A testimonial of how The Pan African Thoracic Society Methods in Epidemiologic, Clinical, and Operations Research has impacted my career path: celebrating 15 years

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Environmental risk factors for asthma in 13-14 year old African children

BACKGROUND: Asthma prevalence in African children is high and increasing, with more severe disease than that in high income countries. Specific factors driving the rising prevalence or disease severity are poorly understood. The aim of this study was to investigate environmental factors associated with asthma and severity in African children using data obtained from International Study of Asthma and Allergies in Childhood, (ISAAC) III. METHODS: A population based cross-sectional study of children aged 13-14 years from 10 African centres who participated in ISAAC III from randomly selected schools. The prevalence of asthma or severe asthma was calculated for each centre. Self-reported environmental exposures included engaging in physical exercise, television watching, biomass and ETS exposure, consumption of paracetamol, large family sizes and having pets in the home. Univariable and multivariable analyses were done adjusting for centre variations. Odds ratio and respective 95% confidence intervals (CI) were calculated. RESULTS: Amongst 28490 adolescents from 232 schools in 10 African centres (4 middle income and 6 low income), the prevalence of asthma was 12.8% (CI 12.4-13.2), while prevalence of severe disease was 8.7% (CI 8.4-8.0). Factors most strongly associated with asthma were maternal smoking (OR= 1.41; 95% CI: 1.23 - 1.64), exposure to open fire heating (OR=1.28; 95% CI: 1.08 - 1.51) and electric heating (OR=1.13; 95% CI: 1.01 - 1.28), engaging in strenuous exercise (OR= 1.29; 95% CI: 1.11 - 1.50 and monthly use of paracetamol (OR 1.23; 95% CI 1.13 - 1.33, while having an elder sibling was protective for asthma (OR=0.87; 95% CI 0.77 – 0.98). Factors strongly associated with severe asthma were maternal smoking (OR=1.61; 95% CI: 1.38 - 1.89), having a cat pet at home (OR=1.14; 95% CI: 1.04 - 1.25), engaging in≥3 weekly physical exercise (OR=1.42; 95% CI: 1.23 - 1.64) and monthly consumption of paracetamol (OR=1.20; 95% CI: 1.07 - 1.34). CONCLUSION: There was a high prevalence of severe asthma in African children. Several environmental exposures were associated with asthma or with severe disease. Strategies to reduce harmful environmental exposures must be strengthened to reduce the burden of childhood asthma in Africa

Oxygen delivery systems and training needs in pediatric and adult settings- a call to action beyond COVID-19 era

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Prevalence and predictors of pulmonary fungal infections in patients with acute leukemia and aggressive lymphomas: Implications for cancer care in developing countries

Objectives: Among patients receiving cancer therapy, pulmonary fungal infections (PFIs) are an important cause of morbidity and mortality. Identifying predictors of PFI can direct targeted prophylaxis to improve outcomes, especially in low- and middle-income countries (LMIC) with limited resources. The objectives of the study were to evaluate the predictors of PFI in hospitalized patients with hematological malignancies in the United States and implications for prioritizing anti-fungal care in LMIC.Materials and Methods: Using the 2018 National Inpatient Sample, we conducted a retrospective study of patients ≥18 years, with acute leukemia or aggressive lymphoma. Demographics and outcomes were compared between patients with and without PFI. Predictors of PFI were evaluated by regression analysis.Results: PFI was diagnosed in 1635 (0.8%) of 205,525 eligible hospitalizations and aspergillosis was noted in 1315 (80.4%) of PFI cases. Patients with acute myeloid leukemia (AML) accounted for 64.2% of cases of PFI. Patients with PFI, when compared with those without PFI, were younger, had higher Charlson comorbidity index, were more likely to be non-Caucasian, and to have AML. Patients with PFI had higher odds of respiratory failure, sepsis, and in-hospital mortality. Variables associated with PFI were Hispanic or native American origin (OR = 1.71; 95% CI: 1.21–2.42), Charlson comorbidity index ≥3 (OR = 1.52; 95% CI: 1.16–2.00), neutropenia (OR = 1.97; 95% CI: 1.58–2.46), malnutrition (OR = 2.30; 95% CI: 1.75–3.01), bone marrow transplant status (OR = 2.28, 95% CI: 1.53–3.39), and AML diagnosis (OR = 3.12; 95% CI: 2.40–4.05).Conclusions: This study identified variables associated with PFI in patients diagnosed with acute leukemia and aggressive lymphomas. In LMIC, where resources are scarce, patients with cancer who have the identified high-risk characteristics should be given priority for antifungal prophylaxis

SARS-CoV-2: Current Perspective on Control, Prevention, and Therapeutic Promise

Background: The novel coronavirus disease (COVID-19) outbreak has halted activities throughout the globe because of its rapid spread. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a β-coronavirus first detected in China. SARS-CoV-2 has been implicated to be transmitted via direct contact, fomite, respiratory droplets, and possibly aerosol. The spread of the disease is complicated due to the slow onset of symptoms and asymptomatic infected patients. Methods: This narrative communication summarizes the recent researches sourced using sensitive search strategies to identify COVID-19 current perspectives on the control, prevention, and therapeutic promise. Result: Several strategies and multiple control measures have been implemented around the globe to contain COVID-19. Considering the exponential spread of the pandemic, several scientists and physicians have been racing to discover possible therapeutics and vaccines for COVID-19. There are clinical trials to investigate the vaccine designed to protect against the infection and also to substantiate the claim made for BCG protection against COVID-19. Although, there is currently no universally approved medication to treat SARS-CoV-2, there have been random reports of existing medications ameliorating the infection, and these regimens are still under clinical trial. There is also the potential therapeutic prospect of rhinothermy to fight SARS-CoV-2 judging from its success in fighting upper respiratory tract viral infection. Conclusion: The information provided in this communication gives a reliable intellectual grounding regarding the current perspective on COVID-19 control, progress made in the development of vaccines and therapeutic regimen, and where future research in this area should be focused. Key words: COVID-19; SARS-CoV-2; control; WHO; respiratory; cases; trac

SARS-CoV-2: Current Perspective on Control, Prevention, and Therapeutic Promise

Background: The novel coronavirus disease (COVID-19) outbreak has halted activities throughout the globe because of its rapid spread. COVID-19  is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a β-coronavirus first detected in China. SARS-CoV-2 has been implicated to be transmitted via direct contact, fomite, respiratory droplets, and possibly aerosol. The spread of the disease is complicated due to the slow onset of symptoms and asymptomatic infected patients. Methods: This narrative communication summarizes the recent researches sourced using sensitive search strategies to identify COVID-19 current perspectives on the control, prevention, and therapeutic promise. Result: Several strategies and multiple control measures have been implemented around the globe to contain COVID-19. Considering the   exponential spread of the pandemic, several scientists and physicians have been racing to discover possible therapeutics and vaccines for COVID-19. There are clinical trials to investigate the vaccine designed to protect against the infection and also to substantiate the claim made for BCG protection against COVID-19. Although, there is currently no universally approved medication to treat SARS-CoV-2, there have been random reports of existing medications ameliorating the infection, and these regimens are still under clinical trial. There is also the potential therapeutic prospect of rhinothermy to fight SARS-CoV-2 judging from its success in fighting upper respiratory tract viral infection. Conclusion: The information provided in this communication gives a reliable intellectual grounding regarding the current perspective on COVID-19  control, progress made in the development of vaccines and therapeutic regimen, and where future research in this area should be focused. Keywords: COVID-19; SARS-CoV-2; control; WHO; respiratory; cases; trac

Spirometry Abnormalities and Its Associated Factors Among Primary School Children in a Nigerian City.

BACKGROUND: There is paucity of data on objectively measured lung function abnormalities in Nigerian children using diagnostic testing methods such as spirometry. Such assessments could prompt early diagnosis and therapeutic interventions. METHODS: This was a cross sectional study among children aged 6 to 12 years in South-Eastern Nigeria. We selected participants from one school using a multistage stratified random sampling technique. A structured respiratory questionnaire was administered to obtain necessary data. The lung functions of the children were measured by spirometry. We used Lower Limits of Normal (LLN) based on GLI reference equations for African-American and mixed ethnicities to define abnormal spirometry. We studied the association between the exposures and lung function using logistic regression/chi-squared tests. RESULTS: A total of 145 children performed acceptable and repeatable tests. There were 73 males (50.3%), mean age of 9.13 years (+1.5) and age range 6 to 12 years. Frequency of respiratory symptoms was cough- 64 (44.1%) and wheeze in 19 (13.1%). Using GLI for African-Americans, fifty-five (37.9%) children had abnormal spirometryobstructive pattern in 40 (27.6%) and restrictive pattern in 15 (10.3%). The two references showed significant differences in interpretation of abnormality (χ2 = 72.86; P < .001). Respiratory symptom-wheeze was an independent determinant of abnormal lung function in this population.(OR = 0.31; 95%CI: 0.10-0.94; P = .04). CONCLUSION: There is a high burden of respiratory symptoms and abnormal spirometry among these children. The need for objective evaluation of lung function especially for children with respiratory symptoms is evident

Bronchiectasis in African children : challenges and barriers to care

Bronchiectasis (BE) is a chronic condition aecting the bronchial tree. It is characterized by the dilatation of large and medium-sized airways, secondary to damage of the underlying bronchial wall structural elements and accompanied by the clinical picture of recurrent or persistent cough. Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where the prevalence is mostly unmeasured, and likely to be higher than high-income countries. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in high-income countries or from data in children with cystic fibrosis. Here we provide an overview of pediatric BE in Africa, highlighting risk factors, diagnostic and management challenges, need for a global approach to addressing key research gaps, and recommendations for practitioners working in Africa.http://www.frontiersin.org/Pediatricsdm2022Paediatrics and Child Healt

Identifying the research, advocacy, policy and implementation needs for the prevention and management of respiratory syncytial virus lower respiratory tract infection in low- and middle-income countries

Introduction: The high burden of respiratory syncytial virus (RSV) infection in young children disproportionately occurs in low- and middle-income countries (LMICs). The PROUD (Preventing RespiratOry syncytial virUs in unDerdeveloped countries) Taskforce of 24 RSV worldwide experts assessed key needs for RSV prevention in LMICs, including vaccine and newer preventive measures. Methods: A global, survey-based study was undertaken in 2021. An online questionnaire was developed following three meetings of the Taskforce panellists wherein factors related to RSV infection, its prevention and management were identified using iterative questioning. Each factor was scored, by non-panellists interested in RSV, on a scale of zero (very-low-relevance) to 100 (very-high-relevance) within two scenarios: (1) Current and (2) Future expectations for RSV management. Results: Ninety questionnaires were completed: 70 by respondents (71.4% physicians; 27.1% researchers/scientists) from 16 LMICs and 20 from nine high-income (HI) countries (90.0% physicians; 5.0% researchers/scientists), as a reference group. Within LMICs, RSV awareness was perceived to be low, and management was not prioritised. Of the 100 factors scored, those related to improved diagnosis particularly access to affordable point-of-care diagnostics, disease burden data generation, clinical and general education, prompt access to new interventions, and engagement with policymakers/payers were identified of paramount importance. There was a strong need for clinical education and local data generation in the lowest economies, whereas upper-middle income countries were more closely aligned with HI countries in terms of current RSV service provision. Conclusion: Seven key actions for improving RSV prevention and management in LMICs are proposed