Welcome to the ESPID 2021 Meeting Calendar
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Introduction (ID 2338)
Recent diphtheria outbreaks: challenges and lessons learnt (ID 233)
Malnutrition as a co-factor for mortality of infectious diseases in the humanitarian setting (ID 234)
PRIMARY CARE CASE MANAGEMENT OF FEBRILE CHILDREN: INSIGHTS FROM THE EPOCT ROUTINE CARE COHORT IN DAR ES SALAAM, TANZANIA (ID 927)
Abstract
Background
More granular data on the quality of care for febrile children in low-resource settings are needed. This study aims to provide insight in the primary healthcare (PHC) case management of febrile children under-five in Dar es Salaam, and to identify areas for improving quality of care.
Methods
We used data of the routine care arm of the ePOCT trial, including children aged 2-59 months who presented with an acute febrile illness to two health centers in Dar es Salaam (2014-2016). For all children research staff performed malaria rapid diagnostic testing and collected presenting complaint, anthropometrics, vital signs, as well as tests performed and routine clinician diagnosis and treatment. We used descriptive statistics to analyze the frequencies of diagnoses, adherence to diagnostics and prescribed treatments.
Results
We included 547 children (47% male, median age 14 months). Most diagnoses were viral: upper respiratory tract infection (60%) and/or gastro-enteritis (18%). Vital signs and anthropometric measurements taken by research staff and urinary testing failed to influence treatment decisions. In total, 518/547 (95%) children received antibiotics, while 119/547 (22%) had an indication for antibiotics based on local guidelines. Antibiotic dosing was frequently out of range. Non-recommended treatments were common (29%), most often cough syrup and vitamins.
Conclusions
Our study points to challenges in using diagnostic test results, concerns regarding quality of antibiotic prescriptions, and frequent use of non-evidence-based complementary medicines in PHC in Tanzania. Larger studies on diagnostic and treatments processes in PHC in Tanzania are needed to inform effective solutions to support PHC workers in case management of children.
Clinical Trial Registration
NCT02225769
PERFORMANCE OF HOST BLOOD TRANSCRIPTOMIC SIGNATURES FOR DIAGNOSIS OF PAEDIATRIC TUBERCULOSIS A SOUTH AFRICAN CASE-CONTROL STUDY. (ID 1564)
Abstract
Background
The lack of an accurate diagnostic tests for paediatric tuberculosis (TB) is a major contributing factor to the burden of TB in children. Host blood transcriptomic signatures have shown potential for being used as diagnostic tests. However, most of these signatures were discovered in adult datasets, but their performance has not been assessed in paediatric studies. Here, we perform a comparison of published transcriptomic signatures to assess their potential in distinguishing TB from other diseases (OD) in children.
Methods
117 children with TB and OD were recruited in South Africa between 2009 and 2013 and whole blood RNA-sequencing was performed. After reviewing the literature, we identified 26 transcriptomic signatures that fulfilled our selection criteria on derivation, which were then assessed both using the models described in their original publication and were also refitted to assess their full potential in classifying the patients in our dataset.
Results
Out of the 26 signatures tested using the previously described models, none achieved the optimum WHO Target Product Profile guidelines for sensitivity (>85%) and specificity (>92%) of a novel non-sputum based diagnostic test. However, when we constructed optimised models, 3/26 signatures met the optimal criteria for distinguishing active TB from OD. We observed a relationship between signature size and performance.
Conclusions
Our results highlight that robust and generalisable models for diagnostic transcriptomic signatures are needed to exploit the full potential of gene expression signals measured in blood, accelerating their development into clinically usable diagnostic tests.
Clinical Trial Registration
Not applicable