Abbi-Monique M. Bilungula^1,2, Benoit Obel Kabengele³, Jean-Marie Ntumba Kayembe³, Rik Gosselink², Daniel Langer²

¹Department of Physical Medicine and Rehabilitation, Cardio-Pulmonary Rehabilitation Unit, Faculty of Medicine, University of Kinshasa, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo, ²Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit of Leuven, University Hospitals Leuven, Leuven, Belgium, ³Department of Internal Medicine, Pulmonology Service, Faculty of Medicine, University of Kinshasa, University Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo.

E-mail: abbimonique.bilungula@unikin.ac.cd

Introduction: A multidimensional patient assessment enables informed treatment decisions, as well as evaluating the treatment’s effectiveness. Pulmonary rehabilitation (PR) is fundamental in the management of chronic respiratory diseases (CRD). However, referrals to PR services remain insufficient in Africa, partly because assessments identifying which patients might require PR are lacking.

Objective: The objective is to describe the functional characteristics of CRD patients in Kinshasa and to identify suitable candidates for PR.

Methods: Patients diagnosed with chronic obstructive pulmonary disease (COPD), asthma, and post-tuberculosis lung disease (PTLD) consulting Kinshasa hospitals for dyspnea (Modified Medical Research Council (mMRC) ≥ 1) were enrolled. We assessed pulmonary function, functional exercise capacity, and muscle strength, as well as symptom severity and habitual activity levels.

Results: Thirty-eight CRD patients were included (mean age 42 ± 19 years, 55% males). 74% had respiratory muscle weakness; 51% had quadriceps sarcopenia; 67% had low grip strength. The mean distance covered in the incremental shuttle walk test (ISWT) was 659 ± 267 m (72% pred), 34% were inactive, and 45% had mMRC≥2. Anxiety was present in 32%, and moderate-to-high symptom burden (chronic airways assessment test (CAAT) ≥10) in 57%. Forced expiratory volume (FEV1) and FVC were moderately correlated with ISWT performance (ρ = 0.495–0.559; P < 0.002); FEV1 and MIP (ρ = 0.507; P < 0.001), and a moderate and negative correlation between FEV1 and dyspnea (ρ = −0.501; P < 0.002). We found no correlation between pulmonary function and other muscle function outcomes.

Conclusion: Most of the patients were PR candidates due to their several physical impairments. These features, moderately correlated with pulmonary function impairments, suggest that pulmonary function alone cannot be used to identify PR program candidates. Patient referrals for thorough assessment in PR services may contribute to improving CRD management in Kinshasa.

Keywords: COPD, Functional assessment Africa, Pulmonary rehabilitation

Abdirahman Mohamed Hasssan Dirie¹

¹University of Health Sciences, İstanbul, Türkey. E-mail: dirie515@gmail.com

Objectives: Pseudomonas aeruginosa is a key hospital-acquired pathogen with intrinsic and acquired resistance to multiple antibiotics. The global rise in multidrug-resistant (MDR), extensively drug-resistant (XDR), and carbapenem-resistant strains has limited treatment options and increased patient morbidity and mortality. However, data from Somalia are limited.

Methods: This retrospective study analyzed respiratory isolates from patients at the Mogadishu Somalia Türkiye Recep Tayyip Erdoğan Training and Research Hospital. Susceptibility testing followed Clinical & Laboratory Standards Institute guidelines using the disk diffusion method. Data were analyzed by age, sex, antimicrobial class, and resistance severity. Statistical analysis was conducted using SPSS v26, with statistical significance set at P < 0.05.

Results: Of 2,134 susceptibility tests from 219 patients, resistance to at least one antibiotic was found in 38.1% of male and 33.1% of female isolates (P = 0.0298). Resistance was highest among patients aged 80–89 (55.2%) and peaked in 2022 (46.4%). MDR and XDR strains accounted for 10% and 30.8% of isolates, respectively. Carbapenem resistance was higher in females, while aminoglycoside and cephalosporin resistance were more common in males.

Conclusion and Discussion: High levels of drug-resistant P. aeruginosa in respiratory infections – particularly MDR and XDR strains – highlight the urgent need for enhanced antimicrobial stewardship and tailored treatment strategies in Somalia.

Keywords: Antimicrobial resistance, Multidrug-resistant, Pseudomonas aeruginosa, Respiratory infections, Somalia

Abdoul Risgou Ouédraogo¹, Adewale Ogundare,², Eyob Kebede Etissa³, Abiodun G. Tekobo⁴, Jean Pierre Sibomana^5, Collins Ordu⁶, Ghislain Bougma⁷, Bertrand Hugo Mbatchou-Ngahane⁸ Amsalu Bekele⁹, Obianuju B. Ozoh¹⁰

¹Health Sciences Training and Research Unit, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso, ²Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria, ³East African Training Intitative, Addis Ababa, Ethiopia, ⁴Lagos State University Teaching Hospital, Lagos, Nigeria, ⁵King Faisal Hospital Rwanda, University of Rwanda, Kigali, Rwanda, ⁶University of Port Harcourt Teaching Hospital, Port Harcort, Nigeria, ⁷Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso, ⁸Douala General Hospital, Douala, Cameroon, ⁹College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,¹⁰Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.

E-mail: oarisgou@yahoo.fr

Introduction: The burden of chronic obstructive pulmonary disease (COPD) is increasing in sub-Saharan Africa (SSA). Low awareness contributes to underdiagnosis, delayed presentation for care, and poor outcomes.

Aim: The aim of the study is to evaluate COPD awareness and knowledge of its symptoms and risk factors among adults in the seven African cities participating in the Raising COPD Awareness in Africa (RACE Africa) project.

Methods: A cross-sectional community-based survey was conducted in Nigeria (Lagos, Port Harcourt, Katsina), Ethiopia (Addis Ababa), Cameroon (Douala), Rwanda (Kigali), and Burkina Faso (Ouagadougou). A structured questionnaire was used to assess the awareness of COPD, asthma, and human immunodeficiency virus (HIV), respectively, including awareness of their risk factors and symptoms. We used logistic regression to explore the factors associated with COPD awareness. Following the survey, we distributed educational materials in the participating communities and more broadly using social media.

Results: There were 7,327 participants (median age 35 years; 52.3% males), and 26.2% had heard of COPD, with large variation across sites. Awareness of tobacco smoking as a risk factor was reported in 7.3%, while 58.9% did not know any cause. Only 6.6% and 5.6% recognized cough and breathlessness, respectively, as COPD symptoms. In contrast, awareness of asthma and HIV exceeded 90%. Tertiary education was independently associated with COPD awareness (AOR = 1.476, 95% CI: 1.196–1.822, P < 0.001).

Conclusion: COPD awareness in Africa is strikingly low compared to other chronic diseases such as asthma and HIV. These findings highlight the urgent need for large-scale, context-specific education to improve COPD literacy and guide policy prioritization.

Keywords: Africa, Awareness, Community survey, Chronic obstructive pulmonary disease, Risk factors

O. Ojo Oluwafemi¹, I. Ndukwu Chizalu³, C. Ayuk Adaeze³

¹Department of Medicine, College of Medicine, Lagos State University, Lagos, Nigeria, ²Department of Paediatrics, Nnamdi Azikiwe University, Awka, Anambra, ³Department of Paediatrics, University of Nigeria, Nsukka, Enugu Campus, Nigeria.

E-mail: adaraymond@yahoo.com

Introduction: Post-tuberculosis lung disease (PTLD) represents a growing public health concern in tuberculosis (TB)-endemic regions, often overlooked despite microbiologic cure.

Aim and Objective: To describe a case of PTLD in a young Nigerian female and highlight diagnostic and management challenges and the need to think ahead in resource-limited settings.

Methods: We report a 20-year-old who presented with a chronic productive cough and dyspnea, 2 years post-TB treatment. Imaging and spirometry were used to establish the diagnosis. Differential diagnoses were considered and excluded from the study.

Results: Chest CT showed cavitations, fibrosis, and bronchiectasis. GeneXpert was negative. Spirometry revealed a mixed obstructive–restrictive pattern. She was treated with antibiotics, inhaled corticosteroids, mucolytics, and chest physiotherapy with symptomatic improvement.

Conclusion: PTLD may mimic recurrent TB but requires distinct, long-term management. This case underlines the need for integrated post-TB care, including rehabilitation, mental health support, and structured follow-up, in low-resource settings.

Keywords: Post-TB lung disease, PTLD.

Diana Marangu-Boore¹, Nancy Njeri²

University of Nairobi, Nairobi, Kenya.

E-mail: dmarangu@uonbi.ac.ke

Objectives: Sweat testing was previously unavailable in Kenya. Although sweat chloride testing is widely recommended for cystic fibrosis (CF) diagnosis, the point-of-care Nanoduct sweat conductivity system is convenient and could be tractable in low- and middle-income contexts.

Methods: We aimed to determine the feasibility of sweat conductivity testing among healthy and ill children and adults in Nairobi, Kenya. In December 2023, we received a Nanoduct device and pilogels as a donation from the University of Bern, Switzerland, to aid in the diagnosis of CF in Kenya. We conducted a descriptive cross-sectional study and performed sweat conductivity testing among children and adults in three outpatient and inpatient health facilities. To rule out or diagnose CF, we used sweat conductivity cut-off values of <60 mmol/L and ±90 mmol/L, respectively.

Results: Of 12 participants, 6 were male, 8 were hospitalized, and 9 were unwell. The median age was 4 years, IQR (1.9, 8), range (0.06, 45). In five children (aged 21 days, 1 month, 4 years, 8 years, and 8 years) hospitalized in public and private hospitals, we were unable to estimate sweat conductivity despite repeating the test twice. In the seven remaining participants, sweat conductivity was normal and ranged between 33 and 45 mmol/L. No adverse events were reported during testing.

Conclusion and Discussion: Sweat conductivity testing among children and adults in Kenya using the Nanoduct system is feasible. Larger studies in patients with a CF-specific phenotype and concurrent genetic testing for cystic fibrosis transmembrane regulator protein (CFTR) mutations are needed.

Keywords: Cystic fibrosis, Kenya, Sweat testing

Elizabeth Maleche-Obimbo¹, Lynette Mwaura¹, Engi Attia², Eugene Makori¹, Duncan Tumwa³, Christine Kundu⁴, Daisy Chebet⁴, Electine Oyuga Dip⁴, Videlis Nduba⁵, Stephen Graham⁶

¹Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya, ²Department of Pulmonology and Critical Care, University of Washington, Washington, USA, ³Nairobi Regional Hospital, Ministry of Defence, ⁴Department of Research and Programs, Kenyatta National Hospital, ⁵Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya, ⁶Department of Paediatrics, University of Melbourne, Melbourne, Australia.

E-mail: eobimbo@yahoo.com

Introduction: Children and adolescents with human immunodeficiency virus (CAHIV) may experience recurrent and severe lung infections, and are at risk of subsequent residual lung sequelae, which may manifest as impaired lung function.

Objective: We sought to characterize lung function and risk factors for impaired lung function in a cohort of CAHIV on antiretroviral therapy (ART) in Kenya.

Methods: CAHIV aged ≤19 years in care at a public hospital in Kenya were enrolled into a longitudinal cohort study. They underwent clinical evaluation and spirometry at enrolment. Impaired lung function was defined as a spirometer parameter below the lower limit of normal (<LLN) of Global Lung Initiative reference norms. Forced expiratory volume (FEV1), forced vital capacity (FVC), forced expiratory flow between 25^th and 75^th (FEF2575), and FEV1/FVC were measured.

Results: The 248 children were of median age 13.0 (IQR 11.2–16.2) years, 45% were female, all were on ART, 39 (17%) had prior TB, and 81 (34%) had prior pneumonia. Impaired lung function was present in 64 (26%) of the children, 44 (17.7%) had low FEV1, 37 (14.9%) had low FEV1/FVC, 32 (12.9%) had low FVC, and 35 (14.1%) had low FEF2575. Impaired lung function was associated with previous TB (OR 3.1), hospitalization at TB diagnosis (OR 5.0), exercise intolerance (OR 5.5), and chronic cough (OR 2.3), P < 0.05 for all factors.

Conclusion: One quarter of this cohort of CAHIV are living with impaired lung function, with diverse abnormalities including obstructive or restrictive impairment, and previous TB was a risk factor. Structured interventions are needed to provide optimal care specific to their needs.

Keywords: Children and adolescents, HIV infection, Kenya, Lung function.

Heba A. Ali^1, Eman M. Fouda¹, Rana A. Mahmoud¹, Haya E. Ibrahim Ahmed¹, Eslam S. Ahmed²

¹Department of Paediatrics, Division of Pulmonology, Ain Shams University Children’s Hospital, Faculty of Medicine, ²Department of General Practitioner, Ain Shams University Children’s Hospital, Faculty of Medicine, Cairo, Egypt.

Introduction: Growth is a major indicator of health status in children with cystic fibrosis (CF). Growth hormone (GH) stimulates height growth in children and adolescents either by direct effects or the production of insulin-like growth factor 1 (IGF-1); however, its role among children with CF and growth failure is poorly understood.

Aim: This study aims to assess GH levels in CF children and to correlate their relations to nutritional status, clinical parameters, and disease severity among children with CF.

Methods: This cross-sectional study was conducted on 41 CF patients who attended the CF clinic, Children’s Hospital, during the period between January 2023 and January 2024. The study was conducted over 2 phases. In phase 1, nutritional rehabilitation was done for all participants using high-caloric formulas, vitamins, and pancreatic enzyme replacement for six months. Phase 2 included those with non-optimal growth, who underwent further assessment of IGF-1 and GH levels. Then, the association between their levels and anthropometric and clinical data was examined.

Results: IGF-1 correlated positively with weight and height after nutritional rehabilitation therapy, while inverse correlations were observed between IGF-1 and the frequency of pulmonary exacerbations (P = 0.03), days of hospital and ICU admission (P = 0.023, 0.033). GH deficiency was observed among 20% of the patients studied. Moreover, GH levels correlated inversely with age of diagnosis, number of hospital admissions, and emergency visits (P = 0.044).

Conclusion: The current study noted a significant link between GH level in CF children and disease parameters, which highlights the value of treatment with GH in reducing disease severity.

Keywords: Children, Cystic fibrosis, Growth hormone, Insulin-like growth factor-1, Severity

Irene Kinera Kagimu¹, Rebecca Nantanda², Philippa Musoke³, Eric Wobudeya^3,4

¹Baylor College of Medicine Children’s Foundation, Kampala, Uganda, ²Lung Institute, Makerere University, Kampala, Uganda, ³Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda, ⁴Mulago National Referral Hospital, Kampala, Uganda.

E-mail: irenekinerak@gmail.com

Background: Post-tuberculosis lung disease contributes to significant morbidity, but factors associated with this condition are not known, especially among the pediatric population.

Methods: We conducted a cross-sectional study at Mulago National Referral Hospital in Uganda, where we recruited children aged 6–16 years of age who had been treated for Pulmonary tuberculosis at least 6 months after the completion of TB treatment. We collected clinical data, performed anthropometry, spirometry, and collected blood for inflammatory markers (C-reactive protein) as well as data on smoke exposure. Chi-square tests and multivariable logistic regression were used to analyze the predictors of prebronchodilator obstruction, which was defined as FEV/FVC < 90%.

Results: Data for 112 participants were analyzed. The mean age was 9 years +/−2.5 years, 59% were male, and 80% lived in urban areas. 75% reported smoke exposure, including charcoal, firewood, tobacco/cigarettes, or biomass. Median C-reactive protein level was 2.5mg/l, and 10.7% had a CRP ≥ 10mg/L. Pre-bronchodilator obstruction occurred in 11.6% and was sustained in 5.6% after the bronchodilator. The factors independently associated with obstruction included older age (OR 1.45, 95% CI 1.05–2.00, P = 0.023) and CRP > 10mg/L (OR 5.49, 95% CI 1.23–24.50, P =0.026).

Conclusion: Children who survived tuberculosis showed pulmonary impairment, some of which was irreversible after bronchodilator therapy. This study underscores the importance of follow-up following pulmonary tuberculosis treatment in children and adolescents.

Keywords: Post TB lung disease, PTBLD, Children, Uganda.

Jean Pierre Sibomana^1,2

¹Department of Medicine, King Faisal Hospital, Kigali, ²College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda.

E-mail: jepisibo@gmail.com

Introduction: Outbreaks of Marburg virus disease (MVD) have occurred in remote areas, where they caused high mortality. However, MVD has hitherto not been described in an urban area. Here, we describe the unfolding and handling of an outbreak of MVD in Kigali, Rwanda’s capital, to share key points that contributed to reduced mortality.

Results: On September 23, 2024, a hemorrhage appeared, with no clear source, during intubation of patients admitted with severe, unexplained febrile illness to the intensive care unit (ICU) of a tertiary hospital. Viral hemorrhagic fever (VHF) was suspected, but samples sent for dengue, Rift Valley fever, and Ebola proved negative. Tests for MVD requested on September 25 returned positive, thus leading to the declaration of the outbreak on September 27. A mobile hospital was established for all confirmed cases; most were healthcare professionals working in the ICU. Surveillance and contact tracing were activated nationally, and the community health worker program screened all suspects using an established algorithm; all deaths from either the community or other health care facilities were tested before burial. By October 05, due to the high mortality in the center, confirmed cases were shifted to a permanent facility with an ICU setup, including arterial blood gas (ABG), complete laboratory, dialysis, and isolation. A retrospective case review of all febrile patients admitted to the ICU from July to September revealed that the likely index case was a 27-year-old man working in a mine site found to be inhabited by Egyptian fruit bats, the known reservoir of Marburg virus; he had not been severely ill, but his wife died in the ICU with post-partum hemorrhage. Nearly all further cases of laboratory-confirmed MVD (n = 66) could be attributed to nosocomial transmission to patients (n = 15, of whom 4 died) and hospital staff (n = 51, of whom 11 died). Fever was presented in 95% of patients, fatigue in 88%, gastrointestinal symptoms in 82%, hemorrhagic manifestation in 42%, and liver dysfunction in 70%. In the treatment center, beyond supportive care, blood products, inotropes, dialysis, chest tubes, and intubation, investigational drugs such as Remdesivir, MBP091 monoclonal antibodies, and ChAd3-MARV vaccine were used. Two patients could be extubated and are now alive. Psychosocial support was provided for patients, healthcare providers, and affected families.

Conclusion: The outbreak was controlled by a multimodal and multisectoral approach, and the last patient was discharged after 45 days from the declaration of the outbreak. Coordinated leadership, compassionate care, and leadership trust were the cornerstones for a case fatality of 23%, much lower compared to the 80–90% in previous outbreaks.

Keywords: Kigali, Marburg virus, Outbreak containment.

Joseph Pyana Kitenge^,2, Patrick DMC Katoto³, Paul Musa Obadia¹, Lilian Nsenga Mukanda¹, Ida Kabeya Mulaji⁴, Célestin Banza Lubaba Nkulu¹, Steven Ronsmans², Jeroen Vanoirbeek², Mohamed Jeebhay⁵, Benoit Nemery²

¹Université de Lubumbashi, Lubumbashi, RD Congo, ²KU Leuven, Leuven, Belgium, ³Université Catholique de Bukavu, Bukavu, RD Congo, ⁴Université de Kolwezi, Kolwezi, RD Congo, ⁵University of Cape Town, Cape Town, South Africa

E-mail: josephnancy.pyanakitenge@kuleuven.be

Aim: Mineworkers are at increased risk of pulmonary tuberculosis (PTB). However, this has been understudied in the African Copperbelt. We investigated the risk of work in copper-cobalt mining among patients treated for PTB in a large public hospital in Kolwezi, the “world’s cobalt capital.”

Methods: In a case–control study (June–December 2023) we enrolled consecutive patients treated for PTB (cases) and patients without TB history attending the malaria clinic (controls). Trained nurses administered a questionnaire focused on current and past occupational and residential histories of the patient and their household members. Children under 13 years were excluded from the current analysis. Unadjusted odds ratios (OR) with 95% confidence intervals were calculated separately for males and females.

Results: Cases (182 males, 63 females) and controls (168 males, 63 females) differed by age in males (38.3 ± 13.6y vs. 35.7 ± 15.6 y) and females (31.8 ± 13.6 y vs. 33.7 ± 11.8 y). Cases had significantly lower BMI than controls among males (20.9 ± 2.6 vs. 23.4 ± 4.4) and females (21.4 ± 3.2 vs. 26.5 ± 5.2). Reporting a current or past job in artisanal or industrial mining was more prevalent among men (48%) and women (17%) with PTB than among control men (29%) and women (6%), thus yielding significant ORs of 2.3 (1.5–3.6) for men and 3.2 (1.0–11) for women.

Conclusion: In this preliminary analysis, past or current work in mining was strongly associated with PTB in both men and women. Further analyses are being done to adjust for relevant variables. The final study will include hospitals in other areas of the Katangan Copperbelt.

Keywords: Pulmonary tuberculosis, Mining industry, Democratic Republic Congo.

Malyun Muzahim Bajaber¹, Boniface Osano, Lynette Mwaura, Joshua Atunga Mangare, Electine Oyuga Dip, Elizabeth Maleche-Obimbo

¹Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.

E-mail: bajabermalyun@gmail.com

Introduction: Post-tuberculosis lung disease (PTLD) is an important cause of chronic morbidity, and evidence among children in Africa remains scarce.

Objective: The objective is to determine the prevalence, patterns, and factors associated with impaired lung function in children and adolescents after completion of treatment for pulmonary tuberculosis (PTB).

Methods: We conducted a cross-sectional survey among children aged 6–19 years who had completed PTB treatment within the past 3 years in four public health facilities in Nairobi. Participants underwent clinical evaluation, review of medical records, spirometry, and 6-min walk test (6MWT). Impaired lung function was defined using Global Lung Function Initiative reference values.

Results: The 108 enrolled children were of median age 15 years, 54% were female, and 7% were living with human immunodeficiency virus, and 106 (98%) had acceptable spirometry. Lung function impairment was detected in 45% (95% CI 37–56%), with restrictive (26%), obstructive (12%), and mixed (7%) patterns. Persistent respiratory symptoms were reported by 45%, including cough (88%), breathlessness (63%), and chest congestion/ sputum (53%). Exercise limitation was observed in 92.6% (achieved <80% predicted 6MWT distance), and 64.8% experienced ≥3% oxygen desaturation during exercise. Children with abnormal spirometry had a longer duration of symptoms before TB diagnosis than those with normal spirometry (median 8 weeks vs. 4 weeks, respectively, P = 0.039).

Conclusion: Nearly half of Kenyan children and adolescents experienced impaired lung function following PTB treatment, predominantly a restrictive pattern. Delayed diagnosis emerged as a key modifiable risk factor. There is a need for structured post-TB assessment, including symptom, spirometry, and functional assessment, and structured post-TB care.

Keywords: Children, Kenya, Lung function, Post TB lung disease.

Melat Oda¹, Rahel Argaw Kebede¹

¹Addis Ababa University, Addis Ababa, Ethiopia.

E-mail: melattesfaye1990@gmail.com

Objectives: Recurrent wheeze represents a substantial burden on pediatric respiratory health globally, and particularly in resource-limited settings such as Ethiopia. Effective management necessitates a nuanced understanding of its phenotypic classification and associated risk factors. Yet, data characterizing these aspects remain scarce within developing nations, hindering the development of targeted interventions.

Methods: An institution-based unmatched case–control study was done to assess the risk factors associated with recurrent wheeze among preschool children in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia. One hundred and forty-five children participated in the study, with 48 cases and 97 controls. Bivariate analysis was performed to identify potential associated factors for the recurrent wheeze. Variables with P < 0.25 on bivariate analysis were entered on multivariate logistic regression to identify independent risk factors associated with recurrent wheeze in preschool children. The significance of the Odds Ratio (OR) was determined with 95% CI and P < 0.05.

Results: The phenotypic characteristics of recurrent wheezing among the study population revealed that multi-trigger wheezing was present in 27 (56.3%) of the participants. Atopic wheezing was observed in 30 (62.5%) of the children. The study revealed that recurrent wheezing in preschool children was strongly associated with male gender, indoor cooking, and a history of Neonatal Intensive Care Unit (NICU) admission.

Conclusion and Discussion: This study highlights the significant prevalence of multi-trigger and atopic wheezing in preschool children, with male gender, indoor cooking exposure, and a history of NICU admission identified as strong independent risk factors. Therefore, it is better to reduce indoor cooking exposure, particularly in households with young children.

Keywords: Ethiopia, Phenotype, Preschool, Risk factors, Wheezing

Nicola Marozva¹, Diane Gray¹, Heather Zar¹, Adnan Custovic¹, Hantos Zoltán¹, Maresa Botha¹, Carvern Jacobs¹, Lesley Workman¹, Shaakira Chaya¹

¹Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.

E-mail: marozvanicol196@gmail.com

Objectives: Bronchodilator responsiveness (BDR) is a marker of reversible airway obstruction, but its determinants and developmental patterns are poorly described, particularly in low- and middle-income countries. We aimed to describe longitudinal BDR from ages 3–10 years and to evaluate associated factors.

Methods: Children enrolled had pre- and post-bronchodilator oscillometry from 3 to 10 years and spirometry from 6 to 10 years. Oscillometry BDR was defined as ≥40% reduction in resistance at 6Hz or ≥60% increase in reactance at 6Hz; spirometry BDR as ≥10% increase in FEV1 or FVC. Associations with early life factors were assessed using mixed-effects logistic regression. Comparison between oscillometry and spirometry BDR was assessed using Kappa and Spearman correlation.

Results: Overall, 897 children had ≥1 successful BDR assessment, contributing 2833 measurements (average three per child). At age 3, 7% had a positive oscillometry BDR, and 8% at 10 years. Children with a positive BDR at 3 years had greater bronchodilator responses early in life, converging with those of the BDR-negative group by 10 years. Recurrent wheezing was associated with nearly two-fold higher odds of positive BDR (OR: 1.76), and prior LRTI also had increased odds (OR: 1.38). No associations were found with age, maternal smoking, or maternal atopy. At 10 years, oscillometry and spirometry BDR were significantly associated, though correlation was weak (ρ = 0.15).

Conclusion and Discussion: BDR was observed in a minority of children and was strongly associated with recurrent wheeze and prior LRTI. While occillometry and spirometry BDR at 10 years were significantly associated, their weak agreement suggests different aspects of airway reversibility.

Keywords: Bronchodilator responsiveness, Oscillometry, Spirometry, Trajectories

Nishan Katuwal^1,2,3, Sarita Gosain¹, Einar Nilsen⁴, Kristoffer H. Hundvin⁴, Srijana Dongol⁵, Markus Haug², Rajeev Shrestha^1,6, Kari R. Risnes^2,3,7, Trude H. Flo^2,3

¹Center for Infectious Disease Research and Surveillance, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal, ²Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, ³Children’s Clinic, St. Olav’s Hospital, Trondheim, ⁴Department of Microbiology, More and Romsdal Hospital Trust, Molde, Norway, ⁵Department of Pediatrics, Dhulikhel Hospital Kathmandu University Hospital, ⁶Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal, ⁷Department of Pediatrics, St Olav’s Hospital, Trondheim, Norway.

E-mail: nishan.katuwal@ntnu.no

Lower respiratory tract infections (LRTIs) remain a leading cause of hospitalization and mortality in children under five worldwide, with a disproportionately high burden in low- and middle-income countries such as Nepal. Despite this, population-level data on viral etiologies and seasonal trends remain scarce. This study aimed to determine the prevalence and distribution of major respiratory viruses among children with LRTIs in Nepal. A prospective observational study was conducted, enrolling 238 children aged 1–59 months presenting with LRTIs at Dhulikhel Hospital from October 2023 to September 2024. Nasopharyngeal swabs were collected and tested by multiplex qPCR for SARS-CoV-2, Influenza A/B, respiratory syncytial virus (RSV), and human metapneumovirus (hMPV). Of 238 children, nearly one in 3 (30.2%) tested positive for at least one of the viral pathogens. RSV was the most common (11.3%), followed by Influenza A (6.7%), hMPV (6.3%), Influenza B (3.4%), and SARS-CoV-2 (2.1%). Seasonal trends showed RSV peaking in September, while hMPV and SARS-CoV-2 peaked in January, and Influenza A in February. Notably, females showed slightly higher positivity rates (29.5%) than males. This study suggests a significant burden of viral etiologies in young children seeking hospital care for LRTI in Nepal, with RSV remaining the predominant pathogen. Seasonal variation underscores the need for timely preventive measures, including vaccination and infection control. Incorporating comprehensive molecular viral diagnostics in resource-limited settings can guide targeted treatment and reduce unnecessary empirical treatments with antibiotics.

Keywords: Children, Lower respiratory tract infection, Nepal, Viral

¹Nnenna Nweke, Joy Eze², Thecla Ezeonu²

¹Department of Paediatrics, Institute of Child Health, Aefutha, Ebonyi State, Nigeria.

E-mail: ugomag@yahoo.com

Objectives: Introduction Asthma is highly prevalent in Nigeria, yet knowledge and attitude about recommended asthma management practices, and inhaler techniques remain very poor, particularly among students in medical and nursing schools. Understanding the medical and nursing students’ attitudes, awareness of inhaler technique, and perceived barriers to inhaler use is vital for improving asthma care in affected individuals.

Methods: A cross-sectional survey was conducted among 376 nursing and medical students from three tertiary institutions in Abakaliki, Ebonyi State, who attended World Asthma Day 2025, organized by EQUI RESP AFRICA in collaboration with the Institute of Child Health (ICH), AEFUTHA. A structured questionnaire assessed demographics, attitude, awareness, and perceived barriers to inhaler use. Attitude and awareness, and scores were classified as good/favorable or poor/unfavorable using a Likert scale format. Associations between demographics and attitudes were analyzed.

Results: Participants were predominantly female 267 (71.2%), with a mean age of 22.8 ± 3.8 years; Only 96 (25.5%) demonstrated good awareness of proper inhaler technique, while 280 (74.5%) had poor awareness. A smaller number, 43 (11.6%) exhibited a favorable attitude toward inhaler use. Cost (69.6%), embarrassment (51.5%), and stigma (49.2%) were major perceived barriers to the use of inhalers among individuals with asthma. Significant associations were found between attitude scores and gender (P = 0.021), institution (P = 0.001), and year of study (P = 0.005).

Conclusion and Discussion: Poor awareness and unfavorable attitudes toward inhaler use are widespread among future healthcare professionals, highlighting a critical knowledge gap in asthma management and the need for enhanced training and education in this area.

Keywords: Asthma care, Attitude, Barriers, Inhaler technique awareness, Medical and nursing students, Nigeria

Nnenna Nweke¹, Obianuju Ozoh², Joy Eze³

¹Institute of Child Health, Aefutha, Ebonyi State, Nigeria.

E-mail: ugomag@yahoo.com

Objectives: Introduction, Vaping and Shisha smoking are increasingly popular among young adults in Nigeria, raising concerns about the impact on their respiratory health. More worrisome is the dearth of data on lung function among university students engaging in these practices.

Aims/Objectives: To determine the prevalence and types of lung function abnormalities among undergraduate vape and shisha users in southeastern Nigeria.

Methods: This cross-sectional study recruited undergraduate students in southeastern Nigerian universities who vape and/or smoke shisha using the snowball sampling technique, where initial participants of the study referred others. Spirometric measurements were performed, and lung function was analyzed using the 2022 Global Lung Initiative reference equations based on a Z-score. Demographic data, including age, sex, and vaping/shisha smoking habits, were collected.

Results: The mean age of respondents was 23.7 ± 4.2 years; most (59.5%) were males, and the predominant age group was 20–29 years. Abnormalities of lung function were observed in 40.5% of participants. Restrictive lung disease was most common, occurring in 14 (31%), while obstructive and mixed patterns respectively, were documented in 2 (4.8%). The 20–29 age group had the highest rates of restrictive (35.3%) and mixed (5.9%) lung disease. Females showed a higher prevalence of restrictive lung disease (41.2%) than males (24.0%).

Conclusion and Discussion: A significant proportion of undergraduate University students in southeastern Nigeria who vape and smoke have abnormal lung function, which is predominantly restrictive. Young adults, especially females, may be more susceptible, highlighting the need for targeted awareness and prevention strategies.

Keywords: Shisha, Southeastern Nigeria, Spirometric lung function abnormality, Undergraduate students, Vape

Nqobile Ndimande¹, Kevin Mortimer¹, Josue Mbonigaba¹, Sandra Kwarteng-Owusu¹, Rebecca Nantanda¹, Jibril Mohammed¹, Tony Kayembe-Kitenge¹, Obianuju Ozoh¹, Khuthadzo Hlongwane¹, Refiloe Masekela¹

¹University of KwaZulu-Natal, KwaZulu-Natal, South Africa.

Objectives: Asthma is the most common chronic respiratory disease among children globally. In addition to the health burden, there is an economic burden, including treatment costs and absenteeism from school. SDG 3.8 aims for all people to have access to healthcare without suffering financial hardship. This study aimed to determine the economic burden of asthma in children and adolescents in sub-Saharan Africa.

Methods: Data were collected cross-sectionally for participants aged 6–7 and 13–14 years who screened positive for asthma from Democratic Republic of Congo (DRC), Ghana, Nigeria, and Uganda. Data included sources of household income, expenditure on asthma treatment, insurance coverage, and absenteeism. To show financial hardship, we calculated catastrophic health expenditure, which occurs when household out-of-pocket health spending is more than 25% of household expenditure as defined by the WHO.

Results: A total of 4,492 participants were screened for asthma. 284 (6.3%) screened positive for asthma, and 214 completed the health economic questionnaire. 35% (77/214) of those missed at least one day of school within the previous 6 months due to asthma. 22% had a doctor diagnosis, and 60% had severe asthma. Severity and hospitalization were associated with higher healthcare resource use, medical costs, and absenteeism. 29% of patients had medical insurance, but only 18% of those stated that it covered all costs. 28% of households experienced catastrophic health expenditure.

Conclusion and Discussion: The costs of asthma for children and adolescents in sub-Saharan Africa are substantial and catastrophic for some households. These findings provide evidence supporting the need for universal health coverage that covers all related costs and increased screening of asthma.

Keywords: Asthma, Economics, Sub-Saharan Africa

Rebecca Nantanda¹, Victor Nthusi², Ada Wright², Egide Kalisa³, Patrick de Marie Katoto⁴, Caradee Wright⁵, Alex Ndyabakira⁶, Pallavi Pant²

¹Makerere Lung Institute, College of Health Sciences Makerere University, Kampala, Uganda ²Health Effects Institute, Boston, USA ³Western University of Ontario, Ontario, Canada, ⁴University of Bukavu, Democratic Republic of Congo, ⁵South Africa Medical Research Council, South Africa,

⁶Kampala Capital City Authority, Kampala, Uganda. E-mail: rnantanda@gmail.com

Introduction: Air pollution is the second leading risk factor for deaths in East Africa, accounting for 294,000 deaths in 2021, representing a 21% increase from 2010 to 2021. Children are particularly at high risk of air pollution-related health impacts through in-utero and post-natal exposures.

Aim: We conducted a scoping review on the health effects of air pollution in children across eight countries in East Africa, to synthesize current evidence, identifying research gaps, and inform air quality action.

Methods: The Arksey and O’Malley methodological framework was used to conduct the scoping review. Studies published since inception and until June 2025 were identified through PubMed and Web of Science. Studies were screened and extracted by two team members, and a third member conducted a quality check on ~10% of the data extracted.

Results: A total of 49 publications were included in the review, of which 20 focused on children’s health outcomes. Most studies used a cross-sectional design, and several utilized Demographic Health Surveys (DHS) datasets. Air pollution exposure was associated with a wide range of health effects, including respiratory symptoms, reduced lung function, anemia, asthma, poor neurocognitive functioning, and stunting. Disparities in exposure and health outcomes based on geographical location or socio-economic status were noted.

Conclusion: Findings were broadly consistent with the global body of evidence and can be used to inform policy decisions. While the number of cross-sectional studies is growing in part due to the use of DHS datasets, there remains a need for longitudinal and cohort studies in the region.

Keywords: Air pollution, Children, Health outcomes, Africa.

Samson Mugane¹, Adeel Shah¹, Samuel Otido¹, Rodney D. Adam¹

¹Aga Khan University, Nairobi, Kenya.

E-mail: smugane@yahoo.com

Objectives: Acute respiratory infections are associated with high morbidity and mortality among children across the globe, with more than 4.3 million associated deaths among children aged five years and less annually. While bacterial agents have traditionally been associated with severe pneumonia, viral agents are increasingly becoming more prevalent, complicating clinical management and public health strategies. Aims and Objectives: (1) To describe the profile of respiratory viruses identified among children admitted with a respiratory infection at a teaching hospital in Kenya over a period of 28 months. (2) To describe the demographic and clinical characteristics of children hospitalized with viral respiratory infections at a teaching hospital in Kenya over a period of 28 months.

Methods: A descriptive analytic study with a retrospective approach will be conducted at the Aga Khan University Hospital in Nairobi, analyzing medical records of children aged 2 months to 18 years with a positive viral Polymerase chain reaction test hospitalized with an ARI from January 2023 to April 2025.

Results: Pending: We are currently abstracting data from 538 cases. The final paper will be completed by the end of October 2025. This study aims to address the knowledge gap regarding viral etiology, clinical characterization, and the effects or outcomes of ARIs in children and adolescents in Nairobi, focusing on the need for localized data.

Conclusion and Discussion: Pending till completion of data analysis. By recognizing prevalent viral pathogens and their clinical characteristics, the findings will lead to more targeted management approaches and inform public health interventions based on local data.

Keywords: Etiology, Children, Clinical characteristics, Hospitalization, Polymerase chain reaction, Viral respiratory infections

Samuel Otido¹, Bernadette Muthee¹, Brenda Gicheru¹, Mary Wanjiru Kaniu¹

¹Aga Khan University Hospital, Nairobi, Kenya.

E-mail: samotido@gmail.com

Objectives: Empyema thoracis is a significant contributor to childhood morbidity in sub-Saharan Africa. This study describes the clinical features, microbiological profiles, and treatment outcomes of children with empyema thoracis admitted to a private tertiary hospital in Kenya.

Methods: A retrospective chart review was conducted among children aged 0–18 years admitted with empyema thoracis between November 2013 and October 2023. Data on clinical features, laboratory findings, chest drain and surgical interventions, and hospital stay were analyzed.

Results: Twenty-nine children were included; 17 (58.6%) were male. The median age was 10 years. Median cough and fever duration before admission were 8 and 7 days, respectively. Hypoxia was present in 30.4%, and 76.9% had prior antibiotic use. Streptococcus pneumoniae and Staphylococcus aureus were the most frequently isolated pathogens. Pigtail catheters (n = 17) and rigid chest tubes (n = 12) were used for drainage. Drainage was successful in 13 (44.8%) children. The median hospital stay was shorter with pigtail catheters (6.75 days) than with rigid tubes (25.8 days). Fifteen children (51.7%) required surgical intervention (Video-assisted thoracoscopic surgery n = 10, mini-thoracotomy n = 5). The post-operative stay was longer with mini-thoracotomy (15 days) compared to video-assisted thoracoscopic surgery (7 days). No deaths were recorded.

Conclusion and Discussion: In this single-center cohort, pigtail catheters were associated with shorter hospital stays and fewer surgical interventions. Mini-thoracotomy led to longer recovery times. The use of minimally invasive approaches may improve outcomes in pediatric empyema.

Keywords: Mini-thoracotomy, Pediatric empyema thoracis, Pigtail catheter, Rigid tube, Video-assisted thoracoscopic surgery

Sanelisiwe Ngaka¹, Refiloe Masekela¹, Diane Gray¹

¹University of KwaZulu Natal, KwaZulu Natal, South Africa.

E-mail: sanelisiwenga@gmail.com

Objectives: Asthma is a common major non-communicable disease worldwide. The first step toward effective treatment and management of asthma is a proper diagnosis. Spirometry is the gold standard for asthma diagnosis; however, its use is limited in certain populations due to complex manoeuvres that require active participation. Oscillometry is a non-invasive measure of lung mechanics and requires no special manoeuvres, making it ideal for younger children. There is limited data on the use of oscillometry in low- to middle-income country settings. This study aims to determine the role and clinical utility of oscillometry in children and adolescents with doctor-diagnosed and spirometry-confirmed asthma.

Methods: Eligible children and adolescents (6–18 years) attending the Pediatric Pulmonology Asthma Clinic at Inkosi Albert Luthuli Central Hospital with a doctor diagnosis and spirometry confirmed asthma. Written consent from guardians and assent from children older than 7 years will be obtained. Oscillatory data will be obtained using the Thorasys Tremoflo C-100 Airwave Oscillometry System according to international standards, and parameters of resistance, reactance, and bronchodilator response will be analyzed.

Results: The study will report the distribution of oscillometry parameters (resistance and reactance) and their variability assessed for technical reliability. The relationship between oscillometry indices and spirometry outcomes will be analyzed.

Conclusion and Discussion: The study is expected to provide information on the diagnostic value and clinical utility of oscillometry and determine the additional value of oscillometry in the detection of small airway dysfunction. The findings may clarify whether oscillometry can serve as a reliable and practical complement to spirometry, especially in younger children.

Keywords: Asthma, Forced oscillatory technique, Oscillometry, Spirometry

Sarah Namusoko¹, Bergström Anna¹, Byamugisha Josaphat¹, Abrahamsson Marielle¹, Höök Susanna¹

¹Mulago National Referral Hospital, Kampala, Uganda.

E-mail: sarah.namusoko@gmail.com

Objectives: Neonatal resuscitation is critical for health professionals working with newborns, particularly in the setting of delivery rooms and neonatal intensive care units. The Helping Babies Breathe (HBB) course, developed by the American Academy of Pediatrics, is one of the most recognized programs focused on training health workers in low-resource settings in essential newborn care and basic resuscitation. However, limited attention is given to exploring the perspectives and experiences of health workers about translating the acquired knowledge into practice. This study aims to explore the perspectives and experiences of midwives before and after training in the HBB course.

Methods: It was a qualitative study. 7 focus group discussions and 2 in-depth interviews were conducted with 47 midwives and 2 managers who had recently been trained in HBB and were clinically active at the high-risk labor ward and theater at the National Referral Hospital.

Results: Three emerging themes illustrated midwives’ knowledge and experience. Excessive workload, limited access to clean equipment, and ethical dilemmas hampered performance and neonatal survival.

Conclusion and Discussion: While HBB training addresses identified gaps, midwives had few opportunities to put into practice what they had learned due to heavy workload and lack of equipment. This highlights the need for a closer examination of the challenges faced by healthcare providers in ensuring effective neonatal resuscitation and survival in low-resource settings. To address this, we propose better routines for organizing work, cleaning and maintaining equipment, and implementing better training routines.

Keywords: Cardiopulmonary resuscitation, Medical education, Neonatology, Training

S. T. Hlophe¹, N. Marozva², F. M. Ducharme³, R. Masekela^1,4

¹Department of Paediatrics and Child Health, School of Clinical Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, ²Department of Paediatrics and Child Health, and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, ³Department of Pediatrics, Faculty of Medicine, and Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada, ⁴Africa Health Research Institute, KwaZulu-Natal, South Africa.

E-mails: sbehlophe@gmail.com; HlopheS@ukzn.ac.za

Objectives: Wheezing in children between the ages of 12 months and 6 years is usually induced by viral respiratory tract infections and has an increased risk of developing subsequent asthma. Short courses of oral corticosteroids are commonly administered to wheezy pre-school children both for episodic wheeze and multiple-trigger wheeze; however, the evidence is conflicting. The aim was to assess the efficacy and safety of episodic or preemptive inhaled corticosteroids (ICS) at the onset of a upper respiratory tract infection (URTI) in preschoolers and compare them to daily ICS in preschoolers with virus-induced wheezing.

Material and Methods: The systematic review search using the following databases, PubMed, Scopus, EBSCO Host, Science Direct, and Web of Science, was conducted. The systematic review protocol was registered with PROSPERO, CRD42023481258. We used the Population, Intervention, Comparator, and Outcomes (acronym) to aid with the systematic search. The Preferred Reporting Items for Systematic Reviews and meta-analyses reporting standards were followed.

Results: There were 11028 articles identified through an electronic database search. Eight met the criteria. All eight articles were randomized controlled trials with a total of 1458 children aged 1 year to 6 years. Half of the studies showed no significant difference between the intervention and the control for asthma symptom scores, episode-free days, frequency of exacerbations, severity of acute episodic asthma, and upper respiratory tract infections varied amongst the studies, whereas the other half was in favor of the ICS. The use of rescue therapy showed an odds ratio of 0.49 (confidence interval [CI] 0.30–0.83) in fluticasone compared to placebo, whereas intermittent versus daily budesonide showed no difference, 0.97 (95% CI, 0.76–1.22). Symptom scores varied from non-significant (P > 0.05) to a significant difference, P = 0.028. Episode-free days in ICS versus placebo groups varied from P = 0.66–0. 012. The difference from baseline in height difference was slower in the budesonide group at 6.23 cm compared to the placebo at 6.59 cm, with a difference in z-scores of −0.24 z-scores (95% CI, −0.40 to −0.08). There was no linear growth difference, P = 0.59 in another study. We were unable to perform a meta-analysis due to heterogeneity of the reported outcomes.

Conclusion: There is conflicting evidence regarding the efficacy of high-dose inhaled ICS for virus-induced wheezing, and insufficient evidence to conclude on side effects such as height impairment. An individual patient data meta-analysis could be a step to progress the evidence.

Keywords: Adverse effects, Children, Inhaled corticosteroids, Virus-induced wheezing

Seyram Wordui¹, Grace Hennessy¹, Leah Ratner¹, Joy Eze¹, Sheila Agyeiwaa Owusu¹, Areej Dakshi¹,

Sandra Kwarteng Owusu¹

¹Department of Child Health, Korle Bu Teaching Hospital. Accra, Ghana.

E-mail: swordui@gmail.com

Objectives: Cystic fibrosis (CF) is historically underrecognized in Africa, and bedeviled with challenges such as delayed diagnosis, limited access to testing, and scarce specialist expertise. The newly formed Pan-African Cystic Fibrosis Research Network (PACFRN) established a Case Conference Group to address these gaps through collaborative case-based learning and multidisciplinary discussions. We describe the structure, activities, and outcomes of the PACFRN case Conference Group as a platform for improving CF diagnosis and management in resource-limited African settings.

Material and Methods: The group, comprising pediatric pulmonologists, geneticists, pediatricians, pediatrician trainees, other specialists from across Africa, as well as international partners, meets virtually. Submitted cases and discussion focus on diagnostic uncertainties, management complexities, and outcomes. Discussions emphasize context-appropriate solutions and shared experiences.

Results: Between April and July 2025, 6 cases from 3 African countries were discussed. Key findings included: (1) Diagnostic challenges: Low clinical suspicion and limited access to confirmatory tests (e.g., sweat chloride, genetic testing). (2) Management barriers: Difficulties accessing pancreatic enzyme replacements and respiratory care. (3) Novel genetics: novel genetics have been presented, which, in the context of unique populations, need further study. (4) Successes: Improved CF awareness among attendees, networking, and strengthened regional referrals.

Conclusion and Discussion: The PACFRN Case Conference Group is an effective, low-cost model for enhancing CF care in Africa. By leveraging collective expertise, it mitigates isolation among practitioners and advocates systemic improvements. Future priorities include expanding membership, standardizing diagnostic pathways, and linking cases to research and advocacy efforts to improve the availability of diagnostic and treatment facilities and overall cost of care.

Keywords: Africa, Cystic fibrosis, Diagnosis, Management

Srijana Dongol¹, Md Shafiqul Islam², Nishan Katuwal^3,4,5, Renu Shahi^1,3, Markus Haug^4,5, Trude Helen Flo^4,5, Rajeev Shrestha^3,6, Charl Verwey⁷, Kari Risnes⁸

¹Department of Pediatrics, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal, ²Projahmo Research Foundation, Dhaka, Bangladesh, ³Center for Infectious Disease Research and Surveillance, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal, ⁴Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, ⁵ Department of Pediatrics, St Olavs Hospital, Trondheim, Norway, ⁶Department of Clinical Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal, ⁷Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa, ⁸Children’s Clinic, St, Olav’s University Hospital, Trondheim, Norway.

E-mail: docsrijana@yahoo.com

Objectives: Early-life insults affect lung function trajectories throughout life. To enable the assessment of lung development in children, we aimed to assess the feasibility of establishing a pulmonary function test (PFT) laboratory for infants and children in Dhulikhel, Nepal, and to train local staff to perform and interpret lung function tests.

Material and Methods: A PFT laboratory was established, and tidal breath flow-volume loops (TBFVL) testing, meeting international quality standards, were performed on healthy children 1–24 months of age, between October 28^th, 2024, and May 29^th, 2025, in Dhulikhel, Nepal. Results were interpreted by local staff after initial training and ongoing oversight provided by international experts. TBFVL indices with their coefficient of variation (CoV) were reported and inter-interpreter level of agreement was established.

Results: Eighty-six children; 69% 0–<4 months, 14% 4–<12 months, and 18% 12–24 months; were included, of which 80 (93%) had successful tests. The CoV ranged from 4.7 (4.4, 5.2) for tidal volume to 19.5 (15.8, 24.1) for TPTEF/TE, with CoV similar across age groups. There was good agreement between local and expert staff on results interpretation.

Conclusion: Establishing a pulmonary function laboratory and achieving high-quality TBFVL measurements with expert-level interpretation is feasible in a semi-urban setting in Nepal.

Keywords: Nepal, Lung function, Pulmonary function test, Tidal breath

Zaahir Abrahams¹, Heather Zar², Siyazi Mda³

¹Department of Paediatrics, Walter Sisulu University, Eastern Cape Province, South Africa.

E-mail: abu.uwais1430@gmail.com

Objectives: Pulmonary tuberculosis (TB) has a high burden in children globally. Microbiological confirmation by culture remains the gold standard, and samples may be obtained through gastric lavage (GL) or induced sputum (IS). Both methods are safe, but GL needs hospitalization.

Methods: A retrospective folder review of all children under the age of 13 years at Dora Nginza Hospital, South Africa, who had a positive TB culture, was conducted. Samples were obtained through GL from November 01, 2014, to October 31, 2015, and by IS from November 1, 2015, to October 31, 2016.

Results: Over this period, 131 children had 226 GL specimens, while 133 children had 238 specimens of IS. Culture for TB was positive in 97 children, and their median age was 25.7 months (IQR 10.6– 76.5). Among the 131 children who had GL, 55 tested positive for TB (42%), while 54 (41%) of the 133 who had IS conducted, were positive for TB. Of the 55 children with positive GL, 48 (87%) had positive TB cultures, whereas 48 (89%) of those with IS had positive cultures. The yield was no difference in yield from GL compared to IS, odds ratio 1.05 (0.71–1.58).

Conclusion/Discussion: The two methods had similar yields, but since IS does not require hospitalization, it is preferable to GL.

Keywords: Gastric lavage, Induced sputum, Microbiological confirmation, Pediatrics, Retrospective, TB culture, Tuberculosis