YetundeAbiola Kuyinu1, SemiuIshaq Adewale1
Lagos State University College Of Medicine, Ikeja, Lagos Nigeria1
A pilot study assessing knowledge of women about Carbon Monoxide and 24 -hour CO levels in selected homes in Lagos, South-West Nigeria
Introduction: Indoor air pollution remain poorly studied and reported in Nigeria. There is poor power supply and large use of gasoline powered generator by the citizens.
The study was conceived to determine the knowledge of women in selected homes in Lagos about carbon monoxide (CO) as well as to measure the 24-hour CO level in their home.
Methods: Convenient sampling of three local government area was done in Lagos, South West Nigeria. A descriptive cross sectional study was carried out within selected household involving Women 18 years and above in charge of each household who were interviewed with an interviewer administered questionnaire. 17 Item questions were used to assess their knowledge about CO. The 24 hour CO level was monitored using the Easy Log USB CO Monitor (Lascar Electronics, Erie, PA,)
Results: The age range of respondent is 21-80 years with Mean 46.18±14.6 years, 62 (62%) were married, 68% had at least Secondary education, more than 70% had lived at the address for more than 5years. 98% were non -smokers. 58% of the household possess a power generating set (56 used petrol, 02-diesel). Primary fuel use for cooking in household was kerosene in 65%, LPG in 32%. Generators were inappropriately placed in 27(43.1%) households. Majority (69%) of the women have not heard of CO. 25 of the 31heard about it from School. Knowledge score was poor in 02(6.5%), fair in 11(35.5%) and good in 18(58.1). Those who have heard about CO were much younger Mean age 41±11.5years compare with 48.66±15.4 in those who have not. t= -2.448, p=0.012
The range of CO level 0-124.5ppm, mean maximum CO of 19.81±26.67. This is not affected by age. Only 53 household had safe CO level while in 26% values greater than 25ppm were recorded. None of the households had CO detector or alarm.
Conclusion: Despite the large use of portable gasoline generators among Nigerians, the knowledge of the women regarding the hazards remain poor. There is need for massive education to increase awareness about CO and other pollutants.
AlphonsusRukewe Isara2, Sunday Ameh3
Owan East Local Government Council/Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria1, Department of Community Health, University of Benin, Edo State, Nigeria2, College of Medical Sciences, University of Calabar, Cross River State, Nigeria3
Introduction of Pentavalent, Pneumococcal conjugate and Inactivated Polio vaccines into routine immunization schedule: caregivers’ experiences in Edo State, Nigeria.
Introduction: Pentavalent vaccine; pneumococcal conjugate vaccines and inactivated polio vaccine were recently introduced into the EPI schedule of routine immunizations in Nigeria. This study assessed caregivers’ awareness, sources of information, uptake and satisfaction with the new vaccines in Etsako Central Local Government Area of Edo State, Nigeria.
Methods: This descriptive cross-sectional study involved care-giver/baby pair, receiving immunization services at the heath facilities. The data collected using a combination of questionnaire and review of records were analyzed using IBM SPSS version 21.
Results: Of the 110 mother-baby pairs, 50 (45.5%) babies were between the ages of 10-19 weeks, and 42, (38.2%) caregivers were within the ages of 35-44 years. Most (90.9%) caregivers were aware of new vaccines introduced into the routine immunization schedule. The major source of information was from health worker, 91 (82.4%). Only 10% were able to correctly identify the three newly introduced vaccines. Pentavalent vaccine was the most frequently obtained antigen, 94 (85.5%), followed by PCV, 40 (36.4%) and IPV, 38 (34.5%). Most (90.9%) caregivers were satisfied with services received regarding the new vaccines. Adverse event following immunization with the new vaccines was reported in only 28.6% of the babies. Caregivers’ level of education (p = 0.021) and satisfaction (p = 0.043) with the new vaccines were significantly associated with up to date uptake of the vaccines
Conclusion: Caregivers’ awareness about the newly introduced vaccines was generally high in this study, but in-depth knowledge of any of these vaccines was low. Only one third of the children had been immunized up to date with the new vaccines. The caregivers expressed a high level of satisfaction with the new vaccines.
Ijeoma Nkem Nina Okedo1
Federal Teaching Hospital Abakaliki1
Comparative evaluation of obstructive sleep apnoea between Persons living with HIV and General Out patients in Federal Teaching Hospital Abakaliki, Ebonyi State, South East Nigeria.
Introduction: Obstructive sleep apnoea (0SA) is under-recognized and under-diagnosed, with lots of negative consequences on patients' health. Undetected OSA can lead to hypertension, heart disease, depression, and death. OSA is also commonly encountered in the care of persons living with HIV (PLHIV). The aims of this study were to compare OSA experience between HIV negative patients and persons living with HIV and to determine the association between OSA and HIV status.
Methods: This cross-sectional comparative study was carried out among patients attending General out Patient clinic and HIV clinic of Federal Teaching hospital Abakaliki. The interviewer-administered Berlin Questionnaire (BQ) and Epworth Sleepiness Scale was used to assess the risk of OSA and EDS respectively among 151 persons living with HIV and 167 HIV negative patients attending the GOP Clinic. These were selected using a systematic random sampling technique after securing ethical clearance. Data was analysed using SPSS version 20. Frequencies and percentages were calculated and analytical components were compared at 95% level of significance.
Results: Of the 167 GOP respondents, most 79(47.3%) were between 20-29 years of age, while among the 151 PLHIV, most 52(34.4%) were between 30-39 years of age. Males were 88(52.7%) and females 79(47.3%) among the GOP while among the PLHIV males were 58(38.4) and females 93(61.6%). Mean BMI and standard deviation among GOP and PLHIV were 25±5.5 and 23±4.6 respectively. Positive snoring experience was significantly higher (ᵡ2 = 24.62, P = 0.000) in GOP 58(34.7%) than in PLHIV 23(15.2%). There was no significant difference (ᵡ2 = 3.645, P = 0.07) in positive daytime tiredness between GOP and PLHIV [58(34.7%), 23(15.2%)] respectively. Positive daytime sleepiness was significantly higher (ᵡ2 =7.797, P = 0.007) among PLHIV than GOP [57(37.7%), 39(23.4%)] respectively. Significantly higher proportion (ᵡ2 = 24.629, P = 0.000) of GOP had high risk of experiencing sleep apnoea than PLHIV [43(25.7%) and 8(5.3%)].
Conclusion: General out patients experience OSA significantly more than PLHIV. However PLHIV experience more daytime sleepiness than GOPs.
Levi Mugenyi1, Winceslaus Katagira1, Bruce Kirenga1
Makerere University Lung Insitute1
Mortality and associated factors among patients with Copd in Uganda
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death globally, with 90% of its attributable deaths occurring in the Low and Middle Income Countries like Uganda. Longitudinal data on the mortality and its predictors among COPD patients is lacking in Uganda. We set up the Uganda Registry for Asthma and COPD (URAC) to fill this data gap.
Methods: COPD patients presenting at 6 tertiary hospitals in Uganda were enrolled into the URAC registry and followed up for two years to determine the incidence and predictors of mortality. The hospitals were Mulago National Referral, and five other regional referral Hospitals (Mbale, Mbarara, Hoima, Arua, and Gulu) located in different regions of Uganda.
Results: We recruited and evaluated a total of 296 COPD patients, 57.6 % Male. A total of 33 (11.2%) died. Higher mortality was observed in males IR=116, compared to females IR=76, IRR=1.51 ( 95% CI=0.72 – 3.26). By age group, incidence rates were 59.9, 27.4, 137.7, 89.9 and 113.6 for age groups 35, 35-44, 45-54, 55-64 and 65+, respectively. COPD stage by FEV1 was significantly associated with mortality, GOLD 4 compared to1 IRR 12.7 (95% CI=2.71 – 119.2, P0.001), GOLD 3 compared 1 IRR 5.8 (95% CI=1.3 – 54.1, P=0.005) and GOLD 2 compared 1 IRR 2.8 (95% CI=0.6 – 25.9, P=0.090). Smoking history was borderline significant IRR 1.7 (95% CI=0.8 – 3.7, P=0.061). Other non-significant factors were HIV positive IRR 1.9 (95% CI=0.6 – 4.7, P=0.090), biomass smoke exposure IRR 0.6 (95% CI=0.2 – 2.8, P=0.172), and exacerbation h/o IRR 1.2 (95% CI=0.6 – 3.0, P=0.296). Age groups, hypertension and obesity were also not significantly associated with mortality.
Conclusion: Among COPD patients in this Ugandan population, GOLD stage by FEV1 was the only prognostic factor for mortality. Co-morbidities did not significantly affect mortality outcomes in this patient population
The Nairobi Hospital, Cicely MacDonnel Nursing School1
Effects of open and closed endotracheal suctioning on oxygenation and ventilator associated events incidences: A systematic review
Introduction: To compare the effects of open and closed endotracheal suction systems on oxygenation and ventilator associated events incidences in adult patients on mechanical ventilation.
Intubation is the placement of a flexible tube into a patient's trachea to maintain an open airway and assist with ventilation and oxygenation. Its presence causes increased secretions hence the need for suctioning to clear the airway.This is done through the endotracheal tube.
Endotracheal suctioning is performed through use of open or closed system.These systems have various advantages and disadvantages as well as complications.
Some of the complications are ventilator associated events (VAE), decreased oxygenation and hemodynamic disturbances.
Methods: A systematic literature search was done from PUBMED, MEDLINE, CINAHL, EMBASE and Cochrane library databases to identify randomized controlled trials comparing open and closed endotracheal suction systems. The search was from studies conducted from 2007 to 2017. The search aimed to identify the effects of open and closed endotracheal suction systems on oxygenation and VAE incidences.
search was also interested in the studies that had been done on adult patients.
Was done manually by going through the studies and critically analyzing the findings then making inferencesin relation to the aim of the study.
Results: The search yielded 118 articles of which 36 articles were incorporated into this study.The results from these articles had the following findings.
All the articles reviewed showed that there was a decrease in oxygen levels and saturation when the open suction was used compared to the closed system.
On further analysis, the patients whom closed suction system was used there was either no changes in the oxygenation level or had an increase. This was from comparison of blood gas analysis done before and after suctioning.
On VAE incidences, there was no difference between the two systems. The laboratory tests done on patients had the same incidence level despite the type of suction system used.
Conclusion: The closed endotracheal suction system is better than the open one in terms of oxygenation levels in that from the results there was either an increase or no change in oxygenation.
Although there was no difference in the incidences of VAE, the closed suction system has various advantages over the open one.
Olayemi Fehintola Awopeju1
Oluwasina Salami1, Gregory Erhabor1
Obafemi Awolowo University, Ile-Ife , Nigeria1
Atopy, disease control and quality of life in asthma: a cross-sectional study of Nigerian asthmatics.
Introduction: Atopic sensitization is one of the strongest risk factors for developing asthma, while quality of life and asthma control are the most commonly patients’ reported outcome measures (PROM) in clinical practice and research. Asthma control remains the central focus of treatment regimens and individual care plans irrespective of disease severity or phenotype. The relationship between atopy and these PROM is complex and not well established, we, therefore, investigated the relationship between these outcomes and sought role of atopy between these outcomes.
Methods: In a cross-sectional study, we consecutively recruited 82 stable asthmatics (mean age 44.3±16.3 years. 59 females) who were previously diagnosed according to the GINA criteria, attending pulmonology clinic of a tertiary hospital. We assessed atopy by skin prick test reactivity to 6 common inhalant allergens. The asthma control, quality of life and lung function were evaluated using the ACT (asthma control test), mini AQLQ (asthma-specific quality of life questionnaire), and spirometry. Correlations between asthma control and asthma specific quality of life were determined using Spearman's Rank correlation coefficient with line of best fit determined using the least-square linear regression. Mann-Whitney U test was used to test the difference between atopic and non-atopic asthmatics.
Results: The median (IQR) ACT score was 18.0 (13.0-22.0) and median (IQR) AQLQ score was 4.7 (3.7-5.9). The ACT scores correlated positively with total AQLQ scores (rho= 0.57, 95% CI 0.41, 0.71; p0.001) with one point increase in AQLQ associated with 2.12(95%CI, 1.40-2.85; p0.001), increase in ACT. Fifty-six of the 82 participants (68%) were classified as atopic based on sensitization to at least one aeroallergens. There is no significant difference the between atopic and non-atopic asthmatics in % predicted Forced Expiratory Volume in one second (77 vs 72) p=0.70, ACT score (18.5 vs 18.0) p=0.91 and total AQLQ score (4.9 vs 4.6) p=0.22.We concluded that better asthma control is associated with better quality of life, however, atopic status does not affect PROM such asthma control or quality of life.We concluded that better asthma control is associated with better quality of life, however, atopic status do not affect PROM such asthma control or quality of life.We concluded that better asthma control is associated with better quality of life, however, atopic status do not affect PROM such asthma control or quality of life.
Conclusion: We concluded that better asthma control is associated with better quality of life, however, atopic status does not affect PROM such asthma control or quality of life.
Heather Zar1, Landon Myer1, Rodney Erhlich1
University Of Capetown1, University Of Nigeria Enugu2
Environmental risk factors for current or severe asthma in 13-14 year old African children participating in ISAAC III
Introduction: Asthma prevalence in Africa is as high as the global average and increasing. There are environmental factors associated with the increase. Comparison of findings across African countries is complicated by lack of consistency in methods Environmental risk factors for current or severe asthma in 13-14 year old children using data obtained from ISAAC III African sites is yet to be estimated.
Methods: Population based cross-sectional study where children aged 13-14 years from 10 African centers who completed both core written questionnaire (WQ) and environmental questionnaires (EQ) of ISAACIII were drawn from school clusters randomly selected. Appropriate ethical clearance was obtained. The dependent variables were current asthma (wheeze in last 12 months) and severe asthma (presence of any 3 defining questions for severity). The independent exposure outcomes were: engaging in physical exercise 3 or more times in a week , television watching 5 or more hours in a day, biomass and ETS exposure, consumption of paracetamol at least once a month, large family sizes and having pets in the home. Univariate and multivariate analyses were done adjusting for center variation. Odds ratio and respective 95% confidence intervals (CI) were calculated. Significant p>0.05% was used.
Results: There were 28490 adolescents in 10 African centers with 4 middle income and 6 low income centers. There was fairly equal M:F distribution. There were 7 groups of factors studied after exclusion of factors with much variability among centers. Maternal smoking was strongly associated with current asthma and severe asthma in adolescents. Exposure to biomass fuels, particularly cooking in the home with firewood predisposed to current asthma. Having a large family protected from current asthma and engaging in heavy exercise is associated with both current and severe asthma. There was a positive association between both current and severe asthma and the use of paracetamol.
Conclusion: The study results demonstrated a number of strong and consistent environmental associations, some of which confirm some fairly established or plausible associations with asthma in children.
Aneesa Vanker,1, 3Diane Gray1, 3, Marco Zampoli 1, 3, Sandra Owusu1,4 Diana Marangu1,5 , Komala Pillay 1, Ebrahim Bandekker,3
Red Cross War Memorial Children Hospital Cape Town South Africa1, College of Medicine, University of Nigeria Enugu Campus2, MRC Unit of Child and Adolescent Health, University of Cape Town3, KomfoAnokye Teaching Hospital Kumasi Ghana4 , University of Nairobi, Kenya5
Pulmonary Capillary Hemangiomatosis presenting without pulmonary hypertension – A case report
Introduction: Pulmonary capillary haemangiomatosis (PCH) is a rare disorder of unknown aetiology and often misdiagnosed as primary pulmonary hypertension or pulmonary veno-occlusive disease. It is a locally aggressive benign vascular neoplasm of the lung characterized by proliferation of benign thin-walled capillary sized blood vessels in the lung parenchyma with alveolar capillary proliferation. It usually affects children and young adults with symptoms typically overlapping those of primary pulmonary hypertension. Prognosis is poor and strongly related to associated hypertension.
Methods: We present a rare case of a three-year-old girl referred with a history of cough followed by episodes of haemoptysis with clotted blood and melena stools, four bouts in one day with haemoglobin dropping from 12.7 to 10.5g/dl.
Results: We present a rare case of a three-year-old girl referred with a history of cough followed by episodes of haemoptysis with clotted blood and melena stools, four bouts in one day with haemoglobin dropping from 12.7 to 10.5g/dl. Her reticulocyte count was 1% and platelet count of 123000/μL. There was no personal or family history of bleeding disorders. She had no clinical or echocardiography signs of pulmonary hypertension nor of portal hypertension. Chest radiography findings were consistent with chronic interstitial lung changes while chest CT showed ground glass opacification, right middle lobe nodular opacities with tree-in-bud appearance areas of pleural fibrosis at lung biopsy site and an absent right pulmonary artery. Cardiac catheterization is awaited. Investigations for infections including tuberculosis and autoimmune conditions were negative. Broncho-alveolar lavage yielded >50% iron laden macrophages A diagnosis of Pulmonary capillary haemangiomatosis (PCH), was made on histology of the lung biopsy She had intermittent bouts of small quantity haemoptysis, a troublesome cough, worsening opacification on chest x-ray and had developed mild tachypneoa at rest with desaturation on six-minute walk exercise Consequently she was started on the mTOR inhibitor, Rapamycin, for its anti-proliferative properties. We continue to monitor her for evidence of pulmonary hypertension.
Conclusion: This case highlights the need for extensive investigation, which may include lung biopsy, and follow-up of children who present with haemoptysis of undetermined origin. Prompt and thorough investigation may allow treatment that improves outcome.
MbatchouNgahane Bertrand Hugo1
Kamdem Felicite1, ChebouRoseline Nina1, Tengang Bruno2, Ebongue Serge3
Department of internal Medicine, Douala general Hospital1Faculty of Medicine and Pharmaceutical Sciences4, Centre des Maladies Respiratoires de Douala2, Douala Military Hospital3
Clinical profile and outcome of pulmonary embolism in Douala, Cameroon
Introduction: Pulmonary embolism (PE) is one of the manifestations of venous thromboembolism. Only few study gives report on PE in subsaharan Africa. we aimed to determine the clinical profile, and outcome of pulmonary embolism in 3 hospitals in Douala, Cameroon.
Methods: It was a descriptive study carried out at the intensive care unit and the internal medicine department of the Douala general Hospital, at the medical service of the Douala Military hospital and at the “Centre des Maladies Respiratoires de Douala”. Patients admitted for PE between January 2009 and May 2017. The diagnosis of PE was confirmed by a thoracic CT angiography.
Sociodemographic characteristics, clinical data, the results of work-up and the outcome of patients were collected. Statistical analyses were done using SPSS 20.0. the study was approved by the institutional review board of the University of Douala.
Results: In total, 103 patients were included in the study, with a male predominance. The median age was 52 years. Among the risk factors, the most common was obesity with 49,5% followed by hypertension with 35% (36 patients). Dyspnoea was present in in 86 patients (83,3%) followed by chest pain in 81 patients (78,6%) and respiratory distress in 58 patients (57.3%). The chest x-ray showed a pleural effusion in 33 patients (47,15%). The cardiac ultrasonography showed an enlargement of the right heart cavities in 61 patients (61%). The sinus tachycardia was present in 64 patients (63,36%). The initial treatment consisted of heparin therapy followed by antivitamin K. The complications during hospitalization were pulmonary infection in 31 patients (30.1%) while the mortality rate was 18.4%.
Conclusion: Pulmonary embolism mostly affects young subjects in Douala. The most frequent risk factor was obesity. Dyspnoea and chest pain are the mains symptoms and the complications rate is high.
Nsuli Liliane Byamungu1
Patrick de Marie Katoto2
Department of Paeditric, University of KwaZulu-Natal, South Africa1, Department of Internal Medicine, Faculty of Medicine, Catholic University of Bukavu, Bukavu, Dem. Rep. of Congo and Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium2
Mediastinal Cystic Teratoma Revealed by Pleural Effusion: Clinico-Pathologic Characteristics and Outcomes after Surgery. Report of a Case from Low Income Setting and a Review of 63 Cases in the Literature
Introduction: Mediastinal cystic teratoma is a rare diagnosis in adolescence, especially in a low-income setting. Pleural effusion as symptom can often lead to respiratory infections diagnosis and delay the resection. We report a case from a low-income setting and analyse data from the literature.
Methods: Clinical record of one adolescent patient from the Democratic Republic of Congo reported here and 63 records from other institutions identified via Medline between May 2017 and November 2017 analysed. We excluded three patients from analysis for missing of clinical data. We described, from full-text articles, demographic, clinico-pathologic characteristics, and surgery outcomes and follow-up of patients.
Results: Of 64 reported cases, 59% were females and mean(SD) age was 26(12)years. Most of them come from high-income countries (Japan 28%, France 25%, USA 18% following by India 7%). Cough, shortness of breath, fever and chest pain were mostly reported. Majority of cases were misdiagnosed with time to first clinical symptoms ranged from one week to two years. Further, our case was first treated twice as tuberculosis (different regimens). About 91% showed an immature form whilst 16% were malignant. Ovarian and pancreatic tissues were mostly retrieved as content. Duration of hospitalisation varied from four days to six months and septic as well neurologic complications were mostly reported. With a follow-up period (of half of cases) ranged from one week to two years, five percent of patient died after surgery and 26 percent relapsed.
Conclusion: Mediastinal teratoma can be misdiagnosed for a long period and revealed by a fatal pleural effusion. The present report expands the spectrum of our knowledge showing the scarcity of reported mediastinal cystic teratoma from low-income countries although a high frequency of pleural effusion in this region and therefore highlight the need of its integration for differential diagnosis of pleural effusion.
Collins Kirui1, Peter Koech1, Alfred Terer1
Ministry of Health, Kapkatet County Hospital1
Interruption of Anti-tuberculosis drugs among adolescent and young adults ages 10-30 years at Kapkatet county hospital, Kenya
Introduction: Adolescents and young people represent a growing share of Tuberculosis (TB) worldwide. Adolescents account for over 40% of the total population in Kenya. UNAIDS report of 2017 flagged Kenya's population of school going teenagers of ages between 15-19 years as the most likely to stop treatment. The main objective is to highlight the interruption of anti-TBs among adolescent and young people at Kapkatet county hospital.
Methods: A retrospective study was done on adolescent and young adults ages 10-30 years old diagnosed with TB and started anti –TBs at Kapkatet county hospital within a period of three years between the periods of January 2015-December 2017. Ministry of health TB registers were used as source documents. Data was extracted and analysis done using SPSS version 21. Relationship associated factors and drug interruption was established. P- Value less than 0.05 was considered significance.
Results: A total of 300 adolescents and young adults were assessed during the review period.63% (n=190) were male and 37 %( n=110) female .Out of 300 adolescent who were on ati-TBs, 94% (n=282) were school going. At the end of the review period, only 60% (n= 180) successfully completed treatment; 60% were female and 40% were male. On Anti-TB drug interruption, 40% (n=120) missed drugs and clinic appointments; 70% (n= 84) were male. There was a positive correlation between male and female on drug interruption (P= 0.002).
Conclusion: Treatment failure was generally high and more focus should be put on males adolescent and young adults. Adolescents and young adults are likely to interrupt treatment both at intensive phase and at continuation phase of treatment related to stigma, bill burden, and duration of treatment, social support and school linkage. There should be structured friendly adolescence and young adult package of care and treatment to improve on anti-TB adherence.
Kirui Collins Kipkosgei1
Kapkatet District Hospital1
TB/ HIV service reduce resistance of drugs among co-infected patients at Kapkatet county hospital
Introduction: TB/HIV co-infection among TB patients tested for HIV stand at 41% in Kenya. At Kapkatet District Hospital is at 26% co-infection rate as at 2016. TB/HIV services at kapkatet hospital started in 2005 and was supported by PEPFAR Project. TB clinic was approximately 100 meters away from HIV clinic. Despite existence of referral mechanism patient got loss in the process due to distance, time and stigma. This contributed to low uptake of ARVS at 9.5% (2014) and increase in number of defaulters while treatment success was at 62% which contributed to resistance of ARVs. In order to address the challenges faced; the hospital management had to set up integrated TB/HIV services under one roof.
Methods: TB/HIV collaboration committee was formed in 2014 comprising of TB/HIV stakeholders and hospital management. In 2015, committee identified the challenges and solutions by review of clinic data. One of the major challenge was separation of TB and HIV clinic. TB/HIV drugs was integrated as comprehensive services including OIs management in the same room
Results: : ART uptake increased from 9.5% in 2013 to 96% in 2014, adherence to anti-TBs was at 70% in 2013 to 94% in 2016. Out of the 51 co-infected patients treatment success was at 98% and viral load suppression was at 90% thus this results was attributed to integration of service and regular follow up of the patients
Conclusion: Integration of TB/HIV at public hospital improve treatment success of TB co-infected patients. Setting up a functional mechanism of collaboration facilitate out the integrated services. The integration of this do not necessarily require additional health care workforce but ensure continuation of care to patient by building confidence on existing healthcare providers this reduce stigma thus improving drug adherence for the patient
Kirui Collins Kipkosgei1
Kapkatet District Hospital1
Nutrition status among TB/HIV co-infected patients attending Kapkatet county hospital, Kericho county Kenya
Introduction: Despite national progress on increased access to care and treatment of patient with tuberculosis, malnutrition remains a challenge and TB/HIV still remain a major cause of mortality in undernourished patients. In Kapkatet County hospital, 60% of patients with TB/HIV co-infection are undernourished. Nutrition is a core component in care and treatment in Kenya today. Undernutrition lower immunity leading to more complications. Currently nutrition supplements supporting TB/HIV patients target only severe acute malnutrition (SAM) with body mass index (BMI) less than 16 kg/m2leaving others. All the relapse TB cases were undernourished and 50% missed admission criteria for nutrition supplementation. Study aimed to evaluate nutrition status of TB/HIV co-infected patients attending Kapkatet county hospital.
Methods: Prospective study of Patients who attended TB/HIV co-infected clinic for care and treatment from January 2015 to December 2016 were assessed for nutritional status. Two nutritionist were assigned to assess all co-infected patients seeking care and treatments and document in the nutrition daily activity register. BMI was the main anthropometric assessment used. Nutrition status and gender was established using STATA.
Results: Undernutrition with BMI 18.5 was 60% (N=112). 80% were male while 20% were female. 15% had BMI 25). There was a positive correlation between nutrition status and gender (P= 0.05) all severe acute malnutrition cases were males while all over nutrition cases were females.
Conclusion: Structured nutrition assessment and counseling is critical in addressing malnutrition in TB/HIV co-infected patients. There is need to continuously support all undernourished (BMI 18.5 kg/m2) more emphasis should be put on male clients in terms of supplementation. Regular and timely supply of nutrition supplements is recommended.
Greg Symons2, Coenie Koegelenberg1, Hassan Alli Tariq2, R Raine2
University of Stellenbosch1, University of Cape Town2
Sleep Study an audit
Introduction: Obstructive sleep apnoea is a common condition associated with increased cardiovascular risk. The condition is diagnosed using nocturnal polysomnography in a sleep laboratory. Data from the public health care sector in South Africa is lacking.
Methods: The study take the form of a retrospective review of folders of patients attending the sleep Sleep Clinic at Groote Schuur Hospital, Cape Town. Who underwent noctural polysomnography studies between 2013 and June 2016.
Results: 175 sleep studies were included in this review. 116 (60%) participants are male and 78 (40%) are female. The mean age of participants is 49.2 years (St Dev 13.1, range 16.9 - 85). The most commonly occurring co-morbid condition in this cohort is hypertension (115). The symptoms most frequently reported by the participants are snoring (153), poor quality sleep (129), excessive somnolence (126), apnoea and gasping (109). The mean Epworth Sleep Score is 14 (st dev 5.8, range 0 - 24). 94 patients are obese.
137 patients were diagnosed with OSA. 82 (48.2%) participants have severe sleep apnoea associated with apnoea/hypoapnoea index greater than 30. Males in this cohort are 3 times more likely to have obstructive sleep apnoea than females (OR 2.9, p0.05 1.3 - 6.6). In addition, males are also more likely to have severe sleep apnoea as compared to females in this cohort. 53 males (71%) had severe sleep apnoea. Patients with severe sleep apnoea tended to be younger with 49 patients distributed in the ages between 30 - 59.
Conclusion: Obstructive sleep apnoea is common this cohort. Males are at greater risk of sleep apnoea independent of other comorbid conditions. Patients with severe sleep apnoea tended to be younger. Further analysis is required.
Lung hydatic cyst in children: Our experience
Introduction: Hydatid infestation of the lung can be primary or secondary.Cystic echinococcosis is regarded as endemic in Sub-Saharan Africa, available evidence suggests that several species or strains within the Echinococcusgranulosus complex are prevalent in sub-Saharan Africa; however, for most countries only scarce data, if any, exist
Methods: We did a retrospective study of all children suffering from Lung Hydatic Cyst admitted in our Paediatric surgery ward, from September 2015 to September 2017; were studied 11 children, collected and analyseddifferent variables such as: age, sex, lung affected, unilateral or bilateral cyst, size of the cysts, treatment and complications, these variables were interrelatedeach other’s, were created tables for its statistic study
Results: From those 11 children suffering from lung hydatic cysts, 8 were females and 3 males; the group of ages more affected was that from 6 to 10 years with 5 patients for a 45,5 %, followed by the groups of 5 to 6 years and more than 10 years with 3 children 27,2 5 each. The left lung was the most affected in 6 patients by 54,5 %, the right lung and bilateral lungs were affected only in 3 patients each 27 %. The surgical treatment, PAIR (punction - aspiration - injection and re aspiration) was performed in 8 children (72,7%). The bronco pleural fistula as a complication accounted in 7 patients and a cyst rupture in only 1 child. We did not have death in our group of patients.
Conclusion: Lung hydatic cyst in our patients were observed more frequently in the left side,
The surgical treatment performed was PAIR mostly in cysts more than 6 cm or with complications.
Conservative treatment is an option in some cases
Abinkeng Tazifua Ebenezer1
MbatchouNgahane Bertrand Hugo1, NgouadjeuDongho Eveline1, Che Vanessa Lum1, LumaNamme Henry2
University of Douala1, University of Yaounde2
Leukocyte count and its diagnostic value in newly diagnosed tuberculosis
Introduction: The diagnosis of tuberculosis (TB) is frequently challenging given that the clinical and radiographic features of TB are often nonspecific. Microscopic examination for acid fast bacilli-the most accessible in resource-limited facilities is of low sensitivity (50-60%). Recent studies show that a high or low monocyte lymphocyte count ratio (MLR) is predictive of active TB. The aim of this study was to determine the blood leukocyte cell counts and the diagnostic value of the monocyte/lymphocyte (MLR), the neutrophil/lymphocyte (NLR) count ratios in newly diagnosed TB patients.
Methods: This was a cross-sectional study. A total of 204 consecutive case files of newly diagnosed TB patients were recruited over 2years from registers of the TB treatment center of the Douala general hospital. Controls were 204 healthy volunteers age and sex matched, recruited at the blood bank of the hospital. Demographic, clinical and hematological data were collected. The diagnostic value of leukocyte counts was determined using receiver operating characteristics curve analysis. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values were also calculated. The areas under the curves (AUC) were determined.
Results: Lymphopenia (22.1%), neutrophilia (14.2%) and monocytosis (23.5%) were the most common abnormalities among newly diagnosed TB patients. The monocyte-lymphocyte count ratio (MLR) and neutrophil-lymphocyte count ratio (NLR) were significantly higher in the patient group compared to control group. NLR˃1.79 and MLR˃0.29 were identified as optimal cut-off values for discriminating TB patients from healthy subjects. The areas under the curves were 0.77 and 0.84 for the MLR and NLR respectively.
The MLR showed 67.2% sensitivity, 83.3% specificity, a PPV of 80.12% and a NPV of 71.73%,
while NLR showed 70.6% sensitivity, 87.3% specificity, a PPV of 84.7% and NPV of 74.79%
Conclusion: Lymphopenia, neutrophilia and monocytosis were the most common abnormalities among newly diagnosed tuberculosis patients. The monocyte/lymphocyte and neutrophil/lymphocyte ratios were raised in TB patients and were fairly predictive of active TB. A NLR, ˃1.79 and MLR, ˃0.29 were the cut-off values for discriminating TB patients from healthy subjects. Similar studies with larger sample sizes are needed to confirm or infirm these findings.
Joy Nkiru Eze1
Adaeze Chikaodinaka Ayuk1, Tagbo Oguonu1
Department of Paediatrics, College of Medicine University of Nigeria/ University of Nigeria Teaching Hospital, ItukuOzalla, Enugu, Nigeria1
Severe Asthma in Children: experience in a tertiary health facility in Nigeria
Introduction: Severe asthma is a heterogeneous disease characterized by sustained asthma symptoms despite treatment with high doses of corticosteroids. Achieving control in this group of patients can be difficult. Three cases are presented to highlight the management challenges in Nigeria.
Methods: Methods: Patient information on initial diagnosis of asthma, frequency of flare ups, medications used and current status were obtained from the case notes.
Case 1: A 6 year old girl diagnosed with asthma at age 3 years. Known triggers were aeroallergens: house dust mite from rug, fumes from generator and a nearby paint industry and these were controlled for. She had recurrent (2 to 3/month) asthma exacerbation despite incremental doses of inhaled corticosteroids, and long acting beta agonist (ICS/LABA), and leukotriene receptor antagonist (LTRA). Her asthma control test score (ACT) remained on the average 19 or below. She had frequent emergency hospital visits for life threatening exacerbations.
Case 2: A 16 year old adolescent female diagnosed with asthma 5 years ago with an average of 6 hospital admissions per year; also has exercise-induced bronchospasms (EIB). She was on low dose ICS/LABA but monitoring was difficult as she defaulted to appointments. She had several medical visits to the private sector for severe exacerbations. Emotional upset was a notable trigger. Her ACT score remained below 19 on most clinic visits despite incremental doses of ICS/LABA, and LTRA.
Case 3: A 12 year old male with asthma symptoms in the last 4 years; had twice weekly flare-ups which increased to daily attacks. Risk and trigger factors were BMI of 30, biofuel smoke exposure and exercise. He was on low dose ICS/LABA. His ACT score remained below 19 on most clinic visits. He received incremental doses of ICS/LABA; and LTRA. Adequate inhaler technique and weight reduction plan were instituted. Need for medication adherence was emphasized. He is currently on a medication step-down process.
Conclusion: Severe asthma is common in children as demonstrated in our case reports. There is need to ensure proper diagnoses, eliminate co-morbidities and institute targeted therapy in children with difficult asthma.
Nelson Chibueze Eze1
Benedict Ndubueze Azuogu1
Department of Community Medicine, Federal Teaching Hospital Abakaliki, Nigeria1
Prevalence and predictors of Tuberculosis treatment default in Abakaliki, Nigeria: Policy implication on its elimination goal
Introduction: Introduction: Tuberculosis (TB) treatment is the most effective strategy for preventing the spread of the disease. Default in tuberculosis treatment remains an important contributor to treatment failure, resurgence of multidrug resistance (MDR-TB), prolonged infectiousness, relapse and death. Patients’ adherence is an important link between medical process and good treatment prognosis. TB treatment default is a threat to its elimination goal and increases the burden of TB. Nigeria ranked 4th among the 22 high burden countries for TB in the world and 1st in Africa. This study determined the prevalence and predictors of tuberculosis treatment default in Abakaliki
Methods: Methods: Data from TB treatment register (686 clients) at Federal Teaching Hospital Abakaliki for the period of 2012 to 2016 were analysed. Key informant interview with nurses was done to determine the factors associated with default. Approval was obtained from the hospital management and permission from nurses. Treatment outcome was grouped as “defaulters” and “non-defaulters”. Data analysis was done using SPSS statistical software version 20. Chi squared test of statistical significance was used in the analysis and level of significance was determined by a p-value of less than 0.05.
Results: Results: The mean age of the respondents was 34.9±5.7 years. Of the 686 clients, 72 (10.59%) defaulted within the five years and out of 98 currently on treatment 11 defaulted giving a prevalence rate of 10.7%. Majority (73.1%) defaulted within the intensive phase of treatment. Reasons for default were feeling of well within the first month of commencement of drug, distance to health facility and pill burden. Among the defaulters, 25% were ≤ 29 years, 52.8% males and 68.1% lived in rural area. Predictors of TB treatment default were male gender (AOR =2.1; 95%;CI:1.4-7.5), rural residence (AOR=1.8; 95%;CI:1.3-5.7).
Conclusion: Conclusion: Default rate was high among clients. Therefore this rate of default needs to be further reduced by repeated counseling, reminder system, effective contact tracing, support group and referral. High default rate is a huge threat to TB elimination goal especially now that there is increase in the incidence of MDR-TB. Further decentralisation of treatment centres closer to rural areas would improve adherence to TB treatment. Keywords: Prevalence; predictors; TB treatment default; implication
Nelson Chibueze Eze1
Benedict Ndubueze Azuogu1, Ijeoma Okedo-Alex1
Department of Community Medicine, Federal Teaching Hospital Abakaliki, Nigeria1
Assessment of prevalence, knowledge of preventive and control measures of pulmonary Tuberculosis among inmates and staff of Abakaliki prisons, Nigeria: An implication for policy implementation
Introduction: Introduction: Pulmonary Tuberculosis (PTB) is one of the major diseases of public health importance especially in prisons where case finding rate has been low. The WHO established five facts of prisons PTB spread include: Prisons receive TB, Prisons concentrate TB, Prisons disseminate TB, Prisons make TB worse, and Prisons export TB. Poor TB case finding result in annual TB transmission risks of 90%. This study assessed the prevalence, knowledge of preventive and control measures of pulmonary tuberculosis among inmates and staff of Nigerian Prisons, Abakaliki
Methods: Methods: A prison-based cross-sectional descriptive study was undertaken among 307 inmates and staff selected using a systematic sampling technique. Informed consent was obtained from the staff and inmates. The respondents were interviewed using a pre-tested interviewer administered semi-structured questionnaire. Good knowledge of pulmonary tuberculosis was assessed by the proportion of respondents who correctly answered 50% of the knowledge questions, and sputum test was done for respondents with cough of two weeks or more. Data analysis was done using SPSS statistical software version 20. Chi squared test of statistical significance was used in the analysis and level of significance was determined by a p-value of less than 0.05. Results were treated with strict confidentiality
Results: Results: The mean age of inmates was 34.96±5.7 years while staff was 38.43±3.5 years. Majority had secondary education. All the staff and 89% of inmate were aware of pulmonary tuberculosis while 63% and 77% of inmates and staff respectively had good knowledge of pulmonary tuberculosis. Knowledge was significantly associated with educational and employment status of inmates but only educational attainment by staff. This study found 2.1% prevalence of PTB by sputum test.
Conclusion: Conclusion: Knowledge of presentation, preventive and control measures of PTB was high among respondents. However this level of knowledge especially by the inmates needs to be improved upon by awareness creation. High PTB burden and poor control policies within prisons potentiate high attributable risk. Implementation of current national or international cell occupancy recommendations would reduce TB transmission by 50% and 94% respectively especially now that there is increase in the incidence of MDR-TB. Keywords: knowledge; PTB; prison inmates and staff
Dia Ndongo1, Kebe Ousmane1, BoyeCheikhSaad Bouh1, NiangMbayame Ndiaye1
Department of Virology, Instiitut Pasteur of Dakar1
Detection and molecular characterization of Enterovirus D68 in Senegal between July and December 2014
Introduction: Despite its first isolated from hospitalized children with pneumonia and bronchiolitis in California in 1962, human enterovirus D68 (EV-D68) has been recognized as an emerging respiratory pathogen in the last decade when it caused outbreaks in several countries. The most recent and largest epidemic of EV-D68 associated with severe respiratory disease began in North America and spread everywhere in the worldwide between August 2014 and January 2015. However, in African countries the epidemiology of EV-D68 remains largely unexplored. This study aims to investigate the circulation and molecular characterization of EV-D68 in Senegal between July and December 2014.
Methods: A total of 435 swabs samples collected through routine influenza like infection (ILI) or acute respiratory infection (ARI) surveillance activities between August and December 2014. Samples collected were tested using the EVD68 specific real-time RT-PCR. Molecular characterization was made by amplification of the VP1 regions, followed by nucleotide sequencing.
Results: EV-D68 infection was laboratory confirmed among 15/435 (3.45%) samples tested using real time RT-PCR. The majority (12/15; 80.0%) of the EV-D68 cases were detected in October. Children under 5 years are more vulnerable to EV-D68 infection with a frequency of 60%. Phylogenetic analysis of the VP1 sequences of 14 EV-D68 cases, revealed that all sequences belonged to the A2 variant of clade A viruses. The VP1 sequence of these strains displayed sequence similarities between 99% to 98% with strains A2 found in Germany (KP657740.1) and French (LN6813392) in the same period.
Conclusion: These results shown the real circulation of EV-D68 in Senegal during this period. However, it is necessary to carry on more investigation to better understanding the epidemiology and the impact of EV-D68 in the population.
AminuSakajiki Muhammad2, Ibrahim Yusuf3, Bello Alhaji Mohammed4, Umar Abdullahi5
Department Of Paediatrics, UsmanuDanfodiyo University Teaching Hospital, Sokoto, Nigeria1,
Department Of Medicine, UsmanuDanfodiyo University Teaching Hospital, Sokoto, Nigeria2,
Department Of Paediatrics, Ahmad Sani YarimanBakura Specialist Hospital, Gusau, Nigeria3,
Comparison of xpertmtb/rif assay and the acid fast bacilli in detecting Tuberculosis in Gusau, North-Western Nigeria
Introduction: Nigeria is among countries with highest burden of Tuberculosis (TB) in the world. Diagnosis of TB in developing countries is mostly clinical, often relying on chest X-ray without sputum smears. Diagnosing extra pulmonary TB is more difficult due to low number of bacteria in clinical specimens. GeneXpert MTB/RIF assay is a real-time PCR assay for the rapid diagnosis of Mycobacterium tuberculosis (MTB) and detection of rifampicin (RIF) resistance. This study aimed to compare GeneXpert MTB/RIF assay with microscopy (Ziehl-Neelsen staining) in the diagnosis of TB in our hospital.
Methods: A retrospective review of patients managed at the DOTS clinic of ASYBSH, Gusau, Nigeria following acquisition of the GeneXpert assay machine. Relevant information of patients managed from October 2016 to June 2017 was reviewed including smear microscopy and GeneXpert MTB RIF assay.
Results: Of the 138 patients followed up at the DOTS clinic during the study period, males were 85(61.6%), with a M:F ratio of 1.6:1. There were 27(19.6%) children and 111(80.4%) adults. Majority 118(85.5%) had pulmonary TB and 136(98.6%) were new cases. Only 38(27.5%) were smear positive while GeneXpert MTB/RIF detected MTB in 54(39.2%); of which 3(2.2%) were MTB/RIF resistant, while MTB was not detected in 39(28.3%). There was no significance between gender and AFB detection (p=0.187) nor with MTB detection (p=0.734). Mycobacterium tuberculosis was detected in 37(26.8%) patients with smear positive TB, and in 16(11.6%) with smear negative TB, this was significant (p=0.001). GeneXpert MTB/Rif had a sensitivity of 97.4% and specificity of 69.2%.
Conclusion: Our study showed GeneXpert assay had a good sensitivity but poor specificity in detecting Mycobacterium tuberculosis in our centre. This test was found to be helpful in the diagnosis of TB, especially in patients who had smear negative sputum. Key words- Acid fast bacilli, GeneXpert MTB/RIF, Tuberculosis
Tewodros Haile Gebremariam1
Chales B. Sherman2, Neil W. Schluger3
Addis Ababa Univeristy College of Health sciences1, Warren Alpert Medical School of School of Brown University2, Columbia University College of Physicians and Surgeons3
Asthma exacerbations and related risks factors among patients seen in chest clinic at TikurAnbessa Specialized Hospital in Addis Ababa, Ethiopia
Introduction: Asthma exacerbations are associated with increased disease morbidity and increased utilization of healthcare resources that are often limited in low-resource countries. Identification of asthmatics at greatest risk for future exacerbations may allow a more focused cost-effective approach to care of these patients. The objective of this study was to identify risk factors for asthma exacerbations in chest clinic patients seen at the largest public hospital in Addis Ababa, Ethiopia.
Methods: In this cross-sectional study, 182 consecutive patients with physician diagnosis of asthma seen in chest clinic at TikurAnbessa Specialized Hospital between July and December 2015 were studied. Demographics, asthma symptoms, medication use, and asthma exacerbation in the past 12 months were obtained from the clinic records. Asthma exacerbation was defined as the self-report of worsening respiratory symptoms for greater than 48 hours.Lung function was measured using a Diagnostic EasyOne Plus model 2001 SN spirometer. The institutional review board approved the study protocol.
Results: Among 182 asthma patients in the study, the mean age was 52+12 years; 124(68%) were female. 93(51.1%) had at least one asthma exacerbation in the past 12 months. Patients with asthma exacerbations were more likely to be female (11.05; 95% CI 6.54-15.55; p=0.001),use biomass fuel (9.59, 95% CI 5.21-13.97, p=0.002), and have more incorrect inhaler technique (6.96, 95% CI 2.59, 11.33,0.008) than those without exacerbations. In the multiple logistic regression, female gender(7.93, 95% CI 2.93, 12.94, p=0.005) and incorrect inhaler technique (6.32, 95% CI 1.55, 11.05, 0.012)were found to be significant.Age, comorbidities, controller medication use, and FEV1 were not found to be significant.
Conclusion: More aggressive management of asthmatics that have characteristics of female gender, use of biomass fuel, and incorrect inhaler technique may lessen asthmatic exacerbations. Further prospective studies are needed to confirm these findings.
John Mungai Ngángá2
Ministry of Health, Meru County Government1, Centre For Health Solutions, USAID TB ARC2
Factors associated with Mortality among TB patients in Meru County, Kenya
Introduction: Tuberculosis continue to be a major cause of death in Sub-Saharan Africa despite the concerted efforts between the various players in the region to control the disease. Some of the risk factors identified include malnutrition, TB/HIV Co-infection among others. Meru county is ranked 5th among the high Tuberculosis burden counties in Kenya and it’s also among the high burden counties for drug resistant in Kenya. This study was carried out to determine some of the factors associated with mortality among TB patients in Meru County.
Methods: Retrospective Cohort data of TB patients who started treatment in 2016 was retrieved and analyzed to determine factors associated with mortality among the TB patients and draw comparisons between the various categories of patients.
Results: A total of 3201 were started on treatment during this period, 2307(72%) were males, while 894 (27%) were females. Overall mortality was 4% (127/3201). Mortality among the HIV co-infected patients was 8.8 % (49/569), while among HIV negative was 2.93% (76/2599). Mortality was markedly high among the HIV co-infected patients not on ART at 18.8% (6/32) as compared to those who were on ART at 8.1%. Among the extra pulmonary cases, mortality was 8.3% (37/446). Mortality among the severely malnourished patients was extremely high at 23% (44/181)
Conclusion: Mortality was found to be significantly high (8.8%) among the HIV co-infected patients as compared to HIV negative patients. Mortality was extremely high (18.8%) among HIV positive patients who were not on ART and among the severely malnourished patients. Special attention should be given to TB/HIV co-infected patients and the malnourished. There is urgent need to ensure that all TB/HIV confected patients are started on ART.
Patrick De Marie Chimusa Katoto1
Caroline Michellier2, Michele Dramaix3, Benoit Nemery1, François Kervyn2
Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium and Department of Internal Medicine, Faculty of Medicine, Catholic University of Bukavu, Bukavu, Dem. Rep. of Congo 1,
Royal Museum for Central Africa, Earth Sciences Department, Natural hazards service2, Research Centre of Epidemiology, Biostatistics and Clinical Research, School of Public Health, UniversitéLibre de Bruxelles, Brussels, Belgium3, Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
Respiratory Health Effects of Sulphur Dioxide Air Pollution from the Nyiragongo and Nyamulagira Volcanoes in the Democratic Republic of Congo: a Time Series Analysis
Introduction: Nyamulagira and Nyiragongo volcanoes are located in the east of the Democratic Republic of Congo. Nyiragongo volcano last erupted in 2002, impacting mainly the infrastructures with large lava flows. Regularly erupting, Nyamulagira volcano is during these periods, among the biggest emitters of volcanic SO2 on earth. We investigated the possible temporal and spatial relationship between eruptive emissions of SO2 and acute respiratory illnesses (ARI) in surrounding populations.
Methods: The total flux of SO2 emitted during eruptions since 2000 and the average spatial distribution of SO2 concentrations in the plume (2004-2008) were based on publicly available remote sensing data. The monthly numbers of diseases recorded as ARI among adults and children were extracted from health data collected routinely over 10 years (2000 to 2010). The monthly numbers of ARI recorded during or after eruptions were compared with those recorded before eruptions; spatial distribution was investigated according to altitude and distance from the volcanoes.
Results: Seven eruptions occurred between 2000 and 2011 with discharges ranging from 0.093 kT to 4.5 kT SO2. Of 150 health centers, 78 provided reliable data. ARI were the second most frequently diagnosed conditions, after malaria, and their frequency appeared to increase over the years. Peaks of ARI were observed during the rainy season. No consistent temporal associations between the incidence of ARI and the occurrence or intensity of volcanic eruptions was observed, neither when the whole area was considered, nor when areas at different distances from the eruption site were considered.
Conclusion: Our investigation did not allow us to link volcanic emissions of SO2 with ARI in the surrounding area. This may be due to the methodological limitations of a retrospective study that relied on routinely collected health data, to insufficient knowledge of the size of the exposed populations and to the absence of information on ground level concentrations of SO2, which may not be high enough to affect human health. Nevertheless, Kivu volcanoes are still active, thus justifying the need for measuring the exposure of the population to SO2 and for evaluating the possible adverse respiratory effects of eruptive and continuous exposure to SO2.
Patrick de Marie Chimusa Katoto1;2
Liliane Byamungu3, Patrick De Boever4, Tim NAWROT1, Benoit NEMERY1
Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium1; Department of Internal Medicine, Faculty of Medicine, Catholic University of Bukavu, Bukavu, Dem. Rep. of Congo 2, University of KwaZulu Natal, Department of Pediatric3, Environmental Risk and Health, VITO, Mol, Belgium4
Ambient Air Pollution in Sub-Saharan Africa: a Neglected Risk Factor for Morbidity and Mortality? a Systematic Review
Introduction: Human development index does not accompany the massive urbanization in Sub-Saharan Africa (SSA). Biomass fuel combustion, industrialization and traffic lead to increased exposure to ambient air pollution (AAP). Despite a growing body of epidemiological studies linking AAP’s with deleterious effects to human health, data from SSA are still scarce. We conducted a systematic review of the literature to map the effects of AAP on the health of SSA’s population.
Methods: We comprehensively searched literature in PubMed, Medline-OVID, EMBASE and Scopus databases as well as the grey literature to identify eligible studies from the inception of the electronic databases to February 7, 2017. We excluded studies assessing indoor air pollution or workplace exposures. Two reviewers independently selected studies, extracted data, and appraised studies.
Results: Of the twenty studies included, data covered locations in only seven countries (out of more than 40) across SSA and more than half conducted in South Africa (SA). Most studies were community-based cross-sectional surveys (15/20). Overall, studies included the general population but seven studies focused on children, two on elderly people, and one on mother-child pairs. Urban/industrialized suburbs were compared to rural/non-industrialized suburbs. Residences in close proximity to roads/mine dumps/refineries were compared to residences far away from these pollution sources. Only five studies assessed the “criteria air pollutants” as defined by the USEPA. Exposure was measured via questionnaire or estimated via aggregated data and rarely personalized or measured continuously using monitoring stations. No studies, except from SA, were based on reliable morbidity or mortality statistics at the level of the region or the country. Self-reported respiratory symptoms were mostly reported. Children and the elderly were found to be more susceptible to the deleterious effect of AAP. Only half of studies clearly defined group comparability.
Conclusion: Rapid urbanization in SSA is associated with rising levels of AAP, the exposure to which is detrimental to the health of people living in the region. Our review indicates that we know little about AAP related-diseases in SSA outside SA. International and national efforts are necessary to address this neglected risk factor to improve quality of life in this region.
Victor Kimathi Kirimi1
Ministry of Health, Kenya1
Epidemiology of Tuberculosis in 3 Maximum Prison Health Facilities, Kenya
Introduction: Kenya is ranked 13th among 22 high-burden tuberculosis (TB) countries in the world. Prisoners form a group of society with a high risk of tuberculosis. In Kenya, there was an estimate of 55,000 prisoners in 2016 with a TB morbidity rate of 10%.We analysed surveillance data to describe TB cases, assess the trends, determine the TB/HIV co-infection and treatment outcomes among patients in Kenyan prison health facilities.
Methods: I reviewed Tuberculosis data from Prison health facilities, between January 2012 and December 2015 and collected data on patient socio-demographics, treatment information and outcomes. A case of TB was defined as bacteriologically confirmed smear positive. Data was downloaded from the TB online register and entered into epi info 7 for analysis. Descriptive analysis was done where means were calculated for continuous variables and proportions for categorical variables.
Results: A total of 4474 cases were analyzed of which male were 3557(80%). The mean age was 33 years (±12.7), 1549(30%) were in the age group 20 -30 years and 1019 (23%) were from Nairobi county. Most had Pulmonary TB cases (3782, 82%). Smear positive cases were 1536 (34%) in 2012, 1397 (31 %) in 2013 and 1493 (33%) in 2014. Out of 2039 smear positive cases at month 0, 452 (22%) tested positive for HIV. Overall treatment success rate was 81 %, 153 (3%) died, 9 (0.2%) had treatment failure and 475 (11%) transferred out to other clinics. Out of the 9 cases with treatment failure, 3 (33%) were diagnosed with multidrug resistant TB.
Conclusion: TB burden was high in males, there was minimal change in the trend over the three years and most cases were from Nairobi County. Our findings indicated lower treatment success rate than the WHO targets so there is need for scale up the patient treatment follow ups.
Lindsay Zurba2, Eligi Shao1, Kelvin Mortmer3, Stellah Mpagama3
Kibong'oto Infectious Diseases Hospital1, Spirometry Training Service Africa CC, South Africa2, Liverpool School of Medicine and Tropical Diseases, UK3,
Deploying Spirometry for characterizing non-communicable chronic respiratory diseases at a National TB Hospital in Tanzania: Patterns and Associated factors.
Introduction: Spirometry is an important tool for assessing pulmonary function in people presumed with respiratory pathology, however the test is not widely available in resource-limited settings. We aim to describe the pulmonary function of the presumed cases of respiratory diseases after integrating spirometry in the diagnostic algorithm of respiratory diseases at Kibong’oto Infectious Diseases Hospital.
Methods: Cross section study where by consecutively, medical charts of patients attending the Kibong’oto National TB hospital from March - December 2017; were reviewed from those undergoing spirometry at the outpatient department after excluding the pulmonary tuberculosis diagnosis.
Results: Baseline Spirometry test was performed in 69 patients who had a mean age of 41 years ± 16 (SD). Male were 40(58%), whereas 14 (20%) had co-infection with human immunodeficiency virus. Additional co-morbidities were severe and moderate malnutrition in 9 (13%) and 5(7%) respectively. Pastoralists, peasants and working in mining as small scale miners were 36 (52%), 23(33%) and 4(6%) respectively. Patients with respiratory symptoms such as cough, chest pain, difficult in breathing were 44 (64%), 39(56%) and 22(32%) accordingly. Thirty-eight had previous history of PTB; 15 (22%) had one episode of TB treatment while 24(35%) had twice or more episodes. Patients with normal pre bronchodilators FEV1/FVC were 49(71%) while 19 (28%) had abnormal values. Abnormal radiographic findings for available films were in 58 (84%) patients; interstitial lung diseases, lung collapse, lung infection were in 14(20%), 6 (9%) and 14(20%). Only occupation in particular peasants and age >65years were statistically significant associated with FEV1/FVC 70%; p values were 0.04 each.
Conclusion: Comprehensive lung management in the primary health care in countries like Tanzania is urgently required as majority of communities are peasants.
A. Arsène Kpangon1
Albert Comlan Dovonou1, Salmane A. Amidou1, Simon Dansou1, M. Julie Hounnouga1, MaximeAle Boni1
Université de Parakou Service de Médecine Interne du Centre HospitalierDépartemental et Universitaire du Borgou1
Risk factors for pulmonary tuberculosis treatment failure in rural settings in Benin, West Africa: A cohort study
Introduction:Tuberculosis (TB) remains a public health issue particularly in North-East of Benin with high frequency of TB treatment failure. The aim of our study was to identify the risks factors of TB treatment failure in rural North-east settings, Bembèrèkè, Benin (West Africa).
Methods:This was retrospective cohort study. We included smear positive pulmonary TB patients who began TB treatment between 1st January 2007 and 31st January 2011 extracted from TB registry. The outcomes of TB treatment were defined according to 2007 WHO guidelines. Failure was defined as remaining smear positive at month 5 or later during TB treatment for smear positive pulmonary TB cases . Treatment successes was defined as being either smear negative (cured) at month 5 of later of treatment or having completed TB treatment in situations where sputum smear microscopy was not done.. The died cases were those who deceased for any reason during TB treatment. For reason of analysis we also defined composite outcome (failure or death). After univariate analysis, multivariate analysis with .05 as level of significance was done focused on socio-demographic variables, HIV status, acid fast bacilli score at baseline.
Results: Two hundred sixty four (264) of two hundred seventy (270) pulmonary TB patients were included in final analysis. The median age was 35 years (IQR=28-46). Twenty three (23) failed on TB treatment with frequency of 8.6% % [5,5%-12,6%]. In multivariate model, positive HIV status (OR, 10.38; 95%CI, 1.77-60.91; P=.01) and male gender (OR, 4.34; 95%CI, 1.03-18.28; P=.046) were each significantly associated with increased risk of TB treatment failure. Only positive HIV status (OR, 12.86; 95%CI, 4.27-38.27; P.0001) remained significantly associated to composite outcome.
Conclusion: Positive HIV status and male gender are the potential risks factors of TB treatment failure. The association between positive HIV status and composite outcome confirmed the deadly association of TB and HIV. We need to really integrate HIV and TB activities in all levels of health system
Sandra Kwarteng Owusu1
Diane Gray1, Ibrahim Bandeker2, Shaakira Chaya1, Diana Marangu1, Adaeze Ayuk 1, Noor Ain Noor Affendi1
Aneesa Vanker 1,Komala Pillay3, Marco Zampoli1
Division of Paediatric Pulmonology and Red Cross War Memorial Children’s Hospital, Department of Paediatrics and Child Health and MRC Unit on Child and Adolescent Health University of Cape Town1
Division of Radiology and Red Cross War Memorial Children’s Hospital, Department of Paediatrics and Child Health, University of Cape Town2
Division of Histopathology and Red Cross War Memorial Children’s Hospital, Department of Paediatrics and Child Health, University of Cape Town3
Hypersensitivity pneumonitis in an 11-year-old girl presenting to a tertiary hospital in Cape Town, South Africa
Introduction: Hypersensitivity pneumonitis (HP), is an immune- mediated inflammatory lung disease caused by inhalation of various antigenic organic particles.HP is a rare interstitial lung disease which is uncommon in children. Repeated exposure provokes an exaggerated immune response of the small airway and lung parenchyma among susceptible individuals .
Methods: We present an 11-year old girl referred to Red Cross War Memorial Children's Hospital, with a two month history of cough, dyspnea on exertion, weight loss and prolonged exposure to pigeons bred at home. Significant findings on physical examination were digital clubbing and bilateral crepitations. She had restrictive pattern on spirometry with vital capacity of 1.12litres, LLN 1.50 and Z-score --3.3 SD, moderately impaired diffusion capacity of the lungs 8.7ml/min/mmHg, LLN 13.5 and desaturated (SaO2) to 86% on exercise testing .
Chest radiograph, revealed diffuse interstitial pattern, while high resolution chest tomography(HRCT) showed extensive bilateral centri lobular opacities, honey comb cysts and emphysematous changes of both upper lobes and fibrosis with traction bronchiolectasis and localised airspace opacification of the right lower lobe.
Broncho alveolar lavage (BAL)showed a mixed cellular profile and positive Gene Xpert. Lung biopsy confirmed HP and immunoglobulin G(IgG) antibody to pigeon mix was also markedly elevated (>200mg/l range 0.02-21).
Results: She was commenced on oral cortocosteriods , hydroxy-chloroquine , antigen avoidance and anti TB medications with marked improvement in lung function and symptoms.
Conclusion: This case highlights the importance of a comprehensive history, high index of suspicion and thorough investigation in diagnosing interstitial lung diseases in childhood amenable to treatment .
Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex1
Case Management of Active Tuberculosis(TB) at the Chest Clinic of Connaught Hospital in Freetown, Sierra Leone
Introduction: Sierra Leone is among the top thirty high TB burden countries in the world. Major factors that contribute to this high TB burden are TB/HIV co-infection, lost to follow up and late presentation to health facilities. Our study assessed TB treatment outcomes and HIV co-infection at Chest Clinic of Connaught Hospital in Freetown, Sierra Leone.
Method: A retrospective study design was used to collate data from treatment cards of TB patients registered at Chest Clinic in 2016. Information from 1127 treatment cards were entered into an excel sheet, stored and analyzed using SPSS version 21.Variables were summarized using mean, standard deviation, frequencies and proportion. Associations between age, sex, type of TB and HIV status were tested with treatment outcomes using chi square. Level of significance was at 5%.
Results: The predominant age group of patients treated at the center was 25-34 years. Approximately 2.7 %( 31) were children below 15 years. Most (778, 69%) patients were males and public facilities were the most common (572, 50.8%) source of referral. Acid fast bacilli (AFB) smear was done prior to anti-TB therapy in 91.1 %( 1027) of patients and 53.0 %( 544) of these were AFB smear positive. Nearly two-thirds (340, 62.4%) showed a degree of “1+” positivity on microscopy. A significant proportion (993, 88.1%) of the patients were new and predominantly (1024, 90.9%) in category I. Pulmonary TB accounts for 96.8% (1091) of patients treated in this center. With a treatment success rate of 57.3%, about a quarter (279, 25%) of the patients was lost to follow up.
Nearly all (1105, 98%) registered active TB patients were tested for HIV. About 31.9% (352) of patients were positive for HIV. Only 14.2 %( 50) and 35.2 %( 124) of HIV infected patients had documentation showing commencement of co-trimoxazole preventive therapy and antiretroviral drugs, respectively.
Age, sex, type of TB, type of patient and HIV status have significant associations with treatment outcomes of TB patients.
Conclusion: With a high proportion of lost to follow up, especially in HIV co-infected patients, we recommend for increase effort in TB case management and strengthening TB/HIV collaboration at the Sierra Leone’s largest DOTS center.
MbatchouNgahane Bertrand Hugo¹,², Chamsadine M1, Mapoure N Y1,2, KenmegneC2, Mbahe S2,
LumaNH2, Doualla MS2
Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon1
Department of Internal Medicine, Douala General Hospital, Cameroon2
Sleep-disordered breathing in stroke patients in a Subsaharan Africa setting
Introduction: Sleep-disordered breathing describes a group of disorders characterized by abnormalities in the frequency and/or depth of breathing while asleep. the most common type is the obstructive sleep apnoea/hypopnoea syndrome. stroke is a risk factor for SDB and can also be a complication. The aim of this study was to determine the prevalence and risk factors for SDB among patients with a past history of stroke at the Douala General Hospital (DGH).
Methods: It was a cross-sectional study carried out in the Neurological Unit of the Douala General Hospital. For at least 3 months. Were included in the study, patients aged 15 years and above with a past history of stroke diagnosed by brain imaging. Patients with other chronic respiratory diseases, cerebral veinous thrombosis, sub-arachnoid hemorrhage or bedridden were excluded. Sociodemographic, clinical data and oximetric parameters data and Mallampati's score were collected. Epworth sleepiness scale and Stopbang questionnaire were also administered. SDB was diagnosed with continuous arterial oximetry over one sleep night. The SDB was defined by an oxygen desaturation index greater than or equal to 5 per hour. The Chi-2 test was used to investigate the risk factors of SDB. Factors with p inferior to 0.005 were then integrated into a multivariate logistic regression model to identify the independent factors associated with SDB.
Results: A total of 110 patients were recruited. Among them, 72 (65%) were male giving a sex ratio of 1.8. The median age was 58.50 years (interquartile range 52 - 63). The prevalence of SDB was 71.8%. Factors associated with SDB were: android obesity (p = 0.001), higtMallampati score (p=0.003) and high score of the Stopbang questionnaire (p = 0.017). After multivariate analysis, only android obesity (OR 3.75; 95%CI 1.41- 9.99; p = 0.008) and a high score of Mallampati (OR 4.37; 95%CI 1.15 - 16.61; p = 0.030) appeared as independent associated factors for SDB.
Conclusion: Three patients out of four stroke victims had an SDB. Screening and management of android obesity could reduce the burden of post-stroke sleep disordered breathing.
MbatchouNgahane Bertrand Hugo2, EkonoBitchong Claire Françoise1, LumaNamme Henry2
Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon1Department of Internal Medicine, Douala General Hospital, Cameroon2
Clinical aspects and outcome of hemoptysis in the respiratory unit of the Douala General Hospital, Cameroon
Introduction: Hemoptysis is the spitting of blood coming from the lower respiratory tract. Its unpredictable nature requires an etiological approach and adequate therapeutic management. The aim of this study was to describe the clinical aspects and the outcome of patient with hemoptysis in the respiratory unit of the Douala General Hospital.
Methods: The study was carried out in the pneumology unit of the Douala General Hospital. It was a descriptive study including records of patients with hemoptysis, aged 15 years and above who were admitted in the unit between January 2009 to December 2016. Socio-demographical data, clinical characteristics, causes of hemoptysis and outcome were collected using a structured data collection sheet. Data were analyzed using SPSS version 20 software. Ethics approval was obtained from the ethical review board of the University of Douala.
Results: A total of 183 records of patients were included during the study period. The male to female sex ratio was 1.65. The mean age of patients was 43.43 ± 16.58 years. The 25 to 34 age group was the most affected. The majority of our patients were living in Douala (72.7%). Hemoptysis was of mild abundance in 84.2% of cases, moderate in 9.8% of cases, massive in 6.0%. Mild anemia was found in 50 patients (35.97%). Sputum smear for acid fast bacilli was performed in 121 patients of whom 44 (36.4%) had a smear positive. The chest X-ray was performed in all patients and was abnormal in 94.5% of cases. Bronchoscopy was performed in 63 patients (34.4%). It was normal in 35 patients (55.6%). The main etiologies were pulmonary tuberculosis (33.88%), sequellae of tuberculosis (27.87%), acute bacterial pneumonia (15.85%), and lung cancers (13.93%). The outcome was marked by death in 6.01% of cases.
Conclusion: Our study showed that hemoptysis affects men more than women. The 25 to 34 age group is the most affected. Hemoptysis of mild abundance was predominant and accompanied mostly by mild anemia. Pulmonary tuberculosis (active or sequellae) was the most frequent cause followed by bacterial pneumonia.
Eric Mubiana1, Kondwelani Mateyo1, Shabir Lakhi1, Peter Mwaba2
University Teaching Hospital- Zambia1, APEX Medical University2
A case series report of Tuberculosis patients with Vitamin D deficiency in Zambia
Introduction: An association of Vitamin D deficiency with Tuberculosis remains a valid assumption. It has been observed that TB is highly prevalent in certain ethnic groupings and regions of the world. Populations with darker skins are prone to vitamin D deficiency. The regions inhabited by people with darker skin coincides with high TB burden settings. Vitamin D has a key role in immune modulation of the host response to Mycobacterium Tuberculosis. Studies have demonstrated early sputum culture conversion to negative, clinical recovery and radiological improvement with Vitamin D supplementation. However, there is currently no consensus on the advantages of its supplementation in TB treatment. We present the first case series report of pulmonary TB patients with severe deficiency of Vitamin D in Zambia. Additional data from randomised control studies is warranted.
Keywords: Vitamin D, Mycobacterium Tuberculosis, Immune Modulation
Gershorm Chongwe1, Veronica Shichizya1, Shabir Lakhi1
University Teaching Hospital1
Multidrug-resistant tuberculosis patients presenting with bronchiectasis and usefulness of the six-minute walk test: A case series report with literature review.
Introduction: Multi-drug resistant Tuberculosis (MDR-TB) is associated with extensive lung damage which impinges on the quality of life during and post-treatment. The six-minute walk test (6-MWT) demonstrates significance in predicting the cardiopulmonary functional status in tuberculosis patients with bronchiectasis. We present a case series of MDR-TB patients with the multifarious manifestation of bronchiectasis and response to the 6-MWT. We found Bronchiectasis can occur in primary MDR-TB, which is attributed to overwhelming inflammatory response and delay in diagnosis. Mycetoma was a common complication. The 6-MWT was found to be useful as a bedside tool for predicting functional status. MDR-TB should be promptly diagnosed to prevent life-limiting sequelae. The findings in this case series challenge the assumption that MDR-TB is less virulent and calls for more studies to understand its pathogenesis. Keywords: MDR-TB, Bronchiectasis, 6-MWT
Tamirirashe C Mahwire1, 2
Moleen Zunza3 Tafireyi Marukutira4, 5, Pren Naidoo6,7
HIV and AIDS/STI/TB Department, Port Shepstone Regional Hospital, Port Shepstone, South Africa1
Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa2
Centre for Evidence Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town3
Centre for Population Health, Burnet Institute, Melbourne, Australia4
School of Public Health and Preventive Medicine, Monash University, Melbourne5
Bill and Melinda Gates Foundation6
Desmond Tutu TB Centre Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences Stellenbosch University7
Impact of Xpert® MTB/RIF Assay on MDR-TB Treatment Success Rates in a Health District in South Africa
Introduction:Xpert® MTB/RIF assay rapidly diagnoses rifampicin resistance enabling early initiation of second line TB treatment. However, the impact of an earlier MDR-TB diagnosis on treatment outcomes is unknown. The study aimed to compare MDR-TB treatment outcomes in cases diagnosed with smear/culture and Xpert®.
Methods: A retrospective cohort study with cohorts defined by the diagnostic assay used in presumptive TB cases. Data were extracted from DR-TB registers including cases from January 2012 to April 2014. Treatment outcomes were assessed at recorded clinical end-points or after two-years for those completing treatment.
Results: 718 patients were enrolled into study. Cure rate (n=148)43.4% in smear/culture group and (n=118)33.5% in Xpert group. [p=0.01]. There were no significant differences between the two groups in terms of gender; age and referral facility .The smear/culture group had a higher proportion of previously-treated TB cases (p<0.01). In the smear/culture cohort 272 of 354(76.3%) and in the Xpert cohort 271 of 345(78%) were HIV positive. Treatment success rates were 195(54.0%) Smear/culture and 159(45.2%) Xpert® cohort (p=0.01). Xpert® reduced Median time to MDR-TB treatment initiation to 18.7 days from 75 days in smear/culture group (p =0.01). Predictors of treatment success. Xpert® diagnosis adjusted Odds ratio (aOR=0.38, p<0.01) and male gender (aOR=0.57, p=0.02) were associated with treatment success. Xpert® increased risk of being lost to follow up (aOR 2.55 p <0.01), time to sputum culture conversion from 4 to 5months (log rank test p=0.01). Time to treatment initiation was not associated with treatment success in logistic regression analysis.
Conclusion: Despite rapid treatment initiation, MDR-TB treatment success rates were poorer in those diagnosed with Xpert®MTB/RIF assay and in males. Additional studies are required to assess possible factors influencing DR TB outcomes.
Eunice Wandia Mailu1
Benson Ulo2, Enos Masini3, Jane Ong’ang’o4, Maureen Kamene1
Ministry of Health - National Tuberculosis, Leprosy and Lung Disease Program (NTLD-P)1
Amref Health Africa Kenya2, World Health Organization (WHO)3, Kenya Medical Research Institute (KEMRI)4
Contribution of community health volunteers in referral of tuberculosis patients in Kenya: A validation
Introduction: Studies have shown that incorporating the services of Community Health Volunteers (CHVs) in TB control programmes can lead to early detection of TB cases, minimizes the number of missed cases and ultimately helps in achieving desired health outcomes. In Kenya, all Presumptive TB cases referred by CHVs, if confirmed with TB should be recorded in the facility TB register as having been referred by a CHV. However, the proportion of TB patients referred by CHVs has remained constantly very low at 4% for the last five years despite the intensive investment under the support of Global Fund. The objective of this study was to determine the actual proportion of notified TB patients that are referrals by CHVs and identify the factors that may be contributing to their incorrect recording and reporting in Kenya.
Methods: This was a cross sectional study of patients in intensive phase of treatment for drug sensitive TB in Kenya conducted between January to April 2017. Data was collected using a pre-designed mobile phone electronic based questionnaire in KOBO collect. Data was analyzed using SPSS and descriptive analysis was conducted to get the proportion of patients referred by CHVs. Inferential statistics were also conducted to determine the factors contributing to incorrect documentation of patient referrals while Multivariate analysis was used to control for confounders.
Results: The proportion of TB patients referred by CHVs was 18%. First point of entry at the health facility was found to be a factor for correct or incorrect recording and reporting. At every entry point of the health facility, the proportion of incorrect recording was higher than correct recording with an overall incorrect recording of 72%. The Odds of being recorded correctly if TB clinic was the first entry was (1.859 95%CI1.003-3.446). Out of the 355 patients who said they were referred by a CHV, only 88 (24.8) were notified to the national TB program as referral by CHVs.
Conclusion: The proportion of TB patients referred by CHVs in Kenya is higher than what is usually reported. Incorrect reporting is associated to health system related problems contributing to poor documentation at all levels. However TB clinic being the first point of patient entry when referred by a CHV has emerged to be more beneficial in ensuring correct reporting. The greatest loss of documenting CHV referrals is during notification to the national TB programme.
Joyce Mbula Manthi1
Sybil Nakitare1, Lawrence Mwaniki1, Jared Mecha2, Catherine Njigua1
Christian Health Association of Kenya (CHAK), Kenya1 ;;University of Nairobi2
Predictors of IPT non-completion in HIV-infected patients in two high-volume faith-based health facilities in Kenya
Introduction: Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Administration of Isoniazid Preventive Therapy (IPT) reduces the risk of developing active TB among PLHIV. In 2014, Kenya, a high TB burden country, in line with the WHO guidelines rolled-out administration of 6-month IPT to all eligible PLHIV. Completion rates have been sub-optimal, with paucity of studies to ascertain why. CHAP Uzima is a CDC funded HIV care and treatment program working in faith-based and affiliated health facilities in Kenya. We set out to assess the patient level predictors of IPT non-completion among PLHIV.
Methods: This was a retrospective cohort analysis of routinely collected program data in two high volume CHAP Uzima supported health facilities. We included all TB-free HIV infected adults and children aged above 2 years who were initiated on IPT between July 2015 and July 2017. Data was abstracted from an electronic medical records system. Multivariate analysis was carried out to determine predictors of IPT non-completion.
Results: Of the 3,563 patients initiated, 756 (21%) did not complete IPT. Median time to non-completion was 3 months (IQR 3-4). Predictors of non-completion were age below 25 years (OR=1.5, p=0.002, CI 1.157-1.907), having detectable viral load (OR=3.5, p0.005, CI 2.33-5.17) and currently being on second-line antiretroviral therapy (OR=1.2, p=0.04, CI 1.01-1.30). Patients aged 15-19 years had the highest non-completion rate (31%). There was no statistical difference by baseline CD4 count for patients with IPT non-completion (OR=0.951, P=0.563, CI 0.802-1.127).
Conclusion: Among PLHIV initiating IPT in CHAP Uzima supported health facilities, non-completion is more likely in patients who are younger and more so adolescents, patients on second line therapy and those classified as virally unsuppressed. Programs initiating IPT should consider paying closer attention to these patient groups including enactment of patient treatment preparation and enhanced adherence counselling prior to IPT initiation. More studies on the specific reasons for non-completion are recommended.
Maureen Wahinya1, Jared OngechiMecha1, George Omondi Oyoo1, Elijah Nyainda Ogola1
University of Nairobi School of Medicine1
Peripheral arterial disease among patients with chronic obstructive pulmonary disease attending the chest clinic at a tertiary hospital in Nairobi, Kenya
Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Cardiovascular disease (CVD) has been shown to be the leading causes of death among COPD patients. Peripheral arterial disease (PAD) is an atherosclerotic process that is characterized by an increased risk of coronary and cerebrovascular ischemic events. PAD has been shown to occur with greater frequency among COPD patients compared to the general population. There is no data on the burden of PAD among COPD patients in Kenya. We carried out the study to determine the prevalence of PAD and the prevalence of some associated cardiovascular risk factors among COPD patients at a tertiary urban hospital in Nairobi, Kenya.
Methods: Patients with a spirometry diagnosis of COPD attending the chest clinic in KNH were consecutively recruited until the minimum desired sample size of 78 patients was achieved. Ankle-brachial index (ABI) was measured using a handheld Doppler device, and blood samples were drawn to analyse for fasting lipid profile, fasting blood sugar and high-sensitivity C- Reactive Protein (hsCRP).
Results: The overall prevalence of PAD was 7.5%. Hyperlipidaemia was the most common cardiovascular risk factor at 47.5%, followed by hypertension at 46.3% and diabetes at 8.8%. Twenty-one percent of the patients were obese, and 96.3% of the patients had hsCRP levels >3mg/l. Only two patients had symptomatic PAD.
Conclusion: The study demonstrated a low prevalence of PAD and a high prevalence of PAD-associated cardiovascular risk factors among our COPD patients. Of the patients who had PAD, only two were found to be symptomatic.
Joyce Bwombengi1, Dr George Nyale2, Dr Joshua Kayima1, Dr Jared Ongechi Mecha1
University of Nairobi School of Medicine1, Kenyatta National Hospital2
Prevalence and associations of non-smoking chronic obstructive pulmonary disease at a tertiary hospital in Nairobi, Kenya
Introduction: Non-smokers comprise a substantial proportion of patients with chronic obstructive pulmonary disease (COPD). Its pathogenesis is poorly understood and documented. No previous studies have been conducted to evaluate its prevalence and associated risk factors in Kenya. This study sought to establish the prevalence of non-smoking COPD among patients on follow-up for COPD at a tertiary level hospital in Kenya.
Methods: We conducted a cross-sectional study among patients followed up with a diagnosis of COPD a chest clinic at a tertiary level facility. Spirometry was performed on consecutive participants with a diagnosis of COPD. Those meeting the criteria for fixed airway disease (FEV1/FVC 70% predicted) completed an interviewer-administered questionnaire to identify selected risk factors for COPD on the basis of previous studies. We defined non-smoking COPD as a post-bronchodilator FEV1/FVC) 70% in a person who had not smoked tobacco.
Results: Between February and May 2016, 84 patients satisfied the inclusion criteria and consented to participate in this study. Males accounted for 72.6% of the participants. The prevalence of non-smoking COPD was 39.3%. The main risk factors in these participants were poorly controlled asthma (66.7%), exposure to biomass fuel (81.8%), history of childhood respiratory tract disease (40.6%) and history of tuberculosis (36.4%).
Conclusion: Non-smoking COPD is common and is associated with low socioeconomic background with a strong history of biomass fuel exposure (from poor ventilation in the cooking area), recurrent childhood pulmonary infections, past tuberculosis, and poorly controlled or chronic asthma.
Carole Okoth1, Julius O Oyugi1, Titus M Munyao1
University of Nairobi School of Medicine1
Diagnostic value of a lateral flow-urine lipoarabinomannan assay in adults with suspected pulmonary Tuberculosis at two urban hospitals in Nairobi, Kenya
Introduction: Tuberculosis (TB) remains a leading cause of morbidity and mortality globally, with low and middle-income countries being disproportionately affected. We sought to determine the diagnostic value of the lateral flow urinary lipoarabinomannan (LAM) assay as a point-of-care diagnosis assay among adult patients with active pulmonary TB.
Methods: The study population consisted of ambulatory and hospitalized patients being investigated for active pulmonary TB at two urban hospitals in Nairobi, Kenya. 241 consecutively sampled adults presenting with features of pulmonary tuberculosis were included. Urine samples were obtained for ULAM assay and; sputum samples for Ziehl-Nielsen microscopy, XpertMTB/Rif test and liquid TB culture. All participants received counselling and testing for HIV infection. CD4+ cell counts were determined for HIV positive patients. Sensitivity, specificity, positive and negative predictive values of the TB diagnostic tests were computed; the liquid culture was used as the gold standard.
Results: Sensitivity of the urine LAM assay was low when applied to a heterogeneous population, 28.6% (95% CI, 20.6-38.3%). The sensitivity in the HIV negative was, 12.7% (95%CI 6.4-23.5%) compared to 58.8% (95%CI 42.2-73.6%) in HIV infection. When combined with sputum ZN microscopy, then with sputum XpertMTB/Rif test, sensitivity increased to 70.6% and 96.2%, respectively. In HIV infection, sensitivity of the urinary LAM assay increased as the CD4+ count decreased being 76.5%, (95% CI 52.1-90.8%); 65.4% (95% CI 46.1- 80.6%) and 33.3% (95% CI 6.2-79.5%) at CD4 cell counts 50, 200 cells/microliter respectively.
Specificity of the urine LAM assay was lower when applied to the HIV positive compared to the HIV negative population, 85.1 % (95%CI 74.4- 91.8%) versus 93.6% (95% CI, 86.4-97.3%) respectively.
Conclusion: The lateral flow urine LAM assay, as an easy to perform, point-of-care test, can contribute to improvement in case detection of pulmonary TB especially among TB/HIV co-infection with severe immunosuppression (CD4+ counts of ≤200 cells/microliter).
Nicholaus Peter Mnyambwa1,2, Esther S Ngadaya2, Kimaro Godfather2, Dong-Jin Kim1, Rudovick Kazwala3, Pammla Petrucka1,4, Sayoki G Mfinanga2
School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania1. National Institute for Medical Research, Muhimbili Medical Research Centre, Dar esSalaam, Tanzania2. Faculty of Veterinary Medicine, Sokoine University of Agriculture, Morogoro, Tanzania3,College of Nursing, University of Saskatchewan, Saskatoon, Canada4
Assessment of sputum smear-positive but culture-negative results among newly diagnosed pulmonary tuberculosis patients in Tanzania
Introduction: Diagnosis of pulmonary tuberculosis (TB) in technology-limited countries is widely achieved by smear microscopy, which has limited sensitivity and specificity. The frequency and clinical implication of smear-positive but culture-negative among presumptive TB patients remain unclear.
Methods: A cross-sectional study was conducted to identify the proportion of nontuberculous mycobacteria (NTM) infections among 94 “smear-positive culture-negative” patients diagnosed between January 2013 and June 2016 in selected health facilities in Tanzania.
Results: Out of 94 sputa, 25 (26.60%) were GeneXpert® mycobacteria TB positive and 11/94 (11.70%) repeat-culture positive; 5 were Capilia TB-Neo positive and confirmed by GenoType MTBC to be Mycobacterium tuberculosis/Mycobacterium canettii. The remaining 6 Capilia TB-Neo negative samples were genotyped by GenoType® CM/AS, identifying 3 (3.19%) NTM, 2 Gram-positive bacteria, and 1 isolate testing negative, together, making a total of 6/94 (6.38%) confirmed false smear-positives. Twenty-eight (29.79%) were confirmed TB cases, while 60 (63.83%) remained unconfirmed cases. Out of 6 (6.38%) patients who were HIV positive, 2 patients were coinfected with mycobacteria.
Conclusion: The isolation of NTM and other bacteria among smear-positive culture-negative samples and the presence of over two-thirds of unconfirmed TB cases emphasize the need of both advanced differential TB diagnostic techniques and good clinical laboratory practices to avoid unnecessary administration of anti-TB drugs.
Keywords: Nontuberculous mycobacteria (NTM); Pulmonary TB; smear-positive; culture-negative; Tuberculosis (TB) diagnosis
Kimesh Naidoo1;2, Visva Naidoo2, Refiloe Masekela2
Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, UKZN1, University of KwaZulu-Natal, Nelson R Mandela School of Medicine2
Management of Bronchiolitis in a HIV Endemic Area: Are Standard Treatment Guidelines being followed?
Introduction: Bronchiolitis is a common cause of lower respiratory tract infection in children.
Standard Treatment Guidelines (STG) have been developed to optimise bronchiolitis care at hospital level. The extent of its use and factors influencing guideline adherence is not known in South Africa.
The objective of the study was to determine whether the STG for the bronchiolitis management were utilised in the management of children admitted with bronchiolitis at King Edward VIII Hospital, Durban, KwaZulu–Natal.
Methods: This study was a retrospective chart audit of children admitted between 1st January 2015 and 31st December 2015. Data including demographics and treatment modalities was collected. Guideline adherence assessment was based on the protocolled management of bronchiolitis as stipulated by STG 2013. For categorical variables (HIV exposure, nutritional status), subgroup comparisons according to adherence were made using Chi Square and Fisher’s exact tests. Wilcoxon Rank Sum test was used for testing associations between length of hospital stay and protocol adherence.
Results: One hundred and ninety-two infants were enrolled. Of these 66% were HIV-exposed. The majority (92%) were well nourished. Full adherence to STG was found in 24% of participants. There was no association between adherence to STG and HIV-exposed/unexposed status and to nutritional status respectively, p>0.05. The mean length of hospital stay was not significantly different depending on adherence or non-adherence 5.1 versus 4.3 days, respectively. One death was reported in the non-adherent group.
Conclusion: There is poor adherence to the STG for bronchiolitis, though this did not impact morbidity and mortality. Future multi-centre studies with the recently published bronchiolitis recommendations assessing adherence to protocols with pre- and post-intervention studies after training of personnel, may provide more evidence of the implications of lack of guideline adherence.
Refiloe Keketso Mopeli1
Charl Verwey1, Mamaila Lebea1, Paul Adams1
Faculty of Health Sciences, University of Witwatersrand. Chris Hani Baragwanath Hospital1
A Case of Haemoptysis in a Girl with Noonan Syndrome
Introduction: Haemoptysis is the expectoration of blood originating from the lower respiratory tract. It is uncommon in children, but can be life threatening. The most common causes are respiratory tract infections, aspirated foreign bodies and bronchiectasis. Noonan syndrome is an autosomal dominant condition characterised by distinctive facial features, congenital heart disease and multiple comorbidities including haematological abnormalities. Bleeding disorders have been reported in up to 65% of patients with NS. Perfusion of the lower respiratory system arises from the pulmonary arterial circulation and the bronchial circulation, and bleeding may arise from either.
Methods: Case report: We describe a seven year old girl with Noonan Syndrome who presented with recurrent episodes of haemoptysis from 6 years of age. She was known with pulmonary stenosis, with transannular patch repair, and post-operative severe pulmonary regurgitation. Initial work-up suggested a diagnosis of Von Willebrand disease, as her Von Willebrand factor activity was 37%, with an acute pneumonia as the cause of haemoptysis. Chest x-ray and computed tomography scan showed a right lower lobe (RLL) dense consolidation. Flexible bronchoscopy revealed an inflammatory polyp with 75% obstruction of the orifice of the RLL. The inflammatory polyp and lobar pneumonia were then thought to be the cause of the haemoptysis, which was exacerbated by her underlying haematological abnormality. She was treated with antibiotics, however the haemoptysis persisted. She underwent cardiac catheterisation and an angiogram showed a tortuous right bronchial artery forming a confluence with an abnormal vessel arising from the right common carotid artery with extravasation of blood into the RLL. She had a successful right bronchial artery embolization and was stable post-procedure. After a further rigid bronchoscopy the patient had another episode of haemoptysis. Ultimately a lobectomy was performed and no further bleeding reported.
Conclusion: Although this patient had NS with an increased risk of bleeding, the cause of her haemoptysis was an abnormal bronchial artery supplying blood to the right lower lobe. This case illustrates the importance of being systematic when investigating any patient with haemoptysis, as the cause may be unrelated to the underlying diagnosis.
Vasco Chikwasha1, James January1
University of Zimbabwe , College of Health Sciences1
Department of Community Medicine
Prevalence of respiratory symptoms among small-scale wood furniture workers in the Zimbabwe informal sector industry
Introduction: Occupational exposure to wood dust has been implicated in respiratory health problems ranging from impaired lung function, chronic bronchitis and asthma. In Zimbabwe, there are numerous small-scale wood furniture workers operating under poor working conditions due to economic hardships.These workers are exposed to multiple occupational hazards such as wood dust, cotton dust and environmental pollution. There is no morbidity and mortality data on respiratory health of wood furniture workers in Zimbabwe. The aim of this study was to determine the most common respiratory symptoms among small scale wood workers and also estimate exposure levels.
Methods: A descriptive cross-sectional survey was conducted amongsmall-scale wood furniture workers at Glenview Home Industry. A modified British Medical Research Council interviewer administered questionnaire on respiratory symptoms (cough, phlegm, wheezing and breathlessness), employment history and smoking habits was used for data collection. Total inhalable wood dust samples were collected using 3-peice dust collectors with 37 mm glass fibre filters. Five area(static) samples and 5 personal samples were collected at strategic points over a minimum period of 4 hours and analysed by gravimetric methods . Results were analysed using Stata version 13.
Results: A total of 161 participants were recruited with median age 25.4 years, IQR (22.5-31.4 years). The prevalence of respiratory symptoms was 77.6% (95%CI 71.1-84.1). The prevalence by individual symptom was; cough 52.2% (95% CI 44.4 - 60.0), phlegm 49.7% (95%CI 41.9 - 57.5), wheezing 41.6% (95%CI 33.9-49.3), and breathlessness 21.7% (95%CI 15.3-28.2). Comparatively, personal wood dusts samples were higher than area wood samples. Out of the 5 personal samples, the minimum total dust concentration was 0.6mg/m3 and the maximum was 26.2mg/m3. For the 5 area samples, the total dust concentration ranged from 0.6mg/m3 to 11.7mg/m3.
Conclusion: Prevalence of respiratory symptoms amongst small-scale wood furniture workers is very high. Majority of findings from exposure samples (both area and personal) showed levels above the set American Conference of Government Industrial Hygienists Occupational Exposure Limits (2014) for soft wood dust. Results suggest the need for targeted interventions that focus on the reduction of wood dust exposure among wood furniture workers.
Willy Ssengoba2, Bruce Kirenga2, Achilles Katamba2, Moses L Joloba2
Makerere University Lung Institute2, Makerere University, Kampala Uganda2
Health Seeking Behavior among Individuals with Cough symptoms at regional referral hospitals in Uganda; Missed opportunity for early Tuberculosis Diagnosis
Introduction: Studies on delays in Tuberculosis (TB) diagnosis in Africa have revealed not only patient important factors but also health system inefficiencies. We assessed the health seeking behavior among individuals who were presumptive TB cases presenting with a cough symptom at regional referral hospitals.
Methods: A cross sectional study of adult presumptive TB patients conducted from October 2015 to December 2016 at five (%) regional referral hospitals in Uganda. All study participants were interviewed about TB symptoms, health seeking behavior following cough symptoms and had a GeneXpert test done.
Results: Of the 1,862 participants interviewed, majority 1,795 (99.9%) reported cough as a symptom, followed by fever 1223 (68%), weight loss 1192 (66.4%), night sweats 1161 (64.6%) and hemoptysis 235 (13.1%). Of the respondents, 1,352 (75%) had sough care for their cough and this was mainly at public health facilities (60%), followed by private health facilities (21.4%), and drug stores/pharmacies (13.5%). Of those that sought care at public health facilities, only 27.5% were asked to provide a sputum sample. Only 13.5% of those that sought care from a private health facility were asked to provide a sputum sample. The estimated crude odds ratio of the association between seeking care at a private health facility and positivity on GeneXpert was 1.5 (95% CI 1.1-1.9), p=0.011
Conclusion: Cough is a main symptom for presumptive Tb patients at regional referral hospitals. The study revealed there are still health system inefficiencies for patients that make an attempt at seeking care that could result in delayed diagnosis especially in instances where patients aren't asked to provide a sputum sample for testing. Improved TB diagnosis at first contact with the health care system has the potential to increase TB case finding and break the cycle of transmission in the community.
Jithan Koshy Koshy1, Akinwumi Ogunrombi1, Vhusani Sididhza2
University of Witwatersrand1, Klerksdorp/Tshepong Hospital2
Early Outcomes of Minimally Invasive Video Assisted Thoracoscopic Decortication: A Single Centre Initial Experience
Introduction: The role of video-assisted thoracic surgery (VATS) approach in inflammatory thoracic conditions has not been widely accepted. The adoption of this approach by sporadic units has shown its' effectiveness in the management of advanced stages of empyema. Our study aims to show that the etiology and stage of empyema does not significantly alter the outcomes of minimally invasive decortication.
Methods: We retrospectively reviewed 34 patients from October 2015 to November 2017 who underwent minimally invasive clear-out and decortication for empyema at the Klerksdorp/Tshepong Hospital cardiothoracic unit.
Results: We performed a total of 37 VATS decortications on 34 patients, the male: female ratio was 3:1 and 67% was due to trauma, 32% was non-traumatic (66% were due to TB and the rest were post-pneumonic, and a case of complicated liver abscess). Of the two etiologic sub-groups, 66% of the non-trauma and 28% of trauma group were HIV positive. In the non-trauma group 33% had active TB and 33% had a previous history of TB. The early post mortality rate for the entire cohort was 0%. There was no statistically significant difference between the trauma vs non-trauma groups in the operative time (131±51mins vs 135±5 mins, p=0.44), mean blood loss (732 mls vs 894mls, p=0.26), conversion rate (8% vs 8.3%), reoperation rate (16% vs 0% p=0.28) and hospital stay (15±14 days vs 15±12 days, p=0.49) respectively. The majority of conversions were in those needing reoperation. All the reoperations were in the trauma group and a sub-group analysis showed that the reoperation rate was not significantly different (p=0.55) in those with stage II empyema (16%) versus stage III (0%).
Conclusion: Minimally invasive clear-out of the pleural space and decortication of the lung is a technically feasible operation regardless of the etiology or stage of empyema. Our sample size constitutes a small cohort and an early experience and we therefore plan to conduct a prospective study to further evaluate this surgical approach.
Makerere University Lung Institute1
Health workers’ practices in assessment and management of children with respiratory symptoms in primary care facilities in Jinja district Uganda: a descriptive study
Introduction: Asthma is the most common chronic childhood condition worldwide, with increasing prevalence in middle and low-income countries. However, asthma is largely under-diagnosed, particularly in children less than five years. Diagnosis of childhood asthma is largely reliant on good history and physical examination. We aimed to describe the health workers’ practices in diagnosis and management of respiratory illnesses among children, with emphasis on asthma, in rural primary care centres in Uganda.
Methods: Health workers´ clinical practices were observed during consultations with children under five years who presented with cough and/or difficult breathing. A short interview with the caregiver was conducted following the consultation and so was a short health facility survey. Data was analysed using descriptive statistics.
Results: Fifty (50) health workers were observed during 220 consultations at six different health centers. Average consultation time was 4 minutes (IQR 3 to 5). The key symptoms of asthma: recurrent cough, difficult breathing and wheezing, were elicited in only 5% of the consultations. The respiratory rate and chest in-drawing were assessed in only 10%. Pneumonia and asthma were diagnosed in 36 (16.5%) and asthma in 1 (0.5%) of the consultations. Antibiotics were prescribed to 32% of all the children but to only 39% of the children diagnosed with pneumonia. In majority (95%) of consultations, health workers did not explain the diagnosis and management plan to the caregivers.
Conclusion: Clinical practices among Ugandan health workers in primary care are insufficient to aid correct identification of children with asthma and other respiratory diseases among young children. Irrational use of antibiotics is widespread. Interventions to improve the health workers’ awareness, knowledge and skills for diagnosis and management of asthma are urgently needed. Clinical practices among Ugandan health workers in primary care are insufficient to aid correct identification of children with asthma and other respiratory diseases among young children. Irrational use of antibiotics is widespread. Interventions to improve the health workers’ awareness, knowledge and skills for diagnosis and management of asthma are urgently needed.
Ronan Doyle1, Rachel Williams1, Judith Breuer1, Alex Pym2
Division of Infection and Immunity, University College London, UK1, Africa Health Research Institute, Durban, South Africa2
Whole genome sequencing Mycobacterium tuberculosis directly from sputum identifies more minority variant mutations than sequencing from culture
Introduction: Mycobacterium tuberculosis high-throughput whole genome sequencing (WGS) reveals the presence of minority genetic variant (MGV) single nucleotide polymorphisms (SNPs) representing mycobacterial subpopulations within individual patients. WGS is usually performed on cultured isolates, even though this can alter the original population structure, because WGS directly from sputum without enrichment yields insufficient DNA for deep genome coverage. Oligonucleotide enrichment technology SureSelectXT (Agilent, CA, USA) can obtain purified M. tuberculosis DNA directly from sputum. Here we compare MGVs identified sequencing from enriched sputum and culture.
Methods: Paired sputum samples from 36 patients (22 with drug-sensitive tuberculosis [DS-TB] and 24 with rifampicin-resistant [RR] TB) were analysed. DNA was extracted directly from one sample, with the other inoculated into MGIT (mycobacterial growth indicator tube) until flagging positive. DNA from sputum samples underwent SureSelectXT enrichment. All samples were sequenced on a NextSeq.
Bioinformatics analysis was performed using CLC Genomics Workbench v10. Mapping was performed to H37Rv and MGVs called when a when more than one nucleotide was reported at a genetic location, each with minimum 10 supporting reads including one in each direction. Variants in or near PE/PPE regions were excluded.
Results: Total number of MGVs in sputum and MGIT samples are shown in the table. Mean coverage was similar between MGIT and sputum samples (191.1 vs 184.3, p=0.89). Sequencing directly from sputum identified median 24 MGV per sample compared to 10 in MGIT (p0.001), and more than twice as many MGVs across the dataset.
Conclusion: Sequencing directly from sputum identifies more MGVs than from MGIT. This contrasts to one other study that has sequenced directly from sputum, but may be due to greater coverage depth and patient numbers here. These results concord with other data suggesting that subculture leads to a loss of MGVs. Direct sputum sequencing may better represent true mycobacterial genetic diversity within patients.
Noor Ain Noor Affendi1
Sandra Kwarteng Owosu1, Komala Pillay2, Marco Zampoli1
Division of Paediatric Pulmonology and Red Cross War Memorial Children’s Hospital, Department of Paediatrics and Child Health and MRC Unit on Child and Adolescent Health University of Cape Town1, Division of Histopathology and Red Cross War Memorial Children’s Hospital, Department of Paediatrics and Child Health, University of Cape Town2
Metastatic thyroid carcinoma of the lung – a case report
Introduction: Thyroid carcinoma is rare in children and accounts only 0.5-3.0% of childhood malignancies. It is commonly presents as a painless neck nodule. The clinical behavior is aggressive in children with regional nodal metastasis occurring 60-80% and 20% of cases respectively at presentation.
Methods and results: We discuss a 9 years old girl who presented with severe respiratory distress and hypoxia with 3 months history of weight loss and chronic cough. On examination, she was cachexic with proptosis. There was bilateral hard-matted cervical lymphadenopathy. Chest x-ray showed diffuse reticulonodular infiltrate pattern without lymphadenopathy. Presumptive diagnosis of disseminated tuberculosis was made before lymph nodes histology confirmed papillary thyroid carcinoma. Unfortunately, she succumbed after 6 days of admission and mechanical ventilation. Post mortem tru-cut biopsy of both lungs confirmed metastatic thyroid carcinoma of the lung.
Conclusion: Lung metastasis disease, although rare, should be considered in the differential diagnosis of a child who presents with reticulonodular pattern infiltrate on chest radiograph as without early diagnosis and treatment, prognosis will be poor.
Irikefe Paul Obiebi1
Oyibo, Patrick Gold1
Delta State University Teaching Hospital1
Effect of wood smoke on the respiratory Health of Workers in a semi-urban community in Niger Delta, Nigeria
Introduction: The process of charcoal production exposes workers directly to wood smoke. Persistent inhalation of wood smoke causes irritation of the respiratory tract and precipitates respiratory diseases as well as exacerbates symptoms of pre-existing conditions. This study aimed to assess the effect of wood smoke on the respiratory health of charcoal workers in a semi-urban community in Niger-Delta, Nigeria.
Methods: This cross-sectional comparative study involved equal numbers of traders matched age, height and sex for charcoal workers. A modified version of British MRC questionnaire on chronic work-related respiratory symptoms among workers was employed to assess respiratory symptoms. Indices of lung function capacity were measured with a hand-held spirometer. SPSS v 22 was used for analysis. Odds ratio, McNemar’s, paired t, and chi-square tests were performed to test significance between exposure and outcome. Logistic regression was used to adjust for smoking, domestic biomass use and age.
Results: Charcoal workers had higher prevalence of respiratory symptoms than controls: chronic cough (9.5% vs. 0.0%), productive cough (13.5% vs. 3.6%), breathlessness (19.6% vs. 13.5%), nasal discharge (34.9% vs. 16.2%), chest tightness (8.8% vs. 0.0%) and wheeze (8.8% vs. 5.4%). Association of work duration and job description with respiratory symptoms was not significant (p > 0.05), although workers were more likely to have chronic cough, productive cough, wheeze, breathlessness, chest tightness and nasal discharge. Only wheeze was significant after adjusting for age, biomass use and cigarette smoking, (OR: 4.22; CI = 1.37 - 12.99). More charcoal workers had COPD (9.5%) than occupational asthma (6.7%); no control had these conditions. Predicted values of FVC, FEV1, FEV1/FVC ratio and PEFR were higher among controls than charcoal workers; however the difference was not significant (p > 0.05). The mean values of FEV1 and FVC were considerably lower for workers, whereas FEV1/FVC ratio and PEFR were higher among workers (p 0.05).
Conclusion: Respiratory symptoms and diseases were more prevalent among charcoal workers who also had reduced lung function capacity. Instituting interventions to reduce workers’ exposure would be an all-important course to pursue if they are to remain healthy and in business.
Irikefe Paul Obiebi1
Patrick Gold Oyobo1, Godson Eze1
Delta State University Teaching Hospital1
Air quality at charcoal kiln sites in a developing nation, Sub-Saharan Africa
Introduction: In Nigeria, at least 1 in 10,000 persons dies from diseases caused or worsened by air pollution every year. Charcoal production is majorly fraught with emission of wood smoke which significantly pollutes air; even fine particles in the smoke can be persistently suspended in air and be inhaled by unsuspecting persons in the environment. Such pollutants are known to instigate and complicate respiratory diseases culminating in deaths in those affected in Niger-Delta. This study aimed to estimate the concentration of air pollutants at charcoal production sites in a community in Niger-delta, Nigeria with a view to highlighting how far they deviate from WHO air quality standards.
Methods: This is a cross-sectional study in which air quality was assessed at charcoal kiln sites with a hand held air tester model CW-HAT 200 (measured particulate matter concentration) and gases were measured with environmental sensor kits Z-1300(SO2), Z-900(H2S), Z- 1200(O3), Z-700(NO), and Z-1500(NH3). Analysis was done with SPSS and ANOVA compared mean differences in air pollutants. Air quality index was calculated using PM2.5 because it is a pollutant majorly derived from combustion of wood.
Results: he maximal PM2.5 and PM10 values at the kiln sites ranged from 20µg/m3 to 1064 µg/m3, and 23µg/m3 to 507µg/m3 respectively. At majority (83.3%) of the sites PM2.5 and PM10 were higher than WHO standard. The mean concentrations of PM2.5 and PM10 were 146.58µg/m3 and 359.33 µg/m3 respectively, and were 5 times more than WHO standard. The air quality at one third (33.3%) of all the sites was very unhealthy but highly hazardous at a site; only two sites had moderately healthy air quality. Average concentrations of ozone, hydrogen sulphide and ammonia at charcoal production sites were significantly higher than within 100meters of the sites and 500 meters away. However, nitric oxide was highest within a 100meters of the sites. The average concentration of sulphur dioxide was higher than WHO standard.
Conclusion: The concentrations of air pollutants from charcoal production are enormous and deviate from acceptable limits. Charcoal workers would need to use improved devices which emit lesser amount of toxic substances for their long-term health benefit.
Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town1
Outcomes of bullectomy in a South African patient cohort
Introduction: Bullous lung disease (BLD) is not uncommon in the South African population and commonly presents as a spontaneous pneumothorax (SP). The objective of the study was to ascertain the indications for bullectomy and short-term outcomes of the procedure.
Methods: An ongoing retrospective study of patients who underwent bullectomybetween (2011-2017) at the Groote Schuur Hospital. Preoperative data (demographics and symptomatology), intraoperative and postoperative data were collected.
Results: Records of 54 patients were reviewed so far. Male to female ratio was 2:1 with a mean age and body mass index (BMI) of 44 years (±13.4) and 21.8 (± 4.5) respectively. Previous pulmonary tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) were seen in 44.4% and 33.3% respectively. Most of the patients (57.4%) had a Modified Medical Research Council (MMRC) Scale of 1, while 46.3% were current smokers. Most patients (65%) presented with a broncho-pleural fistula (air leaks) with a mean duration of 10.2 days (± 13.4) with the most common preoperative diagnosis being secondary SP (50%). Operative approach was by video-assisted surgery (32 patients,59.3%) or thoracotomy (22,40.7%) with 6 patients being converted to thoracotomy (18.7%). Operative finding was stage IV bullae (> 2cm) in 70% of patients. Pleurectomy accompanied bullectomy in 78% of patients. The mean duration of the operation was 95.6 minutes (± 39.8); thoracotomy (121 minutes), VATS (77.8 minutes). There was a high complication rate of 50% with air leaks in 25 of 27 patients (92.5%) with a mean chest tube duration of 7.5 days (± 5). The mean duration of intensive care unit (ICU) stay was 22 hours and this was mainly for postoperative epidural analgesia. None of the patients required postoperative mechanical ventilation. The mean postoperative hospital stay was 9.7 days (± 6.6). There were no postoperative deaths. The mean follow-up duration was 1.65 months (± 1.68).
Conclusion: Bullectomy/pleurectomy is a safe and effective treatment for SP secondary to bullous lung disease and with a low recurrence rate.
PATS MECOR & University of Benin Teaching Hospital, Benin City Nigeria1,
Department of Clinical Pharmacology & Therapeutics, University of Benin, Benin City, Nigeria2
Prescription Costs in Two Tertiary Hospitals in Midwestern Nigeria
Introduction: Prescription costs account for a significant proportion of the healthcare budget in developing countries with implications for affordability and access to health care. Routine analysis of medicine costs (using the WHO complementary drug use indicator) is necessary to generate data for planning. This study assesses the prevailing cost of medicines in tertiary institutions in Mid-western Nigeria.
Methods: In a cross-sectional study, 1800 prescription orders from January to December 2014 in two tertiary hospitals were analyzed using the WHO complementary drug use indicator tool. Data obtained from prescription orders including medicines prescribed, cost assigned to each medicine and aggregate cost for each prescription were analyzed according to the WHO recommended guideline for complementary indicators. All costs were based on the current price list of each hospital. The values are expressed as (Mean +-SD) and percentages.
Results: A total of NGN 3, 667, 548 (USD11, 461) was spent for all the 1800 patient encounters (USD 1 = NGN 200 as at 2014). The cost per prescription ranged from NGN 0 to NGN 43, 950 (USD 0 to USD 219.75). The average cost per prescription was NGN 2037.53 +-2515.72 (USD10.19). Percentage of total drug cost spent on antibiotics was 16.2%, injections and antimalarials accounts for 8.2% and 8.1% respectively while 75.7% of total cost was spent on all other therapeutic categories of drugs.
Conclusion: Prescription cost remains a major consideration in the Nigerian healthcare system noting the high poverty level (minimum wage NGN 18,000 i.e USD 90 per month). The findings are a reflection of what obtains in most other healthcare facilities in the country and calls for determination of the causative factors and institution of a pricing mechanism.
NGN = Nigerian Naira
USD = United States Dollar
Ijeoma Nkem Nina Okedo1
Department of Community Medicine, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria1
Knowledge and Attitude about Obstructive Sleep Apnea among Resident doctors in Ebonyi State, South-East Nigeria
Introduction: Majority of Obstructive Sleep Apnea (OSA) patients in Nigeria remain undiagnosed and untreated, speaking to the need for increased awareness and suspicion among clinicians so that patients can receive optimal management. The knowledge and attitude of resident doctors in Nigeria towards obstructive sleep apnea is not well documented. The aim of this study was to assess the knowledge and attitudes about OSA among Resident doctors in Nigeria.
Methods: A cross-sectional study surveyed 148 Resident doctors selected by systematic random sampling from specialties of the Federal Teaching Hospital Ebonyi state, South-East Nigeria. Information was collected using a validated self-administered OSA Knowledge and Attitudes (OSAKA) questionnaire. Data was analysed using SPSS version 20 with significant level set at 95%.
Results: Of the 148 respondents (response rate, 100%), males were 107 (72.3%) and females were 41(27.7%). Majority (75%) were aged 30-39 years with 64.5% of them in the medical specialties. Mean of knowledge score was 9.03±3.16 with 59.5% having above average knowledge. Ever having managed a patient with OSA symptoms was significantly associated with good knowledge of OSA (P=0.000) but no difference by specialty, gender or undergraduate training on OSA was observed. The mean positive attitude score was 3.23 ± 1.16 with 92% and 95% considering OSA and its identification important respectively. 63-70% were confident in their ability to identify and manage OSA patients. Postgraduate training on OSA, good OSA knowledge and having managed an OSA patient were associated with confident attitude. (P=0.000; P=0.0012, P=0.001 respectively) On logistic regression, having managed OSA patient before was a determinant of good knowledge (Odds ratio [OR] 4.38, Confidence Interval [CI] 1.92, 9.98). Determinants of confidence in identifying and managing high risk patients were postgraduate training (OR 3.17; CI 1.42, 7.14, OR 3.48; CI 1.56, 7.75 respectively) and ever having managed a patient with OSA (OR 2.51; CI 1.05, 5.99; OR 2.56; CI 1.18, 5.55 respectively)
Conclusion: There was good knowledge and attitude about OSA among surveyed resident doctors. Inclusion of trainings on OSA during residency across all specialties is advocated.
Chuka Agunwa1, Ifeoma Okonkwo1, Casmir Ochie1
University of Nigeria Teaching Hospital ItukuOzalla, Enugu State Nigeria1
Care givers knowledge of antibiotic use in children with upper respiratory tract infections and their willingness to learn proper antibiotic use from child educators in Enugu State
Introduction: Antimicrobial resistance (AMR) is a major public health problem. Wrong use of antibiotics in upper respiratory tract infection (URTI) in children contributes to AMR. An objective of the Nigerian AMR action plan is to improve awareness and understanding of AMR through effective communication, education and training. This study the (first of a two-part study) aimed at determining knowledge and practice of caregivers in use of antibiotics for upper respiratory tract infection and willingness to learn proper antibiotic use from child educators (second part follow on study).
Methods: Cross-sectional descriptive study conducted between April and May, 2017 amongst care givers who came to immunize children at 4 primary, secondary and tertiary health facilities in Enugu metropolis. Ethical approval was from the University of Nigeria Teaching Hospital Health Research and Ethics Committee. Data collection was with an interviewer administered questionnaire. Data analysed using IBM SPSS version 20. Discrete variables presented as proportions and continuous variables as means (+ standard deviation). Chi square tests and Fisher’s exact tests performed on categorical variables. P value 80, 60-80%, and 60% were good, fair and poor knowledge respectively.
Results: Total of 292 respondents, mean age 31.5+ 9.2 years with 65.4% being mothers, 13% guardians, 10.6% fathers and 6.5% grandparents. Level of knowledge was 1.4%, 32.9% and 65.8% good, fair and poor knowledge respectively. Majority 60% believed that antibiotics should always be prescribed in URTI and 53.1% knew that antibiotics is used in treatment of bacterial infections. Over half 54.5% had received information on proper use of antibiotics with 45.5% having heard about antimicrobial resistance. A high proportion 74.7% had ever asked doctor to prescribe antibiotics for URTI for the child. Majority 66.1% was willing to learn proper use of antibiotics from their children if taught at school.
Conclusion: There is poor knowledge of antibiotic use in URTI in children and a high demand for doctor’s prescription of antibiotics. Care givers are willing to learn proper antibiotic use from their children if they are taught in school indicating that an opportunity exists for using children as educators in Enugu state contributing to the fight against antibiotic resistance.
Gisèle Badoum1, George Ouedraogo1, Kadiatou Boncoungou1, Soumaila Maiga1
Department of pneumology - YalgadoOuedraogo Teaching Hospital1
Effectiveness and safety of long-term versus short-term treatment regimen of multidrug-resistant pulmonary tuberculosis in Burkina Faso
Introduction: Introduction: The emergence of anti-tuberculosis drug resistance is of big concern in several countries and impede the effectiveness of tuberculosis control worldwide. The treatment protocol in Burkina Faso was a 21 months long-term regimen (LR) and it was costly and burdensome, both for patients and health staff. Following the promising results of Van Deun A. et al in Bangladesh in 2010, Burkina Faso decided, in 2013, to be part of a clinical trial aiming at experimenting the effects of a nine months short-term regimen (SR), under the aegis of the International Union Against Tuberculosis and Lung Disease.
Aim: Compare the efficacy and tolerance of the LR versus the SR multidrug-resistant tuberculosis (MDR-TB) treatment in Burkina Faso
Methods: We compared retrospectively two cohorts of patients who were followed for MDR-TB, from 1 January 2013 to 31 December 2015, in the Pulmonology Services of the University Hospitals YalgadoOuédraogo and SouroSanou in Burkina Faso. The first cohort was under LR, based on the following drugs: pyrazinamide, kanamycin, levofloxacin, ethionamide and cycloserine. The second cohort was under SR, based on: kanamycin, moxifloxacin, prothionamide, isoniazid, clofazimine, ethambutol and pyrazinamide.
Results: A total of 80 patients were included in the study. 47 patients were under LR and 33 ones under SR. There were more retreatment failures in patients under LR than in those under SR (p = 0.00). Also, during follow-up, patients under SR had a higher mean weight than those under LR (p=0.01). Patients with side effects under the SR (51.5%) were not significantly more numerous than those under the RL (51.1%). All SR patients had a smear negative during control of the last three months treatment. There was significantly more therapeutic success in patients under SR (87.9%) than in those under LR (51.1%) (p = 0.00). More deaths were observed in patients under LR than in those under SR (0.00).
Conclusion: The nine months SR is well tolerated and more effective than the 21 months LR. This SR protocol has just been endorsed by the WHO in 2016 yet, a sufficient hindsight is needed to better appreciate its benefits.
Aga Khan University, Karachi1
Potential risk factors for pneumonia among children under 5 years: Findings from Pakistan Demographic Health Survey 2012- 13
Introduction: About 13 million children under 5 years of age die every year in the world, out of which 95% of them are in developing nations, one third of total deaths are due to ARIs. Findings from Pakistan Demographic Health Survey (PDHS) showed that each year approximately 91,000 children die from pneumonia. Hence, identifying potential risk factors associated with acute respiratory infections among children is an important research domain to establish evidence based interventions. So, this study aimed to identify potential risk factors associated with pneumonia among children under 5 years of age from secondary data analysis of Pakistan Demographic Health Survey 2012-13.
Methods: Pakistan Demographic and Health Survey (PDHS 2012-13) is a nationally representative population based random cluster survey. A total of 2429 children under 5 years of age preceding the survey were included in the analysis. Demographic characteristics, potential environmental and socio-economic risk factors were assessed and association were seen for pneumonia. Operational definition of Pneumonia was used as cough accompanied by short, rapid breathing that is chest related.
Results: In the multivariate logistic regression analysis, it was seen that risks of having pneumonia increases among children residing in rural area (AOR: 1.91, 95% CI: 1.31-2.77), in KPK ((AOR: 2.50, 95% CI: 1.29-4.83) and Gilgit Baltistan (AOR: 4.17, 95% CI: 1.86 – 9.35), belong to poorest wealth quintile (AOR: 10.84, 95% CI: 5.60 – 20.99), more among children less than 2 months of age (AOR: 2.86, 95% CI: 1.21 – 6.74), among males (AOR: 1.48, 95% CI: 1.11 – 2.01), having low birth weight ((AOR: 2.83, 95% CI: 1.14 – 7.01), had diarrhea (AOR: 1.62, 95% CI: 1.20 – 2.20), had mother’s smoking exposure (AOR: 1.55, 95% CI: 1.02 – 2.36), using biomass fuel for cooking (AOR: 2.41, 95% CI: 1.62 – 3.55). children were at less risk who ever had vaccination (AOR: 0.73, 95% CI: 0.51 – 0.99).
Conclusion: Identified potential risk factors emphasizing focus on behavioral interventions which target vaccination uptake, hygienic practices and use of safe cooking fuel.
Aysha Zahidie1, Zafar Fatmi1
Aga Khan University, Karachi1
Household expenditure for tuberculosis care, its determinants and coping strategies among adults 18 years and above in Karachi, Pakistan
Introduction: Tuberculosis (TB) remains a major public health burden around the globe. In developing countries, the total cost of TB care often constitutes more than 50% of the yearly income of patients which leads poor into catastrophic situation. So, this study aimed to estimate the average household expenditure of TB care including pre-diagnostic and diagnostic costs among adults attending government health facility in Karachi, Pakistan.
Methods: A cross sectional study was conducted in four government hospitals located in urban setting in Karachi. Non probability consecutive sampling was used to select the participants who have completed at least 1 month of treatment for intensive phase. One standardized questionnaire named, tool to estimate patient's costs was modified and used for getting costs related information. We defined direct medical and non-medical (food and transport) costs as out of pocket payment and indirect costs as loss of productivity. Pre-diagnostic and diagnostic costs were asked and estimates were calculated.
Results: On average, out of 375, 52.1% were female participants with mean age of 32 (±13.7) years spent US$ 55 (includes direct medical and non-medical costs both) as for treatment and follow-up costs for TB care. Approximately, patients spent US$ 70.6 for pre diagnostic and diagnostic costs for TB care. 51.2% patients opted private health care for first place of consultation when they got ill, followed by government facility (44.2%), pharmacy or drug store (3.2%) and dispensary (1.6%). 43.4% of participants were employed formally and informally both. 95.5% of participants have arranged or borrowed money for TB treatment.
Conclusion: For availing TB care, patient and household bear costs for TB care which were highly catastrophic despite of free of charge services have been provided. There is an urgent need to implement strategies for TB care that are affordable for the poor.
Nicolas Meda1, Catherine Bouland2
Laboratoire de Santé Publique (LASAP), Université Ouaga1 Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso1
Environmental and Occupational Health Research Center, School of Public Health, UniversitéLibre de Bruxelles, Brussels, Belgium2
Primary cooking fuel choice and respiratory symptoms among women in charge of household cooking in Ouagadougou, Burkina Faso
Introduction: In developing countries, solid fuels, including biomass fuels, remain the main sources of energy. Approximately 2.5 billion people rely primarily on biomass such as for cooking or heating. Many studies have highlighted the link between indoor air pollution and the occurrence of various health problems including cardiovascular and respiratory diseases, in short, medium and long term. Often in charge of the family food cooking, women are exposed to sometimes high concentration of pollutants contained in the smoke. Hence the purpose of this study that aims to estimate the prevalence of respiratory symptoms in a subset of women in charge of household cooking and assess the association with the type of fuel used for cooking.
Methods: A cross-sectional study was conducted in 3 neighbourhoods of Ouagadougou, involving 1702 women in charge of cooking in their household. Univariate and multivariate logistic regression analyses were performed.
Results: Acute dry cough, breathing difficulties, sneeze, nose tingling and throat irritation are the acute symptoms statistically associated with biomass fuel use if compared to gas butane use, respectively with p-value of 0.000, 0.002, 0.011, 0.031 and 0.000. It is also the case of some chronic respiratory symptoms such as sputum production (p=0.001), shortness of breath (p=0.035) and wheezing (p=0.005). While, self-reported asthma (p=0.140) and chronic cough (p=0.097) are not significantly associated with biomass use as cooking fuel, as it is the case of stuffy nose, runny nose and coughing during effort. When adjusted with age, socioeconomic status and education, dry cough, breathing difficulties, sneeze, throat irritation sputum production and wheezing remain associated with biomass fuel use.
Conclusion: This study confirms that biomass smoke exposure is associated to women respiratory health in Ouagadougou. The use of clean fuels, or in poor context, the improvement of the efficiency of current fuel stoves and energy user behaviours (fuel drying, avoiding smoke exposure as much as possible during cooking, improved kitchen ventilation, properly used and maintained stoves, promoting outdoor cooking) can reduce smoke emission and exposure, and consequently should decrease respiratory health outcomes of these women.
Adama Faye1, Mamadou Fall2, Mor Diaw3, Anta Tal dia1
Institut de Santé et de Développement, BP 16390 Dakar, Sénégal. UniversitéCheikh Anta Diop de Dakar (Senegal)1, UniversitéCheikh Anta Diop de Dakar (Senegal)1,
Laboratoire de ToxicologieetHydrologie, BP 25 064 Dakar-Fann, Sénégal. UniversitéCheikh Anta Diop de Dakar (Senegal)2
Laboratoire de Physiologie et d’explorationsfonctionnellesrespiratoires, BP 5005 Dakar-Fann, Sénégal.UniversitéCheikh Anta Diop de Dakar (Senegal)3
Traffic air pollution and respiratory health effects : a cross-sectional study among bus drivers in Dakar, Senegal.
Introduction: Traffic-related air pollution has been well documented to be associated with increased risks of airway diseases. Bus drivers are exposed to hazards resulting from the inhalation of pollutants from traffic. This study was designed to describe frequency of chronic respiratory symptoms and illnesses as well as its related factors and to assess lung functions among bus drivers.
Methods: This was a cross-sectional study conducted among the bus drivers in HLM, Medina and Petersen districts, Dakar, Senegal. A total of 178 adult men were assessed using a questionnaire inquiring about socio-demographic, respiratory symptoms, toxicological medical evaluation and lung function tests. Logistic regression analysis was done to determine the relationship between various socio-demographic, occupational factors, respiratory symptoms and the respiratory illnesses (chronic obstructive pulmonary disease and asthma).
Results: The results of the study show that 57.9% of bus drivers had a chronic cough, 65.7% had common cold and 53.4% had recurrent headaches. A predominance of these abnormal symptoms was noted in bus drivers located in the HLM district. Lung function tests showed that 38.8% of bus drivers had asthma and 30.3% of COPD. Multivariate analysis found that frequent cold increased the risk of having asthma (OR = 6.3, 95% CI: 1.12-35.79, p = 0.03) and COPD (OR = 7.7, 95 % CI: 1.14-52.8, p = 0.03). The respiratory health status of bus drivers depends on the work area (OR = 3.2, 95% CI: 1.13-9.31, p = 0.02).
Conclusion: Chronic exposure to air pollution from traffic is associated with respiratory symptoms and illenesses and reduced lung function indices among bus drivers.
BaltasaryEtemesi Lubanga2, John Mungai Ng'ang'a3, Eunice Kanana Nteere1
Ministry of Health, Meru County Government.1Kenya Conference of Catholoc Bishops (KCCB)2, Centre For Health Solutions (CHS - Kenya), Tuberculosis Accelerated Response and Care (TB ARC)3
Improving TB treatment outcomes through active tracing by Facility based Health Volunteers in Meru County, Imenti South subcouty, Kenya.
Introduction: Kenya is ranked among the high TB, TB/HIV and drug resistance TB high burden countries. Non-adherence to anti-TB treatment adversely affects treatment Success Rate, contributes significantly to the development of TB drug resistance, increases disease morbidity and mortality. Previous research reported travel expenses, traveling to treatment centers, male sex, poor patient information and communication, alcoholism and homelessness as the major determinants of adherence to anti-TB treatment. According to national leprosy and tuberculosis program 2010 the TB Treatment Interruption rate was 9% which put Kenya among countries with highest Treatment Interruption rate in the region (MOH, 2010).
Methods: Community health volunteers (CHVs) were recruited and trained on defaulter tracing and assigned specific villages/ units where to trace defaulters. Sensitization of TB clinic staff on defaulters tracing and need to keep an up-to-date defaulters list was done to ensure support for CHVs at the clinic level. Frequent meetings with the CHVs were carried out to ensure efforts were on track. Defaulters list was introduced and updated on a weekly basis. Monthly defaulters tracing reports were submitted by the CHVs. CHVs were given a moderate allowances based on the number of client traced and provided with airtime to call defaulters.
Results: A total of 20 CHVs were recruited, trained and assigned different zones where to carry out defaulter tracing. A reduction in LTFU from 39 out of a total 570 (7%) in 2013 to 1.2% in 2014, 2.4 in 2015 and 1.8% (10/557) in 2016. Treatment success rate increased from 88% in 2013 to 94% in 2014 and 93% in 2016.
Conclusion: Active defaulter tracing reduced LTFU from 7% to as low as 1.2% and led to increase of treatment success rate to 94%. Facility based CHVs have the capacity to effectively carry out defaulters tracing with minimal supported and basic training.
Jane Alexandra Shaw1, Coenraad Frederik Nicolaas Koegelenberg1
Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Academic Hospital1
Autologous blood patch for the management of persistent air leak in inoperable patients: a case series
Introduction: Persistent air leak (PAL) after intercostal drain insertion delays lung re-expansion, increases complications, and results in longer hospital stay and higher treatment cost. A proportion of patients with PAL will be inoperable due to severe medical comorbidities and underlying lung disease, and a safe alternative therapy should be sought. It is proposed that the instillation of blood into the pleural space irritates the pleural surface, causing obliteration of the fistula by fibrogenic activity and patch effect, allowing re-expansion of the lung. We present a case series of five inoperable patients with PAL successfully treated with autologous blood patch.
Methods: Five inoperable patients with PAL were treated with autologous blood patch between October 2017 and January 2018. A total of 80-120ml of the patient’s own unheparinized blood was injected via a 50ml bladder syringe which was attached to the intercostal drain, into the pleural cavity. This was clamped for one hour, followed by chest radiography and if bubbling ceased the intercostal drain was removed.
Results: All five patients were successfully treated. The causes of most of the PALs included secondary spontaneous pneumothoraces (n=4) and iatrogenic (n=1). The mean duration of the persistent air leak before pleurodesis was 26 days and a mean time to resolution and removal of intercostal drain was 26 hours. Four patients were discharged within a week of the procedure. One had a prolong hospital stay, but due to medical and social complications unrelated to the procedure.
Conclusion: Autologous blood patch was a viable, safe and cheap intervention for PAL in inoperable cases.
Department of Environmental Health, Mangosuthu University of Technology , Durban, South Africa1,
Discipline of Occupational and Environmental Health, University of KwaZulu-Natal, Durban, South Africa2
Adverse respiratory health in fibreglass reinforcement industry.
Introduction: Fibreglass reinforcement industry employees are exposed to both fibreglass and the agents used in the reinforcing process particularly resins and styrene. They are also implicated with adverse respiratory outcomes. The aim of the study was to determine the adverse respiratory outcomes among employees in the reinforced plastic industry.
Methods: A cross-sectional study was conducted in the fibreglass reinforcement industry based in KwaZulu-Natal, South Africa. The 254 employees were interviewed by answering a questionnaire based on respiratory health and occupational exposures. Lung function tests were conducted for all employees according to SATS standards. Environmental monitoring was conducted for styrene and respirable dust. Total cumulative exposure was calculated for each participant’s lifetime of employment in the company.
Results:The sample consisted of 76.38 % males, with an average age of 39.5 years. The majority of the sample were never smokers (68.90%), while current smokers consisted of 25.59%. Styrene exposure levels for General Laminating department median was 42.81; range (18.03-202.92) and the styrene exposure levels for Fitting department median was 20.68; range (5.2-47.28). The respirable dust exposure level median was 3.28; range (1.18-8.43). The mean exposure duration of employees in the fibreglass industry was 8.06 years (range: 1-39 years).
The prevalence of respiratory symptoms was: chronic cough (15.35%), phlegm (14.17%), breathlessness (6.30%) and wheezing (14.96%). The prevalence of doctor diagnosed respiratory diseases was low: pneumonia (1.57%), chronic bronchitis (1.57%), asthma (2.36%) and pulmonary tuberculosis (7.87%). The mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) of 3.52L/min and 4.39L respectively, among the male and 2.79L/min and 3.54L respectively among females adjusted for age, height and sex.
There was an increased in adjusted odds ratio for symptoms for increase in total cumulative exposure to the pollutants with chronic cough, wheeze and breathlessness odds ratios of 1.02, (95% CI 1.00 -1.04), 1.01 (95% CI 1.00 -1.02) and 1.03 (95% CI 1.02 -1.04) respectively. A statistically significant association (p<0.05) between cumulative exposure for styrene and respiratory outcomes such as chronic cough and breathlessness. Similarly there was a reduction in lung function parameters with exposure. The FEV1/ FVC ratio <70% showed a deficit in the pulmonary lung function of 15.35%. However, these were either marginal or not statistically significant, probably due to sample size.
Conclusion: This study provides evidence that exposure in the fibreglass industry increases the prevalence of respiratory symptoms and is associated with reduced lung function. Greater control of environmental exposures is warranted.