Kingdom⁷
University of Exeter Medical School, Exeter, United Kingdom⁸
Pulmocare Research and Education (PURE) Foundation, Pune, India⁹
Universidad Central de Venezuela, Venezuela; Centro Medico de Caracas Hospital, Venezuela¹⁰
Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom¹¹

Introduction
Asthma and COPD cause a high burden of morbidity and mortality in low- and middle-income countries(LMICs). Access to quality-assured, affordable, and safe essential medicines is variable. Our aim was toreview the existing literature relating to the availability, cost, and affordability of World Health Organization(WHO) Essential Medicines for asthma and COPD in LMICs.
Methods
We performed a systematic literature review, searching 7 databases to identify articles published between
01.01.2010–30.06.2022 (PROSPERO: CRD42021281069). Original studies concerning WHO Essential
Medicines for asthma and COPD in LMICs were included. Review articles were excluded. Two authors
screened, extracted data, and assessed for bias using Joanna Briggs Institute appraisal tools independently.
The main outcomes were availability (WHO target of 80%), cost (compared to median price ratio (MPR)) andaffordability (number of days of work of the lowest paid government employee to pay for one month oftreatment).
Results
Of the 4,742 identiﬁed studies, 29 met the inclusion criteria. They provided data from 60 LMICs. All studies
had a low risk of bias. 6/58 countries met the 80% availability target for short-acting beta-agonist agonists(SABA), 3/48 countries for inhaled corticosteroids (ICS) and 0/4 for inhaled corticosteroid-long-acting betaagonist combination (ICS-LABA). Costs were reported by 12 studies: the MPR range was 1.1-351 for SABA,
2.6-340 for ICS and 24 for ICS-LABA (1 study). Affordability was shown in 10 studies: supply for one month of
SABA inhalers cost around 1-4, ICS 2 7 and ICS-LABA at least 6 days of wages. The included studies showed
heterogeneity.
Conclusion
Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. Thiswas especially true for inhalers containing corticosteroids.

ABSTRACTPOSTER PRESENTATION

Recruitment of a TB and TB/HIV Co-infected participants in a cohort
study; Challenges and lessons learnt
Mr Paul Waiganjo¹, Asiko Ongaya¹, Geofrey Okallo¹, Janice Endsley², Evans Amukoye¹
Kenya Medical Research institute¹
University of Texas medical Branch, Galveston, Texas, USA²

Introduction
Tuberculosis (TB) and (HIV/AIDS) constitute the main burden of infectious diseases in resource-limited
countries. In Kenya the current co-infection ratio among the notiﬁed TB cases is 25.2%. The aim of this study
was to identify reasons associated with recruitment screening failure of a TB and TB/HIV co-infectedparticipants in a cohort study.
Methods
We conducted a cohort study involving recruitment of TB and TB/HIV co-infected participants from threeclinical sites in Nairobi, Kenya. Eligibility of participants to be recruited in the study was determined using a
structured pre-screening form detailing inclusion and exclusion criteria. Participants aged between 18yr and65yrs both male and female were screened. Data was analyzed using SPSS version 2-0. multivariate analysis
was done to determine the various factors associated with recruitment failure.
Results
A total of 875 TB and TB/HIV coinfected participants were prescreened for eligibility. It was found that395(45%) were screening failures with 480(55%) being recruited. Out of recruitment failures 273(69%) weremales while 122(31%) were females. Majority of screening failures were in the age groups 18-35 years
200(50.6%) with males constituting 142(35.9%) and females 58(14.7%). The age groups with age exclusion
and 35-65 years constituted 41(10.4%) and 154(39.0%) respectively. The main reasons contributing toscreening failure were prior history of Tuberculosis disease 68(17.2%), unwillingness to participate 75(19%),age exclusion 39(9.9%), other reasons identiﬁed were clinically unstable 18(4.6%), residing outside Nairobi
16(4.1%), Breast feeding and pregnant 12(3%). However, 119(30.1%) were reported to be screening failure
but the reason was not given. No signiﬁcant baseline predictors were identiﬁed in the multivariable model
dependent on gender or age group (p =0.521).
Conclusion
Although statistically signiﬁcance prior Tuberculosis history, Unwillingness to participate and age exclusion
were major reasons contributing screening failure in this TB and TB/HIV cohort study.

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