PATS & ReSoK Congress
7-10 June 2023

ABSTRACT
BOOK
Oral Presentations

ABSTRACTORAL PRESENTATION

Barriers to Accessing Successful Treatment of TB Infection Among
Male Adolescents and Young Adults: A Political Economy Analysis in
Kenya
Dr Leyla Abdullahi¹, Henry Komen¹, Irene Mbithi², Stephen Malupi², Kerry Millington³,
Jeremiah Chakaya², Eliya Zulu¹
African Institute for Development Policy (AFIDEP)¹
Respiratory Society of Kenya (ReSoK)²
Liverpool School of Tropical Medicine, Liverpool, United Kingdom³

Introduction
Tuberculosis (TB) is a serious public health issue in Kenya. In 2016, the WHO estimated there were 169,000
cases of TB in Kenya and 29,000 deaths (excluding deaths linked to HIV and TB coinfection), making TB the
fourth-leading cause of death in the country, with the highest cases being reported in men (WHO, 2016).
However, little is known on the incidence among Kenyan male adolescents and young adults and the barriers
to access successful treatment of TB infection. The study, therefore, conducted a problem-driven political
economy analysis to understand the barriers.
Methods
In Nov 2022, key informant interviews (n= 16) were conducted in Kenya with purposively selectedparticipants based on their position, knowledge of, and involvement in health policy formulation,dissemination, and implementation. The study utilized a framework analysis approach to analyze the data.
Results
The study found that most Kenyans, including males, focus on food and daily sustenance rather thanhealthcare since it has reached a point where it is a question of life or death. With up to 49% of TB patients
suffering from malnutrition, it has become one of the most severe co-morbidities. Among the 13000
healthcare establishments in the country, only 6000 of them treat TB patients. Out of those 6000, only 300
provide TB diagnosis services. The few facilities, worse in Arid and Semi-Arid Land (ASAL) areas, are only
open Monday through Friday from 8 AM to 5 PM, limiting casual laborers who only get permission during
weekends. Even though TB primarily affects males more than women, some implementing partners andinstitutions offer service delivery based on gender limiting access among men for service delivery. Anotherbarrier to access is the stigma surrounding tuberculosis which is hampering efforts to discover the missing
cases. Some communities still believe that TB is genetically inherited, a curse, associated with witchcraft,and TB patients are automatically HIV positive.
Conclusion
In conclusion, even though TB service providers have started attracting specialized personnel like social
scientists and health economics for health systems, much needs to be done to ensure the ﬁndings are
implemented accordingly.

ABSTRACTORAL PRESENTATION

Characteristics and phenotypes of a COPD patient cohort in Uganda
Dr Patricia Alupo¹, Levicatus Mugenyi², Winceslaus Katagiar¹, Alex Kayongo¹, Nalunjoji Joan¹,
Trishul Siddharthan³, John R Hurst⁴, Bruce Kirenga¹, Rupert Jones⁵
Makerere University Lung Institute¹
Makerere University Lung Institute; Medical Research Council²
University of Miami³
UCL Respiratory, University College London, London, Uk⁴
Plymouth Marjon University, Plymouth, Uk⁵

Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease with varied clinical andpathophysiologic characteristics. Although there is increasing evidence that COPD in low- and middleincome countries may have a different phenotype from that in high income countries, little is known about the
COPD patient phenotype in these settings. We describe the clinical characteristics and risk factor proﬁle of a
COPD population in Uganda.
Methods
We cross sectionally analyzed the baseline clinical characteristics of 323 COPD patients aged 30 years andabove who were attending two national referral outpatient facilities in Kampala, Uganda between July 2019and March 2021. Logistic regression was used to determine factors associated with spirometric disease
severity deﬁned according to GOLD stage (I & II vs III & IV).
Results
The median age was 62 years; 51.1% females; 93.5% scored CAT >10; 63.8% mMRC >2; 71.8% had wheezing;
16.7% were HIV positive; 20.4% had a history of pulmonary tuberculosis, 48.0% had a history of biomass
smoke exposure, and 50% had and eosinophilic count >3%. 51.7% had a history of 3 or more exacerbations in
the past year. Severity by GOLD stage was inversely related to older age, (aOR=0.95, 95%CI=0.92, 0.97), andobesity compared to underweight (aOR=0.25, 95%CI=0.07, 0.82).In regard to clinical factors, more severe
COPD was associated with SPO2<93% (aOR=3.79, 95%CI=2.05, 7.00), mMMRC≥2 (aOR=2.21, 95%CI=1.08,
4.53), and a history of severe exacerbations (aOR=2.64, 95%CI=1.32, 5.26).
Conclusion
COPD patients in this population had speciﬁc risk factor proﬁles and characteristics including HIV, history of
TB and biomass smoke exposure, meriting tailored preventative approaches. Severe disease wasassociated with low SPO2, history of severe exacerbations and high mMRC. Further studies are needed tobetter understand the pathophysiological mechanisms at play and the therapeutic implications of theseﬁndings

ABSTRACTORAL PRESENTATION

Implementing Of Active Case Finding Model The Case Of Oruba
Nursing And Maternity Private Facility
Ms Maren Akoth Aseno¹, Elijah Nyabwa¹, Peter Omware², Stella Omullo³, Winfred Mogusu⁴
Oruba nursing and maternity¹
Ministry of health²
Centre for health solution³
KCCB KARP-komesha Tb⁴

Introduction
Active case ﬁnding is a systematic identiﬁcation of presumptive TB cases from a predetermined target groupor population. In 2021, Oruba nursing and maternity reported a drop in TB cases notiﬁed by 19.4%. This wasdue to knowledge gaps amongst clinicians on active case ﬁnding, poor laboratory staff attitude towards
microscopy, persistent low access to gene expert due to commodity shortage a, poor contact managementof bacteriologically conﬁrmed cases and weak community facility linkage due to lack of community healthvolunteer’s knowledge on contact tracing.
Objectives
To increase number of TB cases diagnosed by 20%by December 2022
Methodology
This is a retrospective study comparing data collected from the facility TB patient register from 2020 before
full implementation of active case ﬁnding at the facility and 2022 during strict implementation of the above
intervention. The number of TB cases notiﬁed was analyzed per year.
Strategies employed were:
1. Two CME’s to sensitize facility staffs on active case ﬁnding to promote use of sputum analysis and use ofcontact management register.
2. Sensitizing three community health volunteers on screening, contact tracing and community facility
referrals of suspects.
3. Formation of active case ﬁnding committee.
4. Strengthening use of sputum microscopy through on job training (2 sessions)
5. Attaching a linkage assistant to help in screening for TB
6. Monthly data review meetings.
Results
In 2020 the facility notiﬁed 36 cases i.e. 31(86%) bacteriologically conﬁrmed and 5(14%) clinically diagnosed
TB cases
In 2021 the facility experienced a drop in Tb cases to 29 i.e. 25(86%) bacteriologically conﬁrmed and 4 (14%)
clinically diagnosed TB cases.
In 2022 after the above interventions the facility experienced an increase in the number of TB cases notiﬁed
to 47 (62%) cases i.e. 33 (70%) bacteriologically conﬁrmed and 14(30%) clinically diagnosed TB cases
Conclusion
With support private facilities can implement active case ﬁnding and contact tracing in facilities as a means
to increase TB cases diagnosed

ABSTRACTORAL PRESENTATION

Multiple overlapping risk factors for childhood wheeze among children
in Benin
Dr Euripide Frinel G. Avokpaho¹, Laure Gineau², Audrey Sabbagh², Eloic Atindégla¹, Arnauld Fiogbé³,
Sean Galagan⁴, Moudachirou Ibikounlé⁵, Achille Massougbodji¹, Judd L. Walson, Adrian J. F. Luty²,
André Garcia²
Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin¹
MERIT, IRD, Université Paris Cité, Paris, France²
Ministère de la Santé, Centre National Hospitalo-Universitaire de Pneumo- Phtisiologie, Cotonou, Bénin³
DeWorm3, University of Washington, Seattle, WA, USA⁴
Centre de Recherche Pour La Lutte Contre Les Maladies Infectieuses Tropicales (CReMIT/TIDRC),
Université d’Abomey-Calavi, Abomey-Calavi, Bénin⁵

Introduction
The African continent is currently facing an epidemiological transition characterized by a shift from
communicable to non-communicable diseases including allergies and asthma. In that context, wheeze has
multiple potential contributory factors that could include some of the endemic helminth infections, as well as
environmental exposures, such as household air pollution. We sought to determine the relative importanceof these risk factors among children in Benin.
Methods
We included 964 children aged 6–14 years living in the commune of Comé, south–west Benin. All children
were participants in the longitudinal monitoring cohort of the DeWorm3 trial designed to evaluate multiple
rounds of community mass treatment with albendazole for interruption of the transmission of soiltransmitted helminths (STH). We used multivariate statistical modelling, controlling for covariates, toinvestigate associations between wheeze and exposure to household air pollution and to other potential
allergy-inducing factors, dietary intake and anthropometry, and STH infection status assessed at the
pretreatment baseline timepoint,
Results
The prevalence of wheezing history was 5.2%, of current wheezing was 4.6% and of severe wheezing was
3.1%, while STH infections were found in 5.6% of children. These proﬂes did not vary as a function of either
age or gender. Infection with Ascaris lumbricoides, but not hookworm species, was signifcantly associatedwith both current wheeze (adjusted Odds Ratio (aOR)=4.3; 95% CI [1.5–12.0]) and severe wheeze (aOR=9.2;
95% CI [3.1–27.8]). Signifcant positive associations with current wheeze, independent of each other and of
STH infection status, were also found for (i) use of open cookstoves (aOR=3.9; 95% CI [1.3–11.5]), (ii) use ofpalm cakes for fre lighting (aOR=3.4; 95% CI [1.1–9.9]), (iii) contact with domestic animals and/or rodents(aOR=2.5; 95% CI [1.1–6.0]), (iv) being overweight (aOR=9.7; 95% CI [1.7–55.9]).
Conclusion
Children infected with A. lumbricoides appear to be at elevated risk of wheeze. Deworming may be an
important intervention to reduce these symptoms. Improving cooking methods to reduce household air
pollution, modifying dietary habits to avoid overweight, and keeping animals out of the house are all
additional measures that could also contribute to reducing childrens’ risk of wheeze.

ABSTRACTORAL PRESENTATION

Assessment of Inhaler Technique Demonstration among Healthcare
Workers in Port Harcourt, Nigeria
Dr Chidiebere Adaku Chukwuma¹, Uchenna Onubogu², Joyce Okagua¹, Dabota Nengi Longjohn¹
Department of Paediatrics and Child Health, University of Port Harcourt Teaching Hospital, Rivers State¹
Department of Paediatrics and Child Health, Rivers State University Teaching Hospital²

Introduction
Pressurized metered dose inhalers (pMDIs) are the bedrock of asthma management. The effectiveness ofthe pMDI is dependent on proper use. Studies have shown that about 90% of asthmatics have poor inhaler
technique, as a result, healthcare professionals must know and teach proper pMDI technique as a key tool toimproving asthma outcomes. This study sought to assess inhaler technique instructions given by healthcare
workers to patients with asthma.
Methods
This study was carried out among doctors, nurses, and pharmacists who attended a workshop on asthma
care training in Port Harcourt, Nigeria, using an interviewer-administered questionnaire that assessed
stepwise instructions and demonstrations given by healthcare workers on how to use a pMDI.
Results
Majority of the respondents where doctors 43(71.7%), while nurses and pharmacists comprised 14(23.3%)
and 3(5%) respectively. There were more female health workers (F: M = 1.7:1). Most healthcare workers had
been practicing for at least 10 years 40(66.7%), knew what a pMDI was 59(98.3%); about two-third 38(63.3%)
had instructed a patient on how to use a PMDI. One respondent, a doctor, that had been practicing for 10 <15yrs, did not know what a pMDI was.
An average of 34.3±20.1% of the instructions in assessing inhaler technique were correctly given by the
respondents. Most of the health workers 59(98.3%) correctly demonstrated the ﬁrst step in using an inhaler,which is taking off the cap and holding the canister upright. The steps that were less frequently
communicated were, the correct position of the head, to tilt it slightly backward 8(13.3%), followed by,
emptying the lungs by exhaling before taking a puff 9(15.0%) and holding the breath for at least 5- 10seconds
after removing the canister from the mouth 10(16.7%).
Conclusion
The quality of instructions and demonstrations given by healthcare workers for pMDI use is suboptimal. This
would directly lead to poor inhaler techniques in patients and poor asthma outcomes. With the call to close
the gap in asthma care, especially in low-middle- income countries, there is a need to train healthcare workers
on proper inhaler techniques, to enable them teach their patients and improve asthma management
outcomes.

ABSTRACTORAL PRESENTATION

Preterm birth, birth weight, infant weight gain and their associations
with childhood asthma and lung function: a study in Kenya
Prof Graham Devereux¹, Evans Amukoye², Jeremiah Chakaya², Richard Kiplimo², Maia Lesosky¹,
Kevin Mortimer³, Amos Ndombi², Fred Orina², Lindsey Zurba⁴, Hellen Meme²
Liverpool School of Tropical Medicine¹
Kenya Medical Research Institute²
University of Cambridge³
Education for Health Africa, Durban, South Africa⁴

Introduction
In sub-Saharan Africa, there is a high prevalence of asthma and high rates of obstructive and restrictive lungfunction deﬁcits. In high income countries, associations between early life parameters and childhood
asthma and lung function have played important roles in highlighting the importance of early life factors in
the aetiology of asthma and lung function life course. In sub-Saharan Africa a few studies have provided
fragmentary, contradictory results. We present here the most comprehensive investigation to date in subSaharan Africa, of early life parameters in relation to childhood respiratory symptoms and lung function.
Methods
Children attending schools in two contrasting areas of Nairobi, Kenya were recruited to a cross-sectional
study of childhood asthma and lung function (Tupumue). Questionnaires quantiﬁed respiratory symptoms
and environmental exposures; lung function was measured by spirometry; parents were invited to bring theMaternal and Child Health (MCH) Booklet containing records of birth weight and serial weights during
infancy.
Results
2373 children participated, 52% girls, median age (interquartile range), 10 years (8-13). Spirometry data wereavailable for 1622. 500 parents provided MCH Booklets and birth weight and infant weight gain data wereavailable for 323 and 494 children, respectively. In multivariate analyses, preterm birth was associated with‘recent wheeze’; odds ratio 1.64, (95% conﬁdence interval 1.03, 2.62), p=0.038; ‘trouble breathing’ 3.18 (95%
CI 2.27, 4.45), p<0.001; ‘dry irritant nocturnal cough 2.36 (95% CI 1.63, 3.41), p<0.001. Birth weight (kg) was
associated with FEV1 z-score, regression coeﬃcient β 0.30 (95% CI 0.08, 0.52), p=0.008, FVC z-score 0.29
(95% CI 0.08, 0.51), p=0.008 and restricted spirometry, odds ratio 0.11 (95% CI 0.02, 0.78), p=0.027. An
association between infant weight gain (kg/month) and FEV1/FVC z-score β -0.61 (95% CI -1.23, 0.01), wasborderline signiﬁcant p=0.053.
Conclusion
For the ﬁrst time in a sub-Saharan setting, associations have been identiﬁed in a single study between
childhood respiratory symptoms and preterm birth and between childhood lung function and birth weightand infant weight gain. These associations are consistent with those reported in high income countries andhighlight early life factors in the aetiology of asthma and lung function abnormalities in sub-Saharan Africa.

ABSTRACTORAL PRESENTATION

Allergic asthma phenotype among Nigerians: towards personalizedcare
Dr Ogochukwu Ekete¹, Tochukwu Ayo-Olagunju¹, Obianuju B Ozoh¹
Department of Medicine, Lagos University Teaching Hospital, Idi-Araba, Lagos Nigeria¹

Introduction
Asthma management, particularly for severe asthma, is transitioning towards personalized care. Allergic
phenotype is characterized by sensitivity to aeroallergens on skin prick testing (SPT) or elevated serum IgE.
The proportion of Nigerians with allergic asthma has not been extensively reported. This is needed fortreatment priority setting.
The aim of the study is to determine the proportion and pattern of allergen sensitization on SPT among
Nigerians with asthma.
Methods
A retrospective review of SPT for persons with diagnosed asthma in Lagos. The allergens tested were grassmix (GM), Bermuda grass (BG), Dermatophagoides pteronyssinus (DP), Dermatophagoides farinae (DF),Aspergillus fumigatus (AF), German Cockroach (GC), Dog Dander (DD), Blomia tropicalis (BT) and Alternaria
alternata (AA). A positive test was considered as a reaction ≥3mm. We report the frequency of positive tests
and considered the presence of one positive test as allergic asthma
Results
Two hundred tests were analyzed for 90 (45%) males and 110 (55%) females. Their age ranged between 4 101 years, the median age was 39 years (IQR 27-51). Forty-six (23%) had concomitant allergic rhinitis. One
hundred and sixty-three (81.5%) had a positive reaction to at least one allergen, 71(35.5%) and 68 (34%) had apositive reaction to 2-3 and >4 allergens respectively. The pattern of allergen sensitivity is as follows: DP
131/200 (65.5%), DF 129/199 (64.8%), German cockroach 99/199 (49.7%), BT 33/89 (37.1%), AF 52/200(26%), Grass mix 40/187 (21.4%), DD 25/125 (20%), AA 9/89 (10.1%), and BG 11/136 (8.1%). There was nodifference in the frequency of allergic sensitization when categorized by age, sex, and presence ofconcomitant allergic rhinitis.
Conclusion
Most asthmatics referred for SPT had allergic asthma and indoor allergens (dust mites, cockroaches, andfungi) were the most common sensitizers. This result provides preliminary guidance towards treatment, but
further studies are needed because a clinical suspicion of allergy may be the indication for these tests.

ABSTRACTORAL PRESENTATION

Delay in seeking healthcare for children less than ﬁve years withsevere pneumonia in Mulago tertiary care hospital, Uganda
Dr Phiona Ekyaruhanga¹, Rebecca Nantanda¹, Hellen Tukamuhebwa Aanyu², John Mukisa³,
Judith Amutuhaire Ssemasaazi⁴, Joseph Rujumba⁵
Makerere University Lung Institute, College of Health Sciences¹
Mulago National Referral Hospital²
Department of microbiology, Makerere University College of Health Sciences³
Department of Epidemiology, Makerere University College of Health Sciences⁴
Department of Paediatrics, Makerere University College of Health Sciences⁵

Introduction
Over 95% of pneumonia-associated deaths in children occur in low-income countries and this is partly due todelayed healthcare seeking. Data on factors associated with delays in seeking care for children withpneumonia in Uganda is scarce.
The study aimed to determine the prevalence, describe the factors associated with delay, and barriers andfacilitators of prompt healthcare seeking for children under ﬁve years with severe pneumonia.
Methods
A mixed methods cross-sectional study was conducted among 384 caregivers of children with severe
pneumonia at Mulago National Referral hospital (MNRH). Quantitative data was collected using structured
questionnaires and qualitative data through focus group discussions with caregivers. Logistic regression
analysis was used to determine the factors that were associated with delay in seeking healthcare. Content
thematic analysis was used to analyze for barriers and facilitators to health care seeking.
Results
The prevalence of delay in seeking healthcare was 53.6% (95% CI: 48.6-58.6). Long distance to the hospital(AOR = 1.94, 95% CI 1.22–3.01, p =0.003), ﬁrst seeking care in pharmacies and drug shops (AOR = 3.33, 95%
CI 1.85–6.01, p =0.001), and monthly income 28USD (AOR = 2.27,95% CI 1.33–3.86, p =0.003) wereindependently associated with delay in seeking healthcare. Limited knowledge of symptoms, delayed
referrals, self-medication, and low level of education were barriers to prompt healthcare seeking while
recognition of the severity of symptoms, support from spouses, and availability of money for transport were
key facilitators of early healthcare seeking.
Conclusion
More than half of the caregivers delayed seeking healthcare for their children with severe pneumonia. Long
distance to the hospital, delayed referral, family income, education level of caregiver, recognition ofsymptoms and their severity as well as family support inﬂuence prompt healthcare seeking.
Research in effective interventions to improve prompt healthcare seeking for children with severe
pneumonia is recommended.

ABSTRACTORAL PRESENTATION

Surviving a minimal invasive program in a developing country
Dr Hussein Elkhayat¹, Mahmoud², Kareem³
Assiut University, Egypt¹
Sallam²
Hosny³Introduction
It was always an aphorism and advise not to change a winning horse. But who look in depth in history willrealize that no horse is winning forever and that every time frame has its own winners as there is no place forthe myth of winning all the time. In medicine it is the same, once upon a time it was the collapse therapy was
the winning horse for TB treatment then with the discovery of anti-tuberculous drugs it becomes obsolete.
The examples are uncountable in surgery. minimal invasive approaches are of increase use nowadays inevery surgical speciality. yet, some argue that it is not possible for developing countries owing to the nature ofdiseases present and the cost that render it ineffective.
we investigate the results of a VATS program in a sub-urban center in a developing country during the last 10
years.
Methods
this is a retrospective observational study conducted in Assiut University, CardioThoracic Surgery
Department in Assiut, Egypt. we enroll all patients that underwent VATS procedure for therapeutic anddiagnostic intends in the last 10 years. we collect the data regarding total number of VATS cases incomparison to open surgery cases, rate of conversion, mortality and need for another operation after VATS
procedure.
Results
during the last 10 years since the developing of VATS program in our center in 2012, we operate upon morethan 500 cases using VATS approach. since 2016, 97.7% of all cases were done using uniportal VATS
technique which was adopted after Prof.Gonzalez workshop in February 2016 in our center. the rate ofconversion from VATS to open surgery was 11.2% then reduced to 8% then raise up to 20% during the last 3
years reﬂecting change in patients selection criteria and learning curve of surgical team. there was no
Intraoperative mortality in our series.
Conclusion
VATS is a winning horse of todays thoracic surgical approaches. learning curve and implementation of VATS
program in a developing country with limited resources can be achieved with good overall results to patientsand surgeonsABSTRACTORAL PRESENTATION

Uniportal thoracoscopic decortication: using SAFE approach "startaway from empyema approach”
Dr Hussein Elkhayat¹
Assiut University, Egypt¹

Introduction
Video-assisted thoracoscopic surgery (VATS) is now a gold standard in treating early-stage empyema, whilemuch debate still exists considering the effectiveness of this approach for late-stage empyema. Most
concerns arise from the crowded rib cage, narrow working space, and ability to free trapped lungs quickly,
mainly if uniportal VATS is used. However, unlike uniportal VATS lobectomy, there is no consensus aboutstandard steps for uniportal VATS decortication to ensure smooth and effective surgery. We try to offer
standard, easy-to-replicate steps for this approach to evaluate the eﬃcacy and safety of the “start away from
empyema” approach for uniportal VATS decortication in the management of stage II and III empyema.
Methods
A prospective case series study has been conducted on 25 patients. All patients with stage II and III
empyema were admitted to the Cardiothoracic Surgery Department between October 2017 and March 2020.
VATS procedure was done under general anesthesia by a double-lumen tube for selective ventilation.
Demographic data, preoperative diagnosis, intraoperative ﬁndings, hospital stay, and complications wererecorded.
Results
Twenty-ﬁve patients were enrolled in this study with a median age of 35 years. The duration of illness ranged
between 14 and 60 days, with a median (IQR) of 25 (17) days. In (88%) of the patients, there was a successful
outcome deﬁned as a near-complete resolution on Chest X-ray (scoring of 3 or 4) and chest US (scoring of 2or 3). Only three (12%) patients had a partially successful outcome. All patients with partial success sufferedfrom infection associated with malignant effusion.
Conclusion“Start away from empyema” approach for uniportal VATS decortication in stage II and III empyema could besafe and effective in treating loculated nonmalignant pleural effusion.

ABSTRACTORAL PRESENTATION

Giant Mediastinal ganglioneuroma in a Female Child
Prof Yasser Elsayed¹, Mohamed fathy, Mohamed Salem, Alai Eisa, Ashraf Enaet, Kerolos Emad,
Bothina Abdelhaseeb, Mona Atef
Military Medical Academy¹Introduction
Gangioneuromas are rare benign neurgenic tumors which arises from neural crest cells that represents theﬁnal maturation stag of neuroblasts [1]. The incidence of ganglioneuoma was reported to be 1 in 1,000,000
and thought to develop de Nov rather than by maturation of existing neuroblastoma [2]. There are no known
risk factors, however the tumours may be associated genetic problems, such as neuroﬁbromatosis type 1 [3].
Ganglioneuromas are commonly classiﬁed as paediatric mediastinal tumours occurring in females morethan males with a ratio about 3: 1 [4]. Most of the cases are asymptomatic and usually discovered
accidentally.
Methods
Surgical resection of the tumour was performed by a team of thoracic and neurosurgery via right slanderedpostero-lateral thoracotomy in the ﬁfth space. During surgery the tumour was found to be well encapsulatedwith ﬁrm consistency, well circumscribed not invading any nearby structures. Due to the huge size of thetumour, it was resected in two pieces.
Results
well improvement post operative.
Conclusion
From this case presentation we concluded that mediastinal ganglioneuroma is a rare nerogenic tumor that
may be asymptomatic or produce vague symptoms in spite of having a huge size. Mediastinal
glanglioneuroma can be diagnosed pathological preoperative by using CT guided needle biopsy. Surgicalresection is mandatory to relieve symptoms and avoid the extremely rare possibility of transformation tomalignant form.

ABSTRACTORAL PRESENTATION

Predictors of Tuberculosis Treatment Outcomes in Public and Private
Health Institutions, Southeast, Nigeria; An Implication for Policy
Implementation, Patient Centered Education and Treatment Follow-Up
Dr Nelson Chibueze Eze¹, Dr Benedict Ndubueze Azuogu², Dr Adaoha Pearl Agu²
Federal Ministry of Health Abuja¹
Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria²

Introduction
Although Tuberculosis treatment centres exist in Nigeria, information on tuberculosis treatment outcomes
and their predictors especially in private health facilities are poorly documented in most places. This study
therefore evaluated predictors of tuberculosis treatment outcomes in public and private health institutions in
Abakaliki, Southeast Nigeria.
Methods
A retrospective study of patients managed for tuberculosis in the two facilities over a ﬁve year period (Jan2018 to December 2022). All patients that have completed treatment over the study period were enrolled.
Relevant information from the case register was retrieved and entered into proforma and study forms.
Tuberculosis treatment outcomes were evaluated according to World Health Organization (WHO) andNational Tuberculosis and Leprosy Control Program (NTBLCP) guidelines
Results
A total of 522 and 732 Tb clients were enrolled in AE-FUTHA and M-4H and their mean ages were 45.3±7.2
years and 46.1±3.8 years in AE-FUTHA and M-4H respectively. Majority (84%) were new cases with treatment
success rate of 82.6% in both facilities (431/522 in AE-FUTHA and 605/732 in M-4H). Treatment outcome
showed that relapse, treatment failure and death were 1.5%, 1.0% and 4.6% respectively in AE-FUTHA, 1.4%,
1.2% and 6.4% respectively in M-4H with default averaging 10% in both facilities. Age (15-29), far distance tohealth facility (>5km) and Tb category (re-treatment) were predictors of poor Tb treatment outcome in AEFUTHA while area of residence (rural), far distance to health facility (>5km) and Tb category (re-treatment)
were predictors of poor Tb treatment outcome in M-4H.
Conclusion
The patients were mostly males with twice (1.6%) DRTb than the females. Although treatment success rate
(82.6%) was close to the 85% WHO bench mark, there were still large pockets of default with similar
predictors of poor treatment outcomes in both facilities. Young people may need to be monitored closely
while on TB treatment to ensure improved treatment outcome. Defaulter rate can be reduced by patientcentered education and counseling, follow-up reminder system, effective contact tracing, and referral tosupport group. Decentralization of treatment centres to rural areas would further reduce defaulter rate.
Key Words: Tuberculosis; Predictors; Treatment outcome; Patient; Education; Follow-up; policy
implementation

ABSTRACTORAL PRESENTATION

Lung function trajectories in South African children with pulmonary
TB: a prospective study
Dr Diane Gray¹, Leah Githinji² ³, Kirsty Brittain² ³, Zoe Franckling-Smith² ³, Lindy Bateman² ³,
Margaretha Prins² ³, Cynthia B Baard² ³, Mark Nicol⁴ ⁵, Lesley Workman² ³, Heather J Zar² ³
Department of Paediatrics and Child Health and MRC Unit on Child and Adolescent Health, University of Cape Town,
South Africa¹
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital²
SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa³
Marshall Centre for Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth,
Australia⁴
Division of Medical Microbiology and Institute for Infectious Diseases and Molecular Medicine, University of Cape Town,
Cape Town, South Africa⁵

Introduction
Post-tuberculosis lung disease is increasingly recognised in adults. There are little data in children, despite ahigh burden of TB disease. We aimed to investigate the impact of childhood pulmonary tuberculosis (PTB) on
lung function.
Methods
A longitudinal prospective study of children <15years, with suspected PTB. Children were classiﬁed as
conﬁrmed (microbiologically proven), unconﬁrmed (clinical diagnosis), or unlikely PTB (non-PTB lower
respiratory tract illness (LRTI)) according to NIH consensus deﬁnitions. Spirometry was done at baseline, 1, 3
months in all, and in addition at 6 and 12 months in conﬁrmed and unconﬁrmed PTB.
Results
152 children with at least 1 successful spirometry test from September 2015-August 2022 were included: 62(41%) conﬁrmed PTB, 61 (40%) unconﬁrmed PTB and 29 (19%) with non-PTB-LRTI. Median (IQR) age was
10.1 (7.5, 11.5) years; 51% were male and 10% were living with HIV. At enrolment, 76% had abnormal
spirometry, with restrictive disease most common. Spirometry [forced expiratory volume in 1 sec z-score (zFEV1); forced vital capacity z-score (z-FVC)] improved in all groups over time. However, in conﬁrmed PTB, zFEV1/FVC decreased by 3 months [from 0.2 (-0.5, 1.4) to -0.4 (-1.1, 0.5)], and remained low through 12months. In contrast to children with conﬁrmed PTB, those with unconﬁrmed disease had steady
improvements in z-FEV1 and z-FVC to 12 months. Risk factors for lower
lung function included older age, female sex and nutritional impairment.
Conclusion
Children with conﬁrmed PTB had reduced lung function over 12 months. Childhood PTB may set a
developmental pathway of lung impairment through life.

ABSTRACTORAL PRESENTATIONInterventions to reduce outdoor air pollution and its impact on asthma
outcome: A systematic review
Dr Sbekezelo Hlophe¹, Dr Reratilwe Mphahlele¹, Prof Kevin Mortimer¹ ², Prof Reﬁloe Masekela¹
University of KwaZulu Natal¹
University of Cambridge²

Introduction
Asthma is one of the most common chronic diseases in children and adults. Exposure to air pollutants canlead to asthma symptoms, exacerbations, and hospitalizations. This systematic review was conducted tocollate data on studies of outdoor air pollution exposure reduction and asthma outcomes.
Methods
We identiﬁed studies from CENTRAL, EBSCOHost, PubMed, Science Direct, Scopus, and Web of Science,
articles written in English published in the 10 years up to 31 March 2022. We included randomised (RCT) andnon-randomised studies that investigated the effects of individual-level outdoor air pollution reduction
interventions on asthma outcomes: symptoms control (asthma control test (ACT), childhood ACT (c-ACT),
asthma exacerbations, forced expiratory volume in one second (FEV1) and ratio of forced expiratory volume
in one second to forced vital capacity (FVC).
Results
Seven studies (one RCT) met the inclusion criteria. Participants' ages ranged from 0 to 65+ years, and theduration of studies ranged from 8 weeks to 9 years. All studies were at risk of bias, as there was no blinding,most had no active intervention and there was lack of clarity on participants selection in some studies.
In one study, 50% of patients reported better symptoms, ACT ≥20 improved post intervention 41.1% to 60.7%
whereas the other reported mean (SD) ACT increase from 20.0 (2.4) at baseline to 21.5 (2.3) after
intervention. For the children who began with ACT or c-ACT score of less than 20, there was signiﬁcant
improvement and a mean difference of 3 and 4 points, respectively. There was a reduction number of daily
asthma admissions, mean 4 vs 2.8 admissions, p < 0.001. Asthma-related emergency department visits
reduced by 25%. Lung function test changes varied from none to greater changes in FVC and FEV1. Due to thediversity of study designs we could not do meta-analyses.
Conclusion
We found few studies of outdoor air pollution reduction interventions on asthma outcomes despite theimportance of this topic. The studies we did ﬁnd had several methodological limitations, but some indicatedpotentially beneﬁcial effects of the intervention. This ﬁeld would beneﬁt from further high quality RCTevidence to inform policy and decision making.

ABSTRACTORAL PRESENTATIONThe Utility of Clinician-Performed Cardiopulmonary UltrasoundAssessment of the Acutely Breathless Patient: Breathlessness Early
Detection with Ultrasound (BED-US) StudyDr Jacqueline Wanjiku Kagima¹, Hellen Karimi Meme², Ingeborg Welters³, Ben Morton⁴,
Jamie Rylance⁵
Kenyatta National Hospital¹
Kenya Medical Research Institute, Centre for Respiratory Disease Research, Nairobi, Kenya²
Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom³
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom⁴
Lung Health Group, Malawi-Liverpool-Wellcome Programme (MLW), Blantyre, Malawi⁵

Introduction
Breathlessness is frequently a diagnostic challenge, being the primary manifestation of disparate
pathological entities including cardiopulmonary, haematological and neuromuscular diseases. Clinicalsigns similarly variable limiting precision in treatment decisions without further investigations. A
cardiopulmonary, clinician-performed point-of-care ultrasound (PoCUS) scan provides rapid imaging tosupport clinical decision-making. The aim of this study was to determine if information gained by PoCUS
supported or changed clinical decision pathways in a busy Emergency unit in a low income country.
Methods
A prospective cohort study was conducted at the accident and emergency department of the Kenyatta
National Hospital (KNH), Nairobi, Kenya, between May 2019 and March 2021. Convenience sampling of 212
acutely breathless patients was conducted in parallel with purposive sampling of the attending doctors withclinical responsibility for care of the recruited patients. Patients were scanned using PoCUS, by a blindedstudy physician according to the modiﬁed Rapid Assessment of Dyspnoea with Ultrasound (RADiUS)
protocol. The results were provided to the treating physician and patients followed up for 72 hours.
Results
The patients in the study were young; median age of 48 years (IQR; 34-65), with a slight female
preponderance 50.7% (107/212). The majority of patients 93.4% (198/212) had grade 3 or 4 according to themodiﬁed Medical Research Council (mMRC) dyspnoea scale. Abnormal cardiac scans were present in 78.6%(162/206) of patients and abnormal lung and doppler scans in 83% (174/211). Cardiovascular comorbidities
were common, with hypertension the most common at 36.6% (78/212). Pleural effusion was the mostcommon cardiopulmonary abnormality noted, 61% (129/211), followed by alveolar interstitial syndrome in
53.5% (113/211). Overall, PoCUS changed the leading diagnosis in 36.3% of cases. PoCUS increased pleural
effusion as the primary diagnosis from 6.9% (14/204) to 14.7% (30/204) (p=0.031). Uncertainty in the
primary diagnosis: “Other” was reduced from 19.6% (40/204) to. 9.3% (19/204) (p=0.002). Clinician reported
conﬁdence improved on a 10-point visual analogue scale (VAS) score by a mean(95%CI) of 1.05 (0.88,1.22)
with the addition of the PoCUS information.
Conclusion
The provision of PoCUS results to clinicians in an emergency department in a low income setting
substantially improved the diagnostic certainty and clinician conﬁdence. Combining a basic lung andcardiac PoCUS into a syndromic “dyspnoea” algorithm, has the potential to elucidate the primary causes of
respiratory distress which are potentially rectiﬁable and also to improve patient outcomes by improved
diagnostic certainty especially pleural disease and reducing the number of uncertain aetiologies ofdyspnoea.

ABSTRACTORAL PRESENTATION

Going AGILE (Adapt, Grow, Innovate, Lean-in and Execute); project
management lessons learned from the Nairobi 2022 TB Prevalence
SurveyDr Cheryl Kerama¹, Sarah Mulera², Ann Kiplimo², David Horne³, Jane Ong'ang'o²
CRDR-KEMRI/UW¹
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
Tuberculosis (TB)is a public health problem of global concern. In 2022, the World Health Organization Global
Task Force on TB Impact Measurement convened to update expert guidance on conduct of TB prevalence
surveys. It asserts that an update to the practice of prevalence surveys is required; to reﬂect all theexperience and lessons learned from surveys implemented in the past 15 years. The Lime Book is considered
the Holy Grail of TB prevalence surveys. However, culture and context speciﬁc project execution lessons
learned are lacking making it diﬃcult for researchers to learn from best practices and pitfalls of
predecessors. We aim to present lessons learned from the aspect of project management of a TB prevalence
survey in a resource-limited setting.
Methods
Observation and documentation were used to record the best practices and pitfalls during the crosssectional study designed Nairobi 2022 TB Prevalence Survey conducted between April to December 2022 in
Nairobi, Kenya.
Results
Best practices included; initiation phase; early stakeholder engagement a year prior with the national TB
program, bureau of statistics, chiefs, and community leaders. Community entry meetings quell study
rumours especially chief’s baraza. Security arrangements are required in advance for the safety of theequipment and staff. Village elder engagement for mobilization is required in addition to the community
health volunteers (CHVs) to gain trust of the community. Procurement and cost management; bulk
purchasing and negotiating ﬁxed cost contracts to mitigate budget expansion is necessary. Serialization of
MFS invitation cards to track ﬁeld interviewer assignment, digital listing tracking to prevent going above
sample size.
Conclusion
Knowledge management is a critical aspect of project management. Robust documentation andmanagement of a lessons learned repository will form an important part of the pillar on analysis and use of
TB surveillance and survey data at country level. Culture and context speciﬁc information in terms of project
initiation, planning, execution, monitoring and evaluation as well as closure is needed. Focusedincorporation of this aspect in future projects on TB prevalence surveys will make them more eﬃcient byleveraging on predecessor data.

ABSTRACTORAL PRESENTATION

Chronic respiratory disease is common in HIV infected children andadolescents in long-term care in Nairobi, and is associated with air
pollution exposure.
Prof Elizabeth Maleche-Obimbo¹, Engi Attia², Walter Jaoko³, Fredrick N Were⁴,
Stephen M Graham⁵
Department of Paediatrics, University of Nairobi & Kenyatta National Hospital, Kenya¹
Department of Pulmonology and Critical Care, University of Washington, USA²
Department of Medical Microbiology & Immunology, University of Nairobi³
Department of Paediatrics, University of Nairobi⁴
Department of Paediatrics, University of Melbourne, Australia⁵

Introduction
Children and adolescents living with HIV (CAHIV) in resource limited settings may experience recurrent andsevere respiratory disease and are at risk of residual lung damage. We sought to determine the prevalence
and clinical presentation of chronic respiratory morbidity among CAHIV in longterm care at a tertiary referral
hospital in Nairobi.
Methods
We conducted a cross-sectional study among HIV infected children and adolescents age <19 years actively
in care at the Kenyatta National Hospital comprehensive care clinic. Parental/guardian consent and assent
was obtained as appropriate, sociodemographic and clinical information were obtained through interview
and review of their medical records, physical examination relevant to respiratory disease, and exercise
testing (six-minute walk test).
Results
We enrolled 320 CAHIV, they were of median age 13 years (IQR 10-16), 46% were female, 61% lived in housesof 1-2 rooms, 50% used unclean cooking fuel most of the time, and 58% had high exposure to outdoor air
pollution from high vehicle traﬃc or combustion activities near their home or school. All were on
antiretroviral therapy, 11% had low CD4 count, and 79% were virologically suppressed 90th centile for age),
6% had ﬁnger clubbing, lowest oxygen saturation at rest was 95%, and 7% experienced oxygen desaturationof 3% or more during exercise testing. High exposure to outdoor air pollution was associated with higher
burden of chronic respiratory morbidity (OR 3.31, p=0.032). Households of children who had chronic
respiratory morbidity were less likely to use polluting cooking fuel indoors (OR 0.26, p=0.003).
Conclusion
More than half of the CAHIV in our care had chronic respiratory symptoms the most common clinicalpresentation being breathlessness, cough and tachypnoea at rest, and outdoor air pollution is an associatedrisk factor. Structured interventions are needed to provide optimal care speciﬁc to their needs.

ABSTRACTORAL PRESENTATION

Latent Trajectory Modelling of longitudinal clinical data: An application
to birth cohort study in the Western Region of The Gambia
Ms Nicola Marozva¹, Brenda Kwambana-Adams², Fatima Ceesay³, Rowan Bancroft²,
Modupeh Betts², Ellen Sambou³, Abdul Khalie Muhammad⁴, Archibald Worwui³, Maia Lesosky⁵,
Robert Heyderman²
University of Cape Town¹
NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London,
London, United Kingdom²
Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara,
The Gambia³
Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town,
South Africa⁴
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom⁵

Introduction
Mixed effects models and Generalized estimation equations are the most frequently adopted approaches
for analysing complex multivariate longitudinal data. However, these methods are not concerned withcategorising participants with similar patterns. More recently, the focus of modelling such data has moved
towards using person-centered statistical approaches such as Latent Growth Mixture models which allows
identiﬁcation of heterogeneity within a population. We aimed to use this approach to investigate whether
distinct developmental trajectories of pneumococcal carriage, which remains high among Gambian infants,
are present from birth through early childhood among PCV13 vaccinated Gambian infants.
Methods
PCV13 vaccinated rural Gambian children were followed up at regular intervals from birth to two years.
Pneumococcal carriage development trajectories were characterised using latent growth mixture model.
Generalised linear mixed effects model was then used to investigate the association between early life
predictors and trajectories identiﬁed
Results
Among 120 children with 1646 observations, a model with two distinct trajectories, persistently high (N=42;35%) and low trajectory (n = 78; 65%) ﬁt the data signiﬁcantly better than other models (p= 0.004). Exposure
to biomass smoke (OR 3.5, 95% CI: 1.05 – 8.35) and inﬂammation (OR 1.19, 95% CI: 1.01 – 2.81) wereidentiﬁed as risk factors for high pneumococcal carriage trajectory.
Conclusion
A distinct group of participants demonstrates a persistently high pneumococcal carriage that may partly beestablished at birth. Reduction of smoke exposure for these participants might reduce the risk of infections
such as pneumonia

ABSTRACTORAL PRESENTATIONDiversity of indoor fungi and associated respiratory disorders in
Nairobi and Busia Counties, Kenya
Ms Olga M Mashedi¹, Bridgit Kimani², Christine Bii², Takashi Yaguchi³, Sheila Okoth⁴Centre for Respiratory Diseases Research- KEMRI¹
kenya Medical Research Institute²
Medical Mycology Center Chiba Japan³
University of Nairobi⁴

Introduction
Poor sanitation and environmental pollution are major contributors to the development of respiratory tract
infections (RTIs) in most African cities. RTIs are globally responsible for one-third of infectious
diseases–accounting for 4.3 million annual deaths. Although fungi are known RTI pathogens, theircontribution and true infection burden remain unknown in Africa. However, invasive fungal infections areassociated with high mortality rates for the diseases. Fungi cause allergies that affect the upper and lower
respiratory tract, eyes, intestinal tract, and skin, yet, public awareness and information on indoor fungicontamination and potential health implications associated with exposure to fungi in Kenya’s urban
residential homes are limited. Furthermore, no studies have been steered to determine the biodiversity offungi mycoﬂora and their distribution in those locations.
Methods
This was a cross-sectional study conducted between January 2018 and December-2020. Residential Units
from Nairobi and Busia Counties were selected based on a systematic sampling method. Questionnaires
were administered to the occupants of the selected households with key components on Demographic,
House and Environmental Characteristics. Fungal exposure and assessments of the households wereconducted using sedimentary sampling methods. Fungal identiﬁcation was done by direct microscopy andmorphological features
Results
A total of 740 fungal species were isolated from 220 selected households. The ﬁndings and their prevalence
followes Actinomycetes 47/740(6.4%), Rhodotorula 80/740(10.8%), Mucor 38/740(5.1%), Aspergillus
ﬂavus 48/740 (6.5%), Aspergillus fumigatus 14/740(1.9%), Aspergillus niger 45/740 (6.1%),whitefungi 30/740 (4.1%), Penicillium137/740(18.5%), Trichoderma 16/740(2.2%), Alternaria spp 33/740 (4.5%),
Fusarium 63/740(8.5%), fungi 67/740, (9.1%) and white yeasts 94/740 (12.7%) respectively. More than half
(121; 55.0%) of the households had between>5 occupants, with mean age of 39 years. Ninety (40.9%)
respondents have a member in their household who has allergies, asthma, and bronchitis. (185; 84.9%) of thehomes that were infested with rats, 192 (87.3%) had cockroaches, and ants, whereas, 104 (47.3%) homes
had either feathered pets. The use of Biomass fuel was observed in (143; 66.8%), Poor ventilation anddampness were reported in147 (67%) of the homes.
Conclusion
There is a vast distribution of fungi in households within Nairobi and Busia Counties in Kenya.There is a needfor increased public awareness and target effort to minimize the burden to reduce the associated respiratory
disorders

ABSTRACTORAL PRESENTATION

Tupumue: a study of asthma, lung function and air pollution exposuresin schoolchildren in an informal (slum) settlement and a more aﬄuentarea of Nairobi
Dr Hellen Meme¹, Fred Orina², Lindsay Zurba³, Evans Amukoye², Cindy M Gray⁴, Sarah E West⁸,
Cressida Bowyer⁶, Maia Lesosky⁷, Jeremiah Chakaya², Kevin Mortimer⁸ ⁹, Graham Devereux⁷
Kenya Medical Research Institute¹
Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya²
Education for Health Africa, Durban, South Africa³
School of Social and Political Sciences, University of Glasgow, Glasgow, Uk⁴
Stockholm Environment Institute, Department of Environment and Geography, University of York, York, Uk⁵
Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, Uk⁶
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, Uk⁷
Department of Medicine, University of Cambridge, Cambridge, Uk⁸
School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa⁹

Introduction
Although one billion people live in informal settlements (also known as slums), the consequences forrespiratory health of living in these settlements remain largely unknown. An unanswered question is whether
the 350-500 million children living in informal settlements are at increased risk of asthma, the commonestchildhood non-communicable disease. The aim of the Tupumue (Kiswahili let us breathe) study was todetermine whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma
and to identify pertinent environmental exposures.
Methods
Children attending schools selected at random in Mukuru (a large informal settlement in Nairobi) and themore aﬄuent residential area of Buruburu were compared. Questionnaires quantiﬁed respiratory symptoms
and environmental exposures; lung function was measured; personal exposure to particulate matter(PM2.5) was measured in a subset and used to estimate exposure for all participating children.
Results
2373 children participated, 1277 in Mukuru (median, interquartile range, age 11, 9-13 years, 53% girls), and1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less aﬄuent homes and had
greater exposures to air pollution sources. Estimated PM2.5 exposures were higher in Mukuru (median
39µg/m³, IQR 35-43) than in Buruburu (median 22µg/m³, 20–25), p<0.001. When compared with Buruburu
schoolchildren, Mukuru schoolchildren had a greater prevalence of the symptoms, ‘recent wheeze’ (9.5% vs
6.4%, p=0.007) and ‘trouble breathing’ (16.3% vs 12.6%, p=0.01), and these symptoms were more severe(sleep disrupted by wheeze, 6.9% vs 4.2%, p=0.005) and problematic. Diagnosed asthma was more common
in Buruburu schoolchildren (2.8% vs 1.2%, p=0.004). There were no differences in lung function between
Mukuru and Buruburu schoolchildren. In multivariate analyses, signiﬁcant adverse associations wereobserved with self-reported exposure to ‘vapours, dusts, gases, fumes’ (‘wheeze’, ‘trouble breathing’), use of
mosquito coils (‘wheeze’), adult smoker(s) in the home (‘trouble breathing’), and living <500m from a majorroad (‘trouble breathing’).
Conclusion
Children living in informal settlements are more likely to develop symptoms consistent with asthma that are
more severe but less likely to be diagnosed as asthma. Self-reported, but not objectively measured, exposure
to air pollution was associated with this increased risk.

ABSTRACTORAL PRESENTATION

Chronic respiratory disease in adult out-patients in three Africancountries: a cross sectional study
Ms Barbara Miheso¹, Amsalu Bekele Binegdie², Asma El Sony³, Tewodros Haile², Rashid Osma³,
Lindsay Zurba⁴, Maia Lesosky⁵, Peter J Burney⁶, Kevin Mortimer⁷, Hellen Meme⁸, Graham Devereux⁷
Kenya Medical Research Institute¹
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis
Ababa University, Ethiopia²
Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Sudan³
Education for Health Africa, Durban, South Africa⁴
Division of Epidemiology Biostatistics, School of Public Health & Family Medicine, University of Cape Town,
South Africa⁵
National Heart and Lung Institute, Imperial College London, Uk⁶
Liverpool school of Tropical Medicine, Uk⁷
Centre for Respiratory Diseases, Kenyan Medical Research Institute (KEMRI), Kenya⁸

Introduction
The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent
population-based studies reporting substantial levels of obstructive and restrictive lung function. Less isknown about the characteristics of patients with chronic respiratory diseases attending out-patient clinics.
The main objective of this study was to characterize the common chronic respiratory diseases encounteredin hospital outpatient clinics in three African countries.
Methods
This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8weeks) attending hospital outpatient departments in Addis Ababa, Ethiopia, Nairobi, Kenya and Khartoum,
Sudan. TB was excluded on clinical grounds and negative GeneXpert test. Patients were assessed using a
respiratory questionnaire, spirometry and chest radiography. The diagnoses of the reviewing clinicians wereascertained.
Results
A total of 519 patients (209 Kenya, 170 Ethiopia, 140 Sudan) participated; the mean age was 45.2 years (SD16.2); 53% were women, 83% had never smoked. Reviewing clinicians considered that 36% (95% conﬁdence
interval [CI] 32–40) of patients had asthma, 25% (95% CI 21–29) had chronic bronchitis, 8% (95% CI 6–11)
chronic obstructive pulmonary disease (COPD), 5% (95% CI 4–8) bronchiectasis and 4% (95% CI 3–6) postTB lung disease.
Symptoms consistent with asthma (wheeze in the last year) were reported by 71% (66-74%), being highest in
Ethiopia (92%, 87-95%) and lowest in Sudan (56%, 48-65%). 15% (9.8-22%) of patients had normal spirometryin Ethiopia, 38% (29-48%) in Sudan and 48% (29-56%) in Kenya. Spirometry consistent with COPD waspresent in 35% (95% CI 30–39). Restrictive spirometry was evident in 38% (33-43%), however there wasusually concomitant ﬁxed airﬂow obstruction. Pure restriction was present in 17% (14-21%) and notassociated with an excess of symptoms.
Conclusion
In Ethiopia, Kenya and Sudan, asthma, COPD and chronic bronchitis account for the majority of diagnoses in
non-TB patients with chronic respiratory symptoms. The suboptimal diagnosis of these conditions will
require the widespread use of spirometry. Studies to identify the clinical burden of chronic respiratory
diseases in other African countries are required.

ABSTRACTORAL PRESENTATION

Assessment and associated factors of respiratory health-related
quality of life of drug susceptible and multi-drug resistant pulmonary
tuberculosis survivors from two Nigerian centers
Dr Jibril Mohammed¹, Daniel Agbo Onazi², Mohamed El-Mustafa³, Patrick de Marie C. Katoto⁴
Department of Physiotherapy, Bayero University, Kano, Nigeria¹
Department of Anesthesia, Jos University Teaching Hospital, Plateau State, Nigeria²
Department of Pharmacology, Faculty of Pharmacy, University of Gezira, Sudan³
Department of Medicine and Center for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch
University, Cape Town, South Africa⁴

Introduction
Pulmonary Tuberculosis (PTB) is a common infection affecting millions of adults especially in low- andmiddle-income countries, with Nigeria being one of the high burden countries. Multi-drug resistanttuberculosis (MDR-TB) is characterized by a long (18-24 months) and costly treatment and associated highmorbidity rates. This study aimed to asses and report on associated factors of respiratory health-related
quality of life of drug susceptible and multi-drug resistant pulmonary tuberculosis survivors from two
Nigerian centers.
Methods
One hundred and ten (110) participants comprising 43 post-susceptible-TB, 45 MDR-TB and 22 age/gendermatched healthy controls were recruited to participate in this study from TB centers in Kano (Infectious
Disease Hospital) and Plateau (Jos University Teaching Hospital) states using contact information fromtreatment registers. Their sociodemographic characteristics comprising age, sex, BMI, occupation,socioeconomic status was measured using standard measures. Respiratory health related quality of life wasmeasured using the Saint George’s respiratory Questionnaire (SGRQ), which was scored from 1-100 points.
Both descriptive and inferential (linear regression) statistics was utilized in analyzing the data obtain using
SPSS v23 software, with alpha probability signiﬁcant at 0.05 level.
Results
The mean age, height, weight and BMI of the study participants were 34.5 9.4 years, 1.65 0.1m, 61.3 11.5kg
and 21.9 6.4 kg/m2, respectively. Majority of the participants were males (61.8%). The results of the study
revealed that the total score on the SGRQ values for post-susceptible- TB, MDR-TB and healthy controls were
30.6 ,28.77, 32.3 ,24.83 and 5.3 ,8.55 points, respectively. One-way ANOVA indicated that SGRQ scores ofsurvivors of both drug susceptible TB and MDR-TB were comparable, and were signiﬁcantly higher than thatof healthy controls (p=0.001). Furthermore, linear regression analyses revealed that none of thesociodemographic variables of age, sex, BMI, occupation, socioeconomic status were signiﬁcantly
associated with respiratory health related quality of life of the study participants (R= 0.16, R2 = 0.028;
Beta;31.155; CI: -8.488 to 70.798; p=0.121).
Conclusion
It was concluded that survivors of drug susceptible TB and MDR-TB have a moderately impaired respiratory
health related quality of life, which was not inﬂuenced by sociodemographic variables.

ABSTRACTORAL PRESENTATION

Antibiotic Prophylaxis After Thoracic Drainage: Systematic or HabitualWithout Evidence?
Dr Gourti Mouad¹, Makloul Mouhsine², Ammor Fatim Zahra², Maidi Elmehdi¹
Medical University of Agadir, Medical Center of Agadir, Morroco¹
Medical Center of Agadir, Morroco²

Introduction
Some surgical procedures are considered risky and therefore require antibiotic therapy that is not considerednecessary by some teams. Therefore, these prescriptions depend on the attitude of each team, the ecologyof the care service, the immunological proﬁle of the patient as well as his antecedents. Our study focuses on
the prescription of antibiotics after thoracic drainage and its interest in the prevention of infection.
Methods
This is a retrospective descriptive study of all cases that required thoracic drainage in the surgicaldepartment of our hospital and done by the same doctor in the same room and with the same aseptic
attitudes. A clinical, biological and radiological follow-up was controlled by the same doctor and validated bya professor of the service. Purulent pleurisy and penetrating thoracic trauma were excluded from the study
as they require a systematic prescription of antibiotic therapy according to the service protocols.
Results
163 cases were included in the study and divided into 2 groups. 100 patients received antibiotic therapy and asecond group of 60 patients did not receive antibiotics. 18 patients were found to have complicated postchest drainage infection including homolateral pneumonia (7), drainage site infection (4), atelectasis (4),generalized infection (5), elevated Crp (9), purulent pleurisy (4). 95% of the patients beneﬁted from daily
physical therapy and the majority of the patients beneﬁted from daily dressing changes. The follow-up of all
patients was good and the mortality was nil.
Conclusion
Post-opérative infection is multifactorial and the prescription of any antibiotic therapy must depend on
several elements.

ABSTRACTORAL PRESENTATION

Catastrophic health expenditure, social protection coverage, andﬁnancial coping strategies amongst adults with symptoms of chronic
respiratory diseases in Kenya: a cross-sectional study
Dr Stephen Mulupi¹ ², Caroline Waithera², Ewan M Tomeny³, Uzochukwu Egere³, Hellen Meme²,
Beatrice Kirubi⁴, Jeremiah Chakaya⁵, Edwine Barasa², Miriam Taegtmeyer⁶, Tom Wingﬁeld³ ⁶
Liverpool School of Tropical Medicine, Department of International Public Health¹
KEMRI- Centre for Respiratory Diseases Research²
Liverpool School of Tropical Medicine, Department of Clinical Sciences³
WHO Collaborating Centre for Tuberculosis and Social Medicine, Stockholm, Sweden⁴
Respiratory Society of Kenya⁵
Liverpool School of Tropical Medicine, Department of International Public Health⁶

Introduction
Despite the socioeconomic consequences of an increasing chronic respiratory disease (CRD) burden, there
is limited evidence on catastrophic health expenditure (CHE) amongst people with CRD symptoms in Kenya.
Methods
We conducted a cross-sectional survey of 296 consecutively-recruited adults with CRD symptoms at ﬁvepublic healthcare facilities in Kenya, collecting data on patient costs, National Health Insurance Fund (NHIF)
coverage, and ﬁnancial coping strategies. CHE prevalence was calculated using World Health Organizationthresholds: direct “out-of-pocket” costs >10% of a household’s monthly total expenditure (“10%-threshold”);
and direct costs >40% of a household’s monthly “capacity to pay” (non-food/rent/leisure/amenities
expenditure; “40%-threshold”). Multivariable logistic regression analyses generated adjusted odds ratios(aOR) with 95% conﬁdence intervals (95%CI) of factors associated with CHE.
Results
Mean direct medical costs, non-medical costs, and lost income contributed 47%, 27% and 26% of total costs,
respectively. Most participants (212/296, 72%) lacked NHIF and 95% (282/296) used coping strategies
during care-seeking. At 10%- and 40%-thresholds, 73/296 (25%) and 153/296 (52%) experienced CHE.
Belonging to the poorest quintile (aOR 4.1, 95%CI=1.1-15) and seeking care at a subcounty (aOR 8.9,
95%CI=3.2-25) or county (aOR 29, 95%CI=8.2-101) hospital were associated with CHE at 10%-threshold.
Being female (aOR 2.2, 95%CI=1.2-4.2), belonging to the poorest quintile (aOR 2.5, 95%CI=1.0-6.0), andseeking care at a subcounty hospital (aOR 2.3, 95%CI=1.1-4.5) were associated with CHE at 40%-threshold.
Conclusion
These ﬁndings suggest a sizeable burden of CHE amongst people seeking care for CRD symptoms in Kenya,
driven by gender and socioeconomic inequalities and impaired healthcare access.

ABSTRACTORAL PRESENTATIONClinical Characteristics And Outcomes Of Covid 19 Pneumonia
Patients On High Flow Oxygen Delivery Systems In Nairobi: A
Retrospective StudyDr Derrick Nyaga Mutiga¹, Marybeth C. Maritim², Eugene Genga², Jackline Kagima³, Patrick Olang⁴
Avenue Hospital Parklands, University Of Nairobi¹
Department Of Clinical Medicine And Therapeutics, University Of Nairobi²
Kenyatta National Hospital³
Department Of Anesthesiology, University Of Nairobi⁴

Introduction
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) is a novel virus that has caused a global
pandemic leading to increased hospitalization and increased need for critical care and mechanicalventilation. As at 16th January 2023 more than 342,000 cases and more than 5,600 deaths were reported in
Kenya. There is limited research and data on clinical characteristics and outcomes of patients with COVID-19
requiring high ﬂow oxygen systems. The aim of this study was to describe the clinical characteristics andoutcomes of critical COVID 19 pneumonia patients requiring high ﬂow oxygen delivery system admitted in
the critical care unit of Avenue hospital Parklands COVID isolation unit between 01 April 2020 and 01 April
2022
Methods
This was a retrospective cohort study among SARS-CoV2 conﬁrmed patients requiring high ﬂow oxygen
delivery systems. The study area was Avenue Hospital Parklands records department. Data was extracted
from the patients’ records and was checked for completeness then entered, cleaned and analyzed using
Statistical Package for Social Sciences (SPSS) version 26. Categorical data was summarized as frequencies
and percentages while Continuous data was described as medians.
Results: A total of 131 patients’ records were included in this study. Male patients were 66% and median age was 57
years. Hypertension (52%) and diabetes (44%) were the commonest co-morbidities. Key laboratory andchest imaging ﬁndings included reduced PO2/FIO2 ratio (100%), elevated C-reactive protein (99%),
lymphopenia (75%), elevated D-dimers levels (74%), elevated aspartate transaminase (63%) and high CT
severity scores (100%).The median duration from onset of symptoms and initiation of mechanicalventilation was 7 days. All patients received steroids and prophylactic low molecular weight heparin. Other
medications used included remdesivir (61%), tocilizumab (57%) and baricitinib (44%). All patients were put
on mechanical ventilation with majority being put on non-invasive ventilation (NIV) (81%). The median lengthof ICU stay was 6 days and longer stay was associated with increased complications. The overall mortality ofpatients with critical COVID-19 pneumonia was 50%
Conclusion
Critical COVID-19 disease was more prevalent in male, older patients with associated pre-existing condition
and mortality in critical COVID-19 disease was high (50%).

ABSTRACTORAL PRESENTATION

Prevalence and factors associated with smoking in Uganda
Dr Joanitah Nalunjogi¹, Frank Mugabe², Winters Muttamba¹, Patricia Alupo¹, Bruce Kirenga¹
Makerere University Lung Institute (MLI), Kampala, Uganda¹
Ministry of Health, Kampala, Uganda²Introduction
Smoking is a major risk factor for the development of lung health diseases worldwide including Tuberculosis,
Lung Cancer and Obstructive Pulmonary diseases. Globally there is an increase in the number of people withlung health diseases with trends increasing annually. Smoking has been noted to decrease annually but at
not the expected rates despite efforts to address it. Worldwide, smoking prevalence is 19.9% with a higher
prevalence recorded among European countries;29.4% compared to African nations; 9.8%. The prevalenceof smoking in Uganda is estimated at 15.1% from the Uganda Non-Communicable diseases risk factors
survey conducted in 2014. Knowledge of the burden of smoking and progress made by efforts to combat
smoking aids in planning for intensiﬁed low-cost smoking cessation programs to accelerate the eradicationof smoking and hence improve lung health. Therefore, we set out to determine the prevalence of smoking in
Uganda and its associated factors.
Methods
We conducted a cross-sectional review of the data obtained from the Uganda National Tuberculosis
Prevalence Survey (UTPS) between 2014– 2015 among individuals 15 years and above. The UTPS set out todetermine the prevalence of tuberculosis and associated factors in Uganda. We analyzed 41,148 records onage, sex, residence, level of education, occupation, marital status and smoking.
Results
The prevalence of smoking in Uganda is 13.9%. The signiﬁcant factors associated with smoking include; age
with OR 2.12, 3.23, 3.91,4.48,5.10 across age groups (25-34, 35-44, 45-54,55-64 and 65+ years), female sex;
OR 0.21, marital status OR; married (0.83), separated (1.31), divorced (1.46), widowed (1.39), urban
residence OR (1.20), education OR;0.60 and employment OR; civil service (1.15), health worker (0.57),
student (0.24), farming (1.15), skilled labour (1.12)
Conclusion
The prevalence of smoking in Uganda is 13.9%. The signiﬁcant factors associated with smoking include; age
with OR 2.12, 3.23, 3.91,4.48,5.10 across age groups (25-34, 35-44, 45-54,55-64 and 65+ years), female sex;
OR 0.21, marital status OR; married (0.83), separated (1.31), divorced (1.46), widowed (1.39), urban
residence OR (1.20), education OR;0.60 and employment OR; civil service (1.15), health worker (0.57),
student (0.24), farming (1.15), skilled labour (1.12)

ABSTRACTORAL PRESENTATION

Challenges in optimizing CASS procedures in a resource limited setup; acase of the KEMRI-CRDR laboratory
Mr Lenis Kalvin Munene Njagi¹, Videlis Nduba¹, Wilfred Murithi¹, Zipporah Mwongera¹,
Robi Chacha¹, Thomas Hawn², David Horne²
Kenya Medical Research Institute¹
University of Washington²

Introduction
Cough aerosol sampling system (CASS) has shown promise as a tool for tuberculosis (TB) diagnosis inresource-limited settings. However, optimizing CASS procedures in these settings can be challenging due tovarious factors such as limited resources, lack of technical expertise, patient characteristics, andinadequate infrastructure.
Objective
To identify and discuss the challenges encountered in optimizing CASS procedures for TB diagnosis in aresource-limited setup.
Methods
A review of literature was conducted to identify the challenges encountered in optimizing CASS proceduresin resource-limited settings. The literature search included peer-reviewed articles, conference proceedings,
and technical reports.
Results
The challenges encountered in optimizing CASS procedures in a resource-limited setup include equipment
procurement, technical expertise, quality control, standardization of procedures, data management, andsustainability. Inadequate resources can make it diﬃcult to procure and maintain the necessary equipment,
and the lack of technical expertise can affect the accuracy and reliability of CASS results. Quality control andstandardization of procedures are also essential to ensure the accuracy and reproducibility of CASS results.
Data management and sustainability are also critical factors to consider in optimizing CASS procedures.
Patient characteristics also morph into the matrix and lack of proper understanding of the procedure canlead to poor performance and outputs.
To overcome these challenges, some possible solutions include building local capacity through training andcapacity building, collaboration with external partners, establishing quality control measures, using
standardized procedures, increasing the study participant knowhow of the process through proper
explanations and visual aids and incorporating digital technologies for data management.
Conclusion
Optimizing CASS procedures in a resource-limited setup is essential for improving TB diagnosis in thesesettings. The challenges encountered in optimizing CASS procedures can be addressed by building local
capacity, establishing quality control measures, and incorporating digital technologies for data
management as well as increasing study participant knowhow of the process.

ABSTRACTORAL PRESENTATION

Laboratory Challenges in Conducting TB Prevalence Survey in
Post -COVID pandemic Recovery Era: The Nairobi 2022 TB Prevalence
Survey Experience
Mr Erick Nyadimo¹, Cheryl Kerama¹, Martha Njoroge¹, Valentine Mibei¹, Ann Waweru¹, David Horne²,
Jane Ong'ang'o¹
Center for Respiratory Diseases Research, Kenya Medical Research Institute¹
University of Washington, Division of Pulmonary and Critical Care and Sleep Medicine. Seattle-Washington, USA²

Introduction
The COVID-19 pandemic either reversed, stalled, or lagged access to TB treatment and diagnosis thus
worsening the burden of TB disease. According to the WHO 2022 TB report, about 10.6 million people
experienced TB infection indicating a 4.5% global increase and 1.6 million TB deaths occurred. Conﬁrmationof TB cases is in the ideal situation based on laboratory analysis; thus, mitigating risks in the laboratories ofinterest is essential. This study aimed at presenting laboratory challenges experienced while conducting a
TB prevalence survey in the post- COVID-19 pandemic recovery era.
Methods
An observational technique was employed to identify and report on the laboratory challenges experienced
while conducting the Nairobi 2022 TB prevalence survey which tested sputum samples from nine clusters in
Nairobi, Kenya.
Results
The major challenges experienced included: inadequate laboratory infrastructure; power outages, process
disruption due to shared lab equipment. Supply chain; delayed supply of essential reagents andconsumables due to global stockout and regulations; the limited number of staff trained in biosafety level III
containment laboratory limiting access to the laboratory; some participants declined sample collection
limiting analysis of all presumptive cases; a two-fold increase in the number of initially projected samples
impacting procurement plans and budget; and the unavailability of a backup laboratory within the study
locality made the unplanned transition of processing tedious. Most of these challenges were successfully
addressed hence reducing their signiﬁcant impacts on the survey outcomes.
Conclusion
There was delayed TB diagnosis predominantly due to supply chain problems, expansion of the study budget,and missed diagnosis of some suspected cases due to decline to produce sputum. A thorough prospective
analysis and a supplementary budget to mitigate unplanned challenges are necessary for prevalence
surveys. Our experienced factors can be used to guide other researchers from low- resource settings on thefundamental issues to be addressed while conducting laboratory-based prevalence survey. This will
enhance the development of quality systems that support medical research input and can be easily
reconstructed in other low- and low middle-income research settings.

ABSTRACTORAL PRESENTATION

Factors Associated with Treatment Delays at DOTS Centers inSouth-West Nigeria
Dr Olatunde Olayanju¹, Idemudia Otaigbe², Kolawole Sodeinde², Olumide Abiodun²,
Akindele Adebiyi²
Babcock University Teaching Hospital, Nigeria¹
Medical Microbiology Department, Ben Carson College of Health and Medical Sciences, Babcock University, Ilisan,Nigeria²

Introduction
Delays in the diagnosis and treatment of tuberculosis can increase the spread of the disease in communities;
this is a potential threat to all efforts at ending the disease. The aim of this study is to determine factors
responsible for late presentation and treatment commencement in patients with tuberculosis.
Methods
This was a cross-sectional study conducted in three different primary health care centers in Ibadan, Nigeria.
Participants were newly diagnosed patients with pulmonary tuberculosis. Their clinical and demographic
data were obtained using a standardized questionnaire to determine factors associated with delays atpresenting in the hospital and obtaining diagnosis. Delays were deﬁned according to the National
Tuberculosis Control Program. The questionnaire was administered by a trained research nurse. Data
regarding patient-related factors and those regarding health system related factors were obtained from allparticipating patients.
Results
A total of 135 patients were recruited for this study, and 68 (50.4%) of them were males. The majority (60.7%)of them were young-aged (25-44 years) while about one-ﬁfth were middle-aged (45-59 years). Almost 70% of
the respondents lived in high-density areas and about 84.6% had received drug prescriptions from nondoctors prior to presentation. Patients’ socio-economic status (p=0.006), type of residential area (p=0.015),
current cigarette smoking status (p=0.016) and seeking treatment elsewhere before presentation (p=0.037)
showed signiﬁcant associations with duration between symptom onset and presentation at the facility. At
the level of the health system, socio-economic characteristics (p=0.006) and seeking treatment elsewhereprior to presentation (p=0.024) showed signiﬁcant associations with duration from presentation in thefacility to sputum collection. There was also a statistically signiﬁcant association between area of residence
and the duration from sputum collection to availability of result (p=0.001) and the duration from presentationin the facility and commencement of anti-tuberculosis medication.
Conclusion
This study showed that there were delays in seeking care and establishing diagnosis of pulmonary
tuberculosis. Associated factors for the delays were socioeconomic factors, area of residence, cigarettesmoking and seeking care elsewhere before presentation. These factors should be considered in policy
formulation towards the global effort at ending tuberculosis.

ABSTRACTORAL PRESENTATION

Assessment of Factors that Affect Diagnosis and Management ofChildhood Tuberculosis Among Healthcare Workers in Siaya County,
Kenya
Dr Felix Oloo¹
Maseno University and Siaya County Department of Health¹

Introduction
Tuberculosis (TB), is the 9th leading cause of death worldwide from a single infectious agent. It ranked above
HIV&AIDS causing 205,000 deaths among children in 2019. An estimated 1.1 million (11%) of TB cases in2018 occurred among children (<15). Kenya ranked 10th globally and 4th in Sub-Saharan Africa of the 30 TB
High-burden Countries that accounted for 87% of all global TB cases. Accurate and prompt diagnosis ofchildhood TB is essential for treatment success by Healthcare Workers (HCWs). This relies on thoroughassessment of evidence from history of exposure, clinical examination and laboratory investigations byskilled HCWs. Establishing the childhood TB burden is challenging due to lack of standard case deﬁnition
that requires positive sputum smear, varied clinical presentation in this age group and inconclusive deﬁnitive
diagnosis. This study aimed at investigating factors affecting diagnosis and management of childhood TB
among HCWs.
Methods
This cross-sectional study utilized mixed methods approach. Purposive sampling was used to select 18
health facilities. Simple random sampling was used to select 241 HCWs. Quantitative data was analyzed
using inferential statistics and 2 test of association was used to determine associations between variables,
while qualitative data was analyzed based on emerging thematic areas.
Results
HCW’s current levels of knowledge on childhood TB diagnosis and management was associated with ability
to conduct Directly Observed Treatment (DOT; χ2 13.240, p<0.001), current employer (χ2 4.246, p=0.041) andattendance of lecture/workshop on childhood TB in the past 12 months (χ2 6.671, p=0.013). Additionally,
facility-based factors were associated with HCW’s knowledge on WHO 2010 mg/kg recommended daily
therapy dosage for ﬁrst-line anti-TB drugs (χ2 18.770, p<0.001), availability of chest radiography (χ2 26.772,
p<0.001) and attendance of lectures and seminars/workshops (χ2 4.872, p=0.032). Furthermore, majority(n=192; 80%) of HCWs identiﬁed constraints to diagnosis and management of childhood TB as drug
management (n=46; 24%), procurement (n=71; 37%) and stock-outs and dosing (n=75; 39%)./Conclusion
Levels of knowledge, facility-bas/////ed factors and constraints inﬂuenced HCW’s ability to diagnose andmanage childhood TB. Training HCWs to conduct DOT, investment in chest radiography and resolving
constraints of drug management, procurement and stock-outs across health facilities was recommended.

ABSTRACTORAL PRESENTATION

Cytokine proﬁle of a TB and TB/HIV co-infected cohort in Kenya
Ms Asiko Ongaya¹, Pascah Bulia¹, Paul Mwangi¹, Dorcas Wanjiru¹, Robi Chacha¹, Jeremiah Kyalo¹,
Yazmin Martinez-Martinez², Megan Files³, Matthew B Huante², Dr. Evans Amukoye¹,
Dr. Janice Endsley²
Kenya Medical Research Institute¹
University of Texas Medical Branch, Galveston, Texas²
University of Washington Seattle³

Introduction
TB/HIV co-infections complexities including those on anti-retroviral therapy (ART), present challenges on
efforts to reduce both infections. Cytokines produced by T-lymphocytes play a role in susceptibility and reinfection to TB. Purpose of this study was to understand how HIV and ART status affects recovery of Th celleffector function and cytokine proﬁle in a TB and TB/HIV cohort on TB treatment.
Methods
A prospective study of TB participants who are either HIV-infected or HIV-uninfected from 3 clinical sites in
Nairobi, Kenya. Blood samples were taken at start of and on completion of TB treatment from 6 groups ofparticipants; Group A (TB-HIV-), B (TB-HIV+ART+), C (TB-HIV+ART-), D (TB+HIV-), E (TB+HIV+ART+), F(TB+HIV+ART-). Cytokine bead array (CBA) was used to assess human Th cell-derived cytokines isolated
from plasma from Nil, TB1 and Mitogen QuantiFERON tubes, including; IL-5, IL-2, IL-6, IL-13, IL-4, IL-9, IL-10, IL17A, IL-17F, IL-22, IFN-γ and TNF-α. CBA is a bead-based immunoassay used to quantify multiple analytes insamples using a ﬂow cytometer. A total of 380 samples were analyzed.
Results
Between no TB and TB groups; There was signiﬁcant changes seen in TNF-α, IL-5, IL-2, IL-13, IL-4, IL-17A and
IL-17F. Slight signiﬁcant changes was seen in IL-6, IL-22 and IFN-γ. No signiﬁcant change was seen in IL-9.
Results show reduced plasma IL-9, IFN-γ and IL-22 activation by mitogen in TB+HIV+ subjects that is
independent of ART status, while IL-17A is moderately reduced in TB+HIV+ART- participants. Cytokine recall
to TB1 antigen was observed to be similar across all TB groups, with the exception that a moderate reductionof IFN-γ and IL-17A was observed in the TB-HIV+ group.
Conclusion
Results identify defects in effector cytokines produced by Th cells that may persist after ART and contributeto poorer TB treatment outcomes in participants with HIV. Increase in T-lymphocyte activation already foundin HIV patients, TB disease can have an impact on viral replication. Functional cytokine status of Th cell
populations, including Th17 and Th22 cells, may differ during TB drug treatment. To understand thesecomplexities, the proﬁle of immune activation markers in TB patients needs to be continuously explored.

ABSTRACTORAL PRESENTATIONHow effective is the primary COVID-19 vaccine series against the
Omicron variant over time? Findings from a rapid living systematic
evidence synthesis and meta-analysis
Ms Comfort Sanuade¹ ² ³, Nana Wu¹ ², Keven Joyal-Desmarais¹ ², Paula A B Ribeiro¹,
Ariany Marques Vieira¹ ², Jovana Stojanovic¹ ⁴, Mohit Jagwani¹, Doro Yip¹, Simon L. Bacon¹ ²
Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Montreal, Canada¹
Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Canada²
Department of Physiotherapy, University of Ibadan, Nigeria³
Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada⁴

Introduction
The Omicron variant of COVID-19 has had an important impact on global systems, including Africa’s
healthcare system. COVID-19 vaccines have become the primary method for most governments to limit
COVID-19 hospitalisations and mortality. However, studies suggest that the effectiveness of the vaccines
may wane over time. Thus, it is essential to understand the long-term Vaccine Effectiveness (VE) of COVID19 vaccines to make evidence-informed decisions on whether and when to administer booster doses.
Therefore, we aimed to synthesise evidence on the long-term VE of the primary series (e.g., 2 doses of a 2dose regimen) of four COVID-19 vaccines (BNT162b2, mRNA-1273, ChAdOx1/AZD1222, and Ad26.COV2.S)against Omicron infections, hospitalisations, and mortality.
Methods
Every month, we conducted a rapid living review of studies reporting VE at baseline (0-6 weeks) and at least
16 weeks (follow-up) after a primary series. Single reviewers evaluated titles, abstracts and full-texts, andextracted data, with a second reviewer verifying at each stage. We pooled VE estimates using three-levelmeta-analytic models. The last update was 22nd February 2023. We used thresholds from the World HealthOrganization (WHO) to evaluate the adequacy of protection against infections (VE ≥ 70%, with a lower 95% CI≥ 50%) and hospitalizations/deaths (VE ≥ 90%, with a lower 95% CI ≥ 70%).
Results
We included 22 studies. For infections, VE estimates across vaccine types declined from 62% [95% CI: 5369%] at baseline to 1% [-23 - 25%] at 40-44 weeks. Similarly, hospitalisation estimates declined from 79% [6886%] at baseline to 60% [41-73%] at 24-28 weeks. These patterns of decline over time were statisticallysigniﬁcant. We had too few studies on mortality to synthesise meta-analytically.
Conclusion
Based on the WHO thresholds, baseline levels of VE for the primary series were insuﬃcient against Omicron
infections and hospitalisations, and declined further over time. Thus, there is a continued need for behaviourbased COVID-19 prevention measures like mask-wearing and isolating when infected, especially among
vulnerable individuals, to achieve global containment of the effects of COVID-19.

ABSTRACTORAL PRESENTATION

Quantifying personal exposure to air pollution among school children in
Nairobi: measurement data from homes, schools and outside spaces
Prof Sean Semple¹, Ruaraidh Dobson¹, Marsailidh Twigg², Ulli Dragosits², Clare Pearson²,
Miranda Loh³, Darpan Das³, Heather Price⁴, Fred Orina⁵, Hellen Meme⁵, Graham Devereux⁶
Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, Scotland¹
UK Centre for Ecology and Hydrology, Bush Estate, Penicuik, Midlothian EH26 0QB, UK²
Institute of Occupational Medicine, Research Avenue North Riccarton, Edinburgh EH14 4AP, UK³
Biological and Environmental Sciences, University of Stirling, Stirling, FK9 4LA, Uk⁴
Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya⁵
Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, Uk⁶

Introduction
Exposure to air pollutants such as ﬁne particulate matter (PM2.5) is common in low- and middle-income
country (LMIC) cities. Vehicle and industrial emissions, together with unrestricted burning of rubbish andemissions from burning solid or biomass fuel for cooking lead to PM2.5 concentrations many times higher
than the World Health Organisation (WHO) guidance limits. Children are particularly vulnerable to the effectsof this exposure. Most studies use ﬁxed-site data from a small number of sites to categorise exposure, but
the recent development of low-cost sensors provides the opportunity to gather data at a personal levelacross different microenvironments including homes, schools, and outdoor areas. This following study
aimed to use low-cost air quality monitors to quantify personal PM2.5 exposure of children attending schoolin two areas of Nairobi: an informal (slum) settlement (Mukuru) and a more aﬄuent residential area
(Buruburu).
Methods
PM2.5 concentrations were measured using PurpleAir PA-II-SD monitors attached to powerbanks. Data weregathered every 2 minutes for 24 hours in the homes of 179 children. Measurements were also gathered from18 schools, and along 41 routes where children walked to school. Time activity and questionnaire data werecombined with these measurements to estimate a 24-hour average exposure for each child.
Results
The median (and Inter-quartile range) 24-hour PM2.5 was 29 (18-46)µg/m³ with children attending school in
Mukuru experiencing close to double (38 (26-53)µg/m³)) the concentrations of those living in Buruburu (20(16-30)µg/m³)). The higher concentrations of PM2.5 experienced in Mukuru, can be attributed to greater
concentrations within homes and outdoors. PM2.5 concentrations in schools in both communities weresimilar (15 (13-18)µg/m³)) and provided the cleanest air that children breathed.dult smoker(s) in the home(‘trouble breathing’), and living <500m from a major road (‘trouble breathing’).
Conclusion
Children in Nairobi experience personal exposure to ﬁne particulate matter that is, typically, much greaterthan the current WHO PM2.5 24h guidance limit of 15µg/m³. Children from informal settlements are exposed
to signiﬁcantly higher (approximately double) concentrations of air pollution than children from more
aﬄuent areas of Nairobi. Low-cost sensors provide simple methods to gather data on air pollution across a
range of micro-environments and to compare intra-urban differences within cities in sub-Saharan Africa.

ABSTRACTORAL PRESENTATION“Asthma is a bully disease” – Experiences of patients with chronic lungdiseases when negotiating the health system in Cape Town Metro,
South Africa
Dr Marie Stolbrink¹ ², Chantel Streicher³, Khanyisa Mcimeli³, Brian Allwood², Kevin Mortimer⁴,
Martha Chinouya⁵
Clinical Sciences, Liverpool School of Tropical Medicine, United Kingdom¹
Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa²
Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa³
Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom⁴
Education Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom⁵

Introduction
Chronic respiratory diseases are common in Cape Town Metro, South Africa. Yet the experiences of how
adults with these diseases, such as asthma or COPD (chronic obstructive pulmonary disease), negotiate thehealth system are poorly understood. Qualitative methodology lends itself to investigate this gap.
Methods
Semi-structured interviews were conducted with purposively sampled adults who had attended public
hospitals with an exacerbation of asthma or COPD. The study was nested in the quantitative “Diagnosing
Airways Disease” study. Interviews followed a topic guide around receiving and understanding theirdiagnosis and treatment, behaviours during an acute ﬂare-up and impacts on daily life. Interviews wereconducted in Afrikaans, isiXhosa, or English, transcribed, and translated into English. They were analysedthematically until saturation was reached. Fully informed consent was gained. Ethical approval was given by
LSTM and SUN .
Results
32 interviews (16 in Afrikaans, 8 in isiXhosa, 8 in English) were completed in 2022. 17 women and 15 men
participated. Most participants were older than 50 years (25/32), and most were unemployed or retired(13/32 and 11/32 respectively).
The identiﬁed themes were causes of lung disease, delays in receiving a diagnosis, challenges in accessing
healthcare and having limited medicines. Causes included environmental aspects such as air pollution,
housing, and occupational exposures. Delays were inﬂuenced by self-treatment, restricted investigations,and limited time with health professionals. Challenges included crime, inaccessible ambulances, andexposure to respiratory pathogens in healthcare facilities. Many reported sharing medicines. Many paid
privately for medicines or services to overcome perceived shortcomings of the public system.
Conclusion
The identiﬁed themes were explored through the lens of “structural violence”, where “social structures stop
individuals, groups and societies from reaching their full potential” (Galtung, 1969). In Cape Town Metro such
structural elements may be scant healthcare professionals, insuﬃciently enforced policies on e.g., housing
or work-place exposures, poverty, crime, and limited government support. This made it diﬃcult for patients tosuccessfully navigate their illness experience and forced some to pay out of pocket to receive better care.

ABSTRACTORAL PRESENTATION

Predictive performance of race- and non-race-based Global Lung
Function (GLI) FEV1 equations among Nigerian children aged 6-11
years: a cross-sectional analysis
Dr Peter Ubuane¹, Ayodeji Olushola Akinola¹, Motunrayo Oluwabukola Adekunle¹,
Olufunke Adewumi Ajiboye², Barakat Adeola Animasahun¹ ³, Fidelis Olisamedua Njokanma¹ ³
Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria¹
Department of Physiotherapy, Chrisland University, Abeokuta, Ogun State, Nigeria²
Department of Paediatrics & Child Health, Lagos State University College of Medicine (LASUCOM), Ikeja, Lagos, Nigeria³

Introduction
The widely-used race-based Global Lung Initiative (GLI) spirometric reference equations (Caucasian,African, Asian and Mixed-ethnicity) are increasingly criticised as potentially perpetuating longstanding
systemic socio-economic deprivations/inequality; consequently, an additional non-race-based equation(Global) was developed. However, its performance in local populations needs to be evaluated before clinicaluse because of geographical variations in the socio-economic/nutritional, environmental and genetic
determinants of lung function.
Aims/objectives
As no previous study has evaluated this new global equation, we explore its ﬁt, along with that of other GLI
equations, to FEV1 data of Nigerian school-aged children.
Methods
Secondary analysis of FEV1 (measured with an electronic peak-ﬂow meter: Asma-1TM, Vitalograph, UK) andanthro-demographic data from a cross-sectional study of the functional capacity of healthy children in
Lagos, after excluding those with recent hospitalization or respiratory infections. FEV1 values wereconverted to z-scores using GLI calculator (http://gli-calculator.ersnet.org/index.html). Goodness-of-ﬁt wasdeﬁned as mean (SD) z-score of 1.645 Z-scores) and 5% below lower limits of normal (< 1.645 Z-scores).
Results
Data were available from 766 healthy children (46.9% boys) aged 6-11 years [mean (SD) age= 8.9(1.6) years]
from 14 primary schools, with 8.6%, 0.5%, 69.7% and 29.8% being stunted, wasted, normal-weight andoverweight/obese. The ﬁt of GLI equations were: Global [girls: -1.04 (0.97), 24.1%, 0.5%; boys: -0.87 (0.97),
19.8%, 1.7%); Caucasian [ girls: -1.31 (1.03), 78.4%, 0.5%; boys: -1.22 (1.05), 73.8%, 0.3%]; African-American[girls: -0.17 (1.10), 9.1%, 5.4%; boys: 0.03 (1.11), 7.2%, 7.5%]; North-eastern Asian [girls: -1.22 (1.06), 32.2%,
0.7%; boys: -1.43 (1.62), 42.9%, 3.9%]; South-eastern Asian [girls: -0.38 (1.10), 12.3%, 3.9%; boys: -0.53 (1.11),
14.5%, 3.1%] and Mixed [-0.79 (1.10), 19.7%, 2%; boys: -0.68 (1.11), 17.8%, 2.5%]. Fit was independent of
nutritional status.
Conclusion
The new global and Caucasian, Asian and mixed GLI equations over-estimated the FEV1 of these urbandwelling, predominantly well-/over-nourished Nigerian children. Only the African-American equation ﬁtted
both sexes, similar to Arigliani et al’s ﬁnding among children in northern Nigeria. Southeast Asian equation
ﬁtted only girls. Further determination of the best equation(s) for our population requires bench-marking of
FEV1 and other spirometric variables to disease outcomes.

ABSTRACTORAL PRESENTATION

Assessment of the functional capacity of Nigerian children with sickle
cell anaemia using the six-minute walk test
Dr Peter O. Ubuane¹, Chiemeka I. Igwe² ³, Biobele J. Brown³ ⁴, Adegoke G. Falade³ ⁴
Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria¹
Alderney Hospital, Poole, UK²
Department of Paediatrics, University College Hospital, Ibadan, Nigeria³
Department of Paediatrics, College of Medicine, University of Ibadan, Nigeria⁴

Introduction
Nigeria has the highest global burden of children with sickle cell anaemia (cSCA) (2% national prevalence).
SCA-associated chronic anaemia and hypoxaemia results in impaired functional capacity (FC) [ability toperform daily activities] which is independently associated with poorer outcomes. Hence, periodic
monitoring of FC is recommended as part of sickle cell care. Although cardiopulmonary exercise test is thegold-standard measure of FC, it is generally unavailable in low-resource settings because of high cost andexpertise; the six-minute walk test (6MWT) is a simpler but reliable and valid alternative measure of FC basedon the self-paced distance walked in 6-minutes [six-minute walk distance, 6MWD]. Impaired 6MWD inchildren with SCD is associated with nocturnal desaturation and silent infarcts. However, there is no
published report of 6MWT among cSCA in Nigeria, hence our study.
Methods
We cross-sectionally enrolled cSCA in steady state, aged 6-14 years, at the Paediatric Haematology Clinic of
the University College Hospital, Ibadan, Nigeria (January to October 2020) to perform standardised 6MWT(American Thoracic Society’s guidelines) on a 30-m long corridor, measuring their 6MWD, pre- and post-test
oxygen saturation (pre-SpO2, post- SpO2) and pre- and post-test Borg’s perceived dyspnoea and fatigue
ratings (pre-dyspnoea, post-dyspnoea; pre-fatigue, post-fatigue). Impaired 6MWD and exercise-induced
oxygen desaturation (EOD) were deﬁned as 3%, respectively.
Results
95 children cSCA [48.4% girls; mean (SD) age= 10.2(2.3) years] walked 495 (66.2) m [%predicted 6MWD: 95.9
(14.3) m], with mean (SD) pre-SpO2, post-SpO2, pre-dyspnoea, post-dyspnoea, pre-fatigue, and post-fatigueof 96.3 (2.6) %, 96.3 (2.9) %, 0.2 (0.5) and 1.6 (1.0), respectively (pre-/post-test changes: p<0.05). The
prevalence of impaired 6MWT and EOD were 2.3% and 11.6%, respectively. Borg’s dyspnoea and fatigue
scores were signiﬁcantly associated with EOD (p<0.05).
Conclusion
Although the prevalence of impaired FC was low, there was a high prevalence of EOD among Nigerianchildren with SCD. Because EOD has been previously associated with nocturnal hypoxaemia which is in turn arisk factor for increased morbidity and mortality, there is need for further prospective evaluation of thisﬁnding for possible intervention.

ABSTRACTORAL PRESENTATIONCOVID-19 Outbreak and Containment among Healthcare workers in a
Tertiary Hospital in Nigeria
Dr Ifeoma Ude¹, Regina Oladokun¹, Babatunde Ogunbosi¹, Oreoluwa Morakinyo¹, Joy Alejo¹,
Olugbenga Akinrinoye¹, Adeyemi Labaeka¹, Oluwaseun Bello¹, Adesola Adelaja¹
University College Hospital, Ibadan¹

Introduction
Globally, health services have been strained due to the crippling effect of coronavirus disease 2019 (COVID19) pandemic and outbreaks among healthcare workers (HCWs). In most countries in Africa, the unspeciﬁc
symptoms of COVID-19 are similar to vector-borne conditions such as malaria. Amongst the HCWs, various
risk factors for the different cadres abound. This study describes COVID-19 outbreak and containment
among HCWs in a Pediatric unit in a tertiary hospital
Methods
This was a retrospective review of outbreak containment effort among HCWs during the second wave of the
COVID-19 pandemic between December 2020 and January 2021. It involved all cadres of frontline staff(physicians, nurses and domestic staff) working in the Department of Pediatrics, College of Medicine,
University of Ibadan who were eligible for testing according to the NCDC guidelines.1 Demographic,
exposure, clinical and laboratory details and outcomes were recorded.
Results
A total of 110 HCWs were included, 53 (48.2%) HCWs were symptomatic, most had body ache (51.9%) andfatigue (51.9%).
A nasopharyngeal swab PCR test for SARS-Cov2 was done by 107 HCWs, 52 (47.3%) were positive, and ofthese 32 (61.5%) had contact with a conﬁrmed case. Of the positive cases, 37 (70%) were symptomatic, and15/57 (23.3%) were asymptomatic.
Most cases occurred among house physicians and staff in the newborn unit.
Majority (61.5%) of positive cases had mild illness and no HCW was hospitalized. The outbreak wascontained after a period of 8weeks by the following measures: symptom screening, isolation of conﬁrmed
cases, contact tracing and environmental decontamination
Conclusion
This study highlights the risk encountered by HCWs and the importance of timely COVID-19 outbreak
response in healthcare settings. Contact tracing using level of exposure and/or symptoms is valuable in
infection containment. We recommend more awareness of COVID-19 among all cadres of HCWs. We also
advocate closer supervision of frontline HCWs with less experience (such as the house physicians) topractice optimal infection preventive measures.

ABSTRACT

CLINICAL CASE

Malignant pleural mesothelioma and environmental and occupational
exposure to asbestos: a case report from Lubumbashi, DR Congo
Dr Joseph Pyana Kitenge¹ ² ³, Carolyn Baigrie⁴, Carolyn Baigrie¹ ², Benoit Nemery²
Université de Lubumbashi (DR Congo)¹
KU Leuven (Belgium)²Centre Médical Du Centre Ville (DR Congo)³
Pathcare house (South-Africa)⁴

Patient Description
We present a case of malignant pleural mesothelioma in a 59 year-old man in DR Congo. The relation between
exposure to asbestos and malignant mesothelioma has been demonstrated in numerous studies but
malignant pleural mesothelioma has not been reported in Sub-Saharan Africa, except for South-Africa andZimbabwe.
Case History
Patient followed up since February 2019 for dry cough and left chest pain, and left pleural effusion on chest xray. He was treated for tuberculosis without bacteriological evidence and underwent several pleuralpunctions. In May 2019, he was admitted urgently for severe chest pain and referred to us for further advice.
A detailed environmental and occupational history revealed a probably substantial past exposure toasbestos: ﬁrst as a child in Lubudi, where his father worked in a cement-plant that produced asbestoscement materials until 1977, and then possibly as an adult through his work as an automobile mechanic(including repairing of brake lining).
Physical Examination Results
Tachycardia and tachypnoea on admission. Dullness and auscultatory silence over the lower third of the left
hemithorax.
Results of Pathological Tests and Other Investigations
Chest x-ray showed left pleural effusion and lung atelectasis. Chest HRCT was compatible withmesothelioma in the left lower hemithorax. Spirometry showed a moderate restrictive impairment.
Histopathology with immune histochemistry on pleural tissue obtained by needle biopsy conﬁrmed the
diagnosis of malignant pleural mesothelioma.
Treatment Plan
Anti-tuberculosis treatment was stopped and antalgic medication was given. No chemotherapy or otheroncologic treatment could be offered.
Expected Outcome of the Treatment Plan
Palliative care.
Actual Outcome
The patient died in December 2019 after having developed paraplegia and respiratory distress.

ABSTRACT

CLINICAL CASE

Pulmonary alveolar proteinosis and whole lung lavage in Kenya: acase report
Dr Evans Onyango¹, George Nyale², Edwin Walong³, Jackson Atina², Andrew Owuor², Jared Mecha¹,
Wanjiku Kagima²
University of Nairobi, Faculty of Health Sciences, Department of Clinical Medicine and Therapeutics, Kenya¹
Kenyatta National Hospital, Pulmonology Department, Nairobi, Kenya²
University of Nairobi, Faculty of Health Sciences, Department of Human Pathology, Kenya³
Patient Description
A 36-year-old previously healthy Kenyan lady who lived in Nairobi and worked as a high-school teacher.
Case History
Our patient was referred and presented with a ﬁve-month history of progressive shortness of breath and dry cough withassociated unintentional weight loss of 15kg. She was previously healthy and had no history of occupational or inhalational
exposure to organic or inorganic dust. There was no history of cigarette smoking or passive smoking.
Physical Examination Results
On examination, she was not pale, had no ﬁnger clubbing, cyanosis, or ankle edema, and had no evidence oflymphadenopathy. A respiratory system examination revealed a respiratory rate of 28 breaths per minute. Chest
auscultation revealed diffuse bilateral crackles. Cardiovascular, abdominal, and central nervous system examinations werenormal.
Results of Pathological Tests and Other Investigations
Laboratory investigations on admission were normal apart from polycythemia and elevated lactate dehydrogenase (LDH).
Other investigations to rule out secondary causes were done; the complete blood count and peripheral blood ﬁlm did notshow any morphological evidence of any hematological malignancy. A human immunodeﬁciency virus (HIV) antibody test
was negative. The antinuclear antibody test (ANA) and antineutrophil cytoplasmic autoantibody test (ANCA) were both
negative. The Extractable Nuclear Antigen (ENA) panel was also negative. A Gene-Xpert test for Mycobacterium
tuberculosis genome detection was negative. An anti-GM-CSF antibody test was not performed because it was notavailable locally and the cost of sending samples abroad was prohibitive.
A chest radiograph revealed a reticular nodular pattern of bilateral and perihilar distribution. High-resolution computed
tomography revealed a “crazy-paving” appearance in the upper, mid, and lower lobes of both lungs with ground glass opacity
and smooth interlobular septal thickening suggestive of pulmonary alveolar proteinosis.
A pulmonary function test revealed a restrictive pattern: forced vital capacity (FVC)=2.28L (73 %), forced expiratory volume
in 1 second (FEV1) =2L (74 %), and FEV1/FVC= 88%.
Her arterial blood gas (ABG) revealed signiﬁcant hypoxemia while breathing room air: partial pressure of oxygen (PaO2) 6.2
kPa.
At this point, the working diagnosis was an interstitial lung disease likely pulmonary alveolar proteinosis with differentials of
pulmonary alveolar hemorrhage and interstitial pneumonitis.
Cytological examination of the bronchoalveolar lavage ﬂuid (BALF) revealed multiple large and foamy alveolar
macrophages and increased numbers of lymphocytes. Microbiological investigation of BALF was negative and cytology
showed no malignant cells. The BALF cytology showed periodic acid–Schiff positive (PAS) positive eosinophilic material. A
transbronchial lung biopsy revealed intra-alveolar granular material which was also strongly PAS positive. This is consistent
with pulmonary alveolar proteinosis.
Treatment Plan
Due to severe dyspnea and hypoxemia on exertion, she was on oxygen therapy and subsequently underwent whole lunglavage in the operation theatre. The WLL was done under general anesthesia. For WLL of her left lung, our patient underwent
general anesthesia and was intubated with a double lumen endotracheal (ET) tube of 41 Fr. A total of 7 lavages were done forclearing the lavage eﬄuent from the left lung. Cycles were repeated until 14 L of total lavage volume was used and clear ﬂuid
eﬄuent was obtained. The eﬄuent from whole lung lavage gave an initial “milky” appearance with a high sediment level andgradually turned less opaque with a lower sediment level. The procedure lasted approximately 4 hours. No complications
were observed during or after WLL.
Expected Outcome of the Treatment Plan
The expected treatment of PAP with whole lung lavage is improvement in hypoxemia and reduced requirement of oxygen.
Actual Outcome
The treatment she received through WLL resulted in marked improvement in her symptoms, exercise desaturation, andsubsequent chest radiograph image.
She was put under close observation in the medical critical care unit then transferred to the respiratory ward and was later
discharged on day 3 following the procedure with no oxygen requirement.
Whole lung lavage of the contralateral lung was performed 6 weeks later but unfortunately, the patient succumbed
immediately post-procedure. A postmortem was performed and revealed asphyxia due to widespread alveolar proteinosis
as the cause of death.

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CONGRESS ORGANISER
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