Posters

01 - RESPIRE: A collaboration across research programmes and their supporting platforms in Bangladesh, Bhutan, India, Indonesia, Malaysia, Pakistan and Sri Lanka
Authors: RESPIRE Core Team
 

Abstract: Visit this poster display to learn how RESPIRE's studies, programmes and platforms work together to enable world-leading research to reduce the burden of respiratory disease.
Further information is available on the following pages
• Programmes and studies: https://usher.ed.ac.uk/respire/research
• Supporting platforms: https://usher.ed.ac.uk/respire/platforms

02 - The oxygen care cascade in four South Asian countries: availability, bedside readiness, hypoxaemia detection and treatment
Authors: Ahmed Ehsanur Rahman1, Dr Shabina Ariff2, Dr Mimi Lhamu Mynak4, Shafiqul Ameen1,
Sabit Saad Shafiq1, Harshpreet Kaur³, Hareem Fatima2, Sadman Sowmik Sarkar1, SN Singh3, Dr Sajid Soofi2, Shams El Arifeen1
1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 2Aga Khan University, Pakistan, 3King George's Medical University, India. 4JDW National Referral Hospital, Bhutan
 

Abstract: Background: Safe oxygen care requires more than equipment availability. Functional oxygen and pulse oximetry must be available at the bedside, patients must undergo routine SpO₂ assessment, and detected hypoxaemia must trigger appropriate treatment. We assessed how facility-level availability translated into ward-level readiness and documented oxygen care in Bangladesh, Bhutan, India and Pakistan.
Methods: We analysed selected indicators from two domains of the RESPIRE medical oxygen study. Domain 2 was a cross-sectional assessment of 450 facilities and 2,228 wards. Bedside readiness was assessed using acuity-specific standards: mixed-acuity wards required at least one functional pulse oximeter and one functional oxygen outlet per five beds; high-acuity wards required at least one pulse oximeter per two beds and one oxygen outlet per bed. Domain 4 reviewed more than 6000 admitted patient records and assessed documented SpO₂ measurement, hypoxaemia (SpO₂ <90%) and oxygen treatment.
Results: Facility-level availability was high, but ward-level readiness was substantially lower. Functional oxygen was available in 100% of facilities in Bangladesh and Bhutan and 99% in India and Pakistan, while 47%, 31%, 29% and 40% of wards, respectively, met the oxygen bedside-readiness standard. Functional pulse oximetry was available in 97%, 97%, 98% and 79% of facilities, but only 21%, 66%, 25% and 24% of wards, respectively, met the pulse-oximetry bedside-readiness standard. Admission SpO₂ was documented in 25% of admissions in Bangladesh, 82% in Bhutan, 97% in India and 54% in Pakistan. Documented hypoxaemia represented 3%, 17%, 7% and 11% of all reviewed admissions, respectively, while documented hypoxaemia with oxygen treatment represented 3%, 16%, 6% and 9%. Oxygen was also documented among patients with SpO₂ ≥90% in 13%, 31%, 37% and 22% of admissions, respectively; this does not necessarily indicate inappropriate treatment because other documented clinical indications were not represented in this indicator.
Conclusion: Near-universal facility availability did not ensure bedside readiness or consistent oxygen-care processes. Strengthening oxygen systems requires acuity-matched ward equipment, routine admission pulse oximetry, protocol-based treatment for detected hypoxaemia, and systematic documentation and audit of the oxygen-care pathway.

03 - Oxygen system institutionalisation in four South Asian countries: governance, quality assurance, provider training and prescribing practice

Authors: Ahmed Ehsanur Rahman1, Dr Shabina Ariff2, Dr Mimi Lhamu Mynak4, SN Singh3 ,Shafiqul Ameen1, Sabit Saad Shafiq1, Harshpreet Kaur³, Hareem Fatima2, Sadman Sowmik Sarkar1, , Dr Sajid Soofi2, Shams El Arifeen1
1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 2Aga Khan University, Pakistan, 3King George's Medical University, India. 4JDW National Referral Hospital, Bhutan
 

Abstract: Background: Oxygen security requires more than production capacity. Governance, recurrent financing, maintenance, trained personnel, clinical standards and accountable prescribing determine whether oxygen is reliably and safely delivered. We assessed system institutionalisation and provider knowledge, attitudes and practices in Bangladesh, Bhutan, India and Pakistan.
Methods: We drew on two domains of the RESPIRE medical oxygen study. Domain 1 used 60+ stakeholder interviews to qualitatively assess five system domains: policy and governance, financing and planning, maintenance and biomedical capacity, quality assurance and monitoring, and continuity and backup of oxygen supply. Each domain was synthesised as strong, partial or weak. Domain 3A assessed 1,898 healthcare providers across the four countries using knowledge, attitude and practice (KAP) scores and selected indicators on oxygen-therapy training, prescribing and discontinuation practices.
Results: System-level weaknesses varied across countries. Bangladesh was rated partial for policy and governance and continuity of oxygen supply, but weak for financing and planning, maintenance and biomedical capacity, and quality assurance and monitoring. Bhutan was weak for policy and governance, maintenance and biomedical capacity, and continuity of supply; India was partial across the first four domains and strong for continuity of supply; Pakistan was partial for policy and governance and financing, weak for maintenance and quality assurance, and strong for continuity of supply. Mean knowledge, attitude and practice scores were 77%, 80% and 74% in Bangladesh; 76%, 84% and 77% in Bhutan; 75%, 79% and 72% in India; and 73%, 39% and 73% in Pakistan, respectively. Across countries, 1,548/1,888 (82%) providers reported no oxygen-therapy training, 292/1,135 (26%) reported unclear prescriptions, 145/1,142 (13%) verbal-only discontinuation, and 828/1,139 (73%) reported relying on their own judgement when no order was available.
Conclusion: System-level weaknesses in governance, maintenance and quality assurance coexisted with provider gaps in training, prescribing and documentation. Oxygen investment should therefore be tied to three system commitments: recurrent financing for maintenance and quality assurance; competency-based provider training with accessible ward-level clinical guidance; and standardised prescribing, discontinuation and accountable documentation.

04 - Applying the ATMO₂S scorecard in Bangladesh: a government-engaged process to translate stakeholder assessment into medical oxygen priorities

Authors: Ahmed Ehsanur Rahman1, Shafiqul Ameen1, Sabit Saad Shafiq1, Sadman Sowmik Sarkar1, Shams El Arifeen1
1International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)

Abstract: Background: Medical oxygen is an essential medicine required across all levels of care, yet national oxygen security depends on more than equipment. Governance, financing, supply planning, workforce, regulation, monitoring and safe clinical use must function as an integrated system. The Access to Medical Oxygen Scorecard (ATMO₂S), developed by the Lancet Global Health Commission on Medical Oxygen Security, assesses 19 policy items across four domains: Architecture, Availability, Affordability and Adoption.
Objective: To apply ATMO₂S in Bangladesh to identify priority system gaps and actions for strengthening national medical oxygen security.
Methods: National policies, plans, regulations and oxygen-system documents were reviewed and mapped to the 19 ATMO₂S indicators. National stakeholders then reviewed the evidence and assigned consensus scores for each item using a three-point scale: 1=criteria not met, 2=partially met and 3=met. Findings were synthesised into policy priorities for dialogue and validation.
Results: Bangladesh scored 8/12 for Architecture, 8/18 for Availability, 8/12 for Affordability and 6/15 for Adoption, with Architecture strongest and Adoption weakest. Medical oxygen was added to the National Essential Medicines List on 8 January 2026, but the national oxygen roadmap remained in draft without costing, and a 27-member coordination committee had not become a standing mechanism. No national system was identified for tracking routine oxygen supply against need, no verifiable current national need quantification was available, and no national oxygen contracting guidance was found. Oxygen quality is regulated by DGDA, but supply-chain oversight and safe distribution remain incomplete. Financing was only partially institutionalised, while Adoption showed major gaps in trained workforce, biomedical engineering capacity, routine HMIS indicators and public information; clinical guidelines existed, but audit data were lacking.
Conclusion: Bangladesh has made important policy and infrastructure gains, but these have not yet translated into a fully institutionalised oxygen system. Priority actions are to establish a financed national oxygen system, shift investment towards lifecycle management and workforce capacity, and embed oxygen within routine health information and accountability systems.

05 - Scale up of pulse oximetry in outdoor management of childhood illnesses in Bangladesh: a hybrid effectiveness–implementation study

Authors: Ahmed Ehsanur Rahman1, Shafiqul Ameen1, Sadman Sowmik Sarkar1, Sabit Saad Shafiq1, Shams El Arifeen1
1 International Centre for Diarrhoeal Disease Research, Bangladesh

Abstract: Background: Pneumonia remains a leading cause of under-five mortality in Bangladesh, with hypoxaemia contributing significantly to severe disease. Pulse oximetry (PO) enables objective detection of hypoxaemia and is recommended by the World Health Organization as part of routine assessment of children with suspected pneumonia. However, integrating PO into routine outpatient Integrated Management of Childhood Illness (IMCI) services remains challenging in resource-limited settings.
Objectives: This study aims to evaluate the effectiveness of integrating PO into routine IMCI services in Bangladesh and assess key implementation outcomes during national scale-up.
Methods: We conducted a hybrid effectiveness–implementation study using a stepped-wedge cluster randomised controlled trial across three districts and 30 Union Sub Centers (USCs). Implementation outcomes included adoption, acceptability, feasibility, appropriateness, fidelity, and sustainability. Data were collected through IMCI register, structured observation of PO usage, reassessment, day-six community follow-up of children classified with pneumonia, and qualitative enquiries.
Results: Across 30 USCs in three districts, 3,345 children presenting with cough or difficulty in breathing were assessed by IMCI service providers, of whom 2,915 (87.1%) underwent pulse oximetry assessment. During structured observation of IMCI assessment, service providers successfully measured an SpO₂ reading in 651/657 (99.1%) children with cough and difficulty in breathing. A stable SpO₂ reading was measured in a single attempt for 527/651 (81.0%) children, while 508/655 (77.6%) measured a stable SpO₂ reading within one minute. Among 755 children classified with pneumonia, 705 (93.4%) were prescribed amoxicillin according to IMCI guidelines. Treatment failure occurred in 6.0% of children in the control group and 4.9% in the intervention group.
Conclusion: Pulse oximetry was feasible to integrate into routine outpatient IMCI services at peripheral-level facilities, with high uptake and successful measurement by service providers.

06 - Perspectives on Maternal and Infant RSV Vaccination in Pune, India: A Qualitative Study of Pregnant Women, Parents, and Healthcare Providers
 

Authors: Sayali R Kasture 1, Eesha D Chawan 1, Kajal S Tonde 2, Kiran S Kadam1, Radhika K Nimkar 2,  Nisha S Mutalikdesai1, Aditi A Apte1,2, Dhiraj M Agarwal1,2,  Rutuja G Patil 1,2, Girish B Dayma1,2
1 Community Health Research Unit, KEM Hospital Research Centre, Pune, India, 2 Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
 

Abstract: Background: Respiratory Syncytial Virus (RSV) is a leading cause of lower respiratory tract infections among infants worldwide, with the highest burden occurring during the first six months of life. Maternal RSV vaccination during pregnancy and infant immunisation strategies offer promising approaches to reducing severe RSV disease. However, evidence on the acceptability of these interventions in low- and middle-income country settings remains limited. This study explored stakeholder perceptions and anticipated acceptability of RSV preventive interventions in urban and rural communities of Maharashtra, India.
Methods: A qualitative study was conducted using focus group discussions and in-depth interviews with community members (pregnant women, mothers, and mother-in-law, husband, father, and community leaders), healthcare providers, and public health officials across urban and rural settings in Pune, Maharashtra. Participants were purposively sampled to capture diverse perspectives. Data were analysed using thematic analysis and mapped to the Theoretical Framework of Acceptability (TFA).
Results: Awareness of RSV and available preventive interventions was low among community members and healthcare providers. Despite this, participants generally expressed positive attitudes towards RSV prevention and recognised the potential benefits of protecting young infants from severe respiratory illness. Facilitating factors supporting acceptance included trust in healthcare providers, positive experiences with existing maternal and child immunization programmes, and perceived effectiveness of RSV vaccination. Key barriers centered  around vaccine safety due to limited clinical evidence for a new vaccine, information and communication gaps, cost, accessibility and availability. Key suggestions for increase acceptability were importance of healthcare worker training, community sensitisation, effective communication, post-introduction monitoring, and equitable access. Healthcare providers supported both maternal and child vaccination; however, they suggested that integration of RSV vaccine in the national immunisation schedule and particularly during pregnancy will increase the vaccine uptake.
Conclusions: RSV vaccination was broadly acceptable across stakeholder groups despite limited awareness of RSV disease and its preventive interventions. Successful introduction of RSV prevention programmes will require targeted communication, community engagement, healthcare provider preparedness, and health system strengthening. These findings provide important evidence to inform future RSV prevention policies and implementation strategies in India and similar resource-constrained settings.

07 - TB: Find the Missing Millions - Improving Detection of Smear-Negative Tuberculosis in Malaysia through the AMASSMENT Study

Authors: Chee Kuan Wong¹, Wai Khew Lee², Sarah Jane Jia Chyi Chan³, Suhashini Sivasegaran⁴, Jiloris Dony⁵, Roddy Teo⁶, Karuthan Chinna⁷, Jayakayatri Jeevajothi Nathan⁸, Helen R Stagg⁹, Harish Nair¹⁰, Harry Campbell¹⁰, Ee Ming Khoo⁸
1. Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
2. Luyang Health Clinic, Kota Kinabalu, Sabah, Malaysia
3. Manggatal Health Clinic, Kota Kinabalu, Sabah, Malaysia
4. Sandakan Health Clinic, Sandakan, Sabah, Malaysia
5. Kota Kinabalu Public Health Laboratory, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
6. Tuberculosis and Leprosy Control Sector, Sabah State Health Department, Kota Kinabalu, Sabah, Malaysia
7. Center for Transformative Nutrition and Health, Institute for Research, Development and Innovation, IMU University, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
8. Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
9. Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
10. Usher Institute, University of Edinburgh, Edinburgh, United Kingdom

Abstract

 \*Introduction\*
Sabah has a high tuberculosis burden and limited primary-care access to GeneXpert, contributing to delayed diagnosis of smear-negative pulmonary tuberculosis (SNPTB). The AMASSMENT study developed and evaluated a Clinical Algorithm Scoring System (CASS) as a primary-care triage tool for SNPTB.
\*Methods\*
This 37-month, two-phase study was conducted in three Sabah primary health clinics and enrolled 700 symptomatic, smear-negative patients with chest radiographs suggestive of pulmonary tuberculosis. Phase 1 developed a 21-parameter weighted CASS using a modified Delphi process. Phase 2 prospectively assessed CASS against mycobacterial culture, the gold standard, and compared it with GeneXpert Ultra. This abstract reports Phase 2 of the study.
\*Results\*
Forty-nine participants (7.0%) were culture-positive. At the prespecified cut-off, CASS achieved 98.0% sensitivity, missing one culture-confirmed case, but low specificity (22.6%). GeneXpert Ultra sensitivity and specificity were 94.0% and 86.2%, respectively. All culture-positive cases were started on treatment before culture results: 46 after GeneXpert positivity and three after clinical assessment. Median culture turnaround time was 50 days. Multivariate analysis identified chest X-ray cavities (aOR=5.91), consolidation (aOR=3.68), upper-zone involvement (aOR=1.94), and high-TB country immigrant status (aOR=2.12) as independent predictors.
\*Conclusion\*
CASS showed high sensitivity and limited specificity with a high negative predictive value. It may help triage patients for rapid molecular testing, thus saving costs while Malaysia moves toward universal bacteriological diagnosis. Findings are limited by few culture-positive cases, recruitment from three Sabah clinics, and restricted eligibility criteria. External validation and implementation studies in diverse Malaysian primary-care settings are needed before adoption.

08 - Evaluating a school-based asthma training programme for primary school teachers: a pilot cluster-randomised controlled trial.

Authors: Siti Nurkamilla Ramdzan1, Nursyuhada Sukri1, Christine Shamala Selvaraj1, Karuthan Chinna2, Norita Hussein1, Rizawati Ramli1, Nik Sherina Hanafi1, Ping Yein Lee3, Adina Abdullah1, Jayakayatri Jeevajothi Nathan1, Ai Theng Cheong4, Sazlina Shariff Ghazali4, Hani Salim4, Bee Kiau Ho5, Salbiah Mohamed Isa5, Asiah Kassim6, Azainorsuzila Ahad7, Yong Kek Pang8,Chee Kuan Wong8, Ee Ming Khoo1, Jürgen Schwarze9, Hilary Pinnock9

Abstract: Background: The World Health Organization recommends asthma first-aid training for school staff to support children with asthma; however, no structured programme is available in Malaysia. We developed a school-based asthma training programme to improve teachers' asthma knowledge and preparedness to provide timely and appropriate care. This study evaluated the programme's effectiveness, feasibility, and acceptability using a pilot cluster-randomised controlled trial (cRCT).
Methods: A pilot mixed-methods cRCT was conducted among government primary school teachers in Klang District, Malaysia. Seven of 23 eligible schools expressed interest, and four schools were randomly allocated to the intervention (two schools) or control group (two schools). Intervention teachers received a one-time asthma training session, while controls received general health education. Asthma knowledge was assessed at baseline and at 1, 3, 6, and 12 months using a validated questionnaire. Generalized Estimating Equations with a modified intention-to-treat approach were used. Feasibility and acceptability were evaluated using the Kirkpatrick training evaluation model.
Results: A total of 223 teachers were enrolled (intervention, n=115; control, n=108). After excluding participants without post-baseline data, 183 teachers were analysed. Teachers in the intervention group demonstrated significantly greater improvements in asthma knowledge over time than those in the control group (Wald χ² = 19.99, p = 0.001). The intervention achieved up to Kirkpatrick Level 3 outcomes, with high acceptability and improvements in teachers' confidence and behaviours supporting asthma self-management among children.
Conclusion: The programme demonstrated good feasibility and acceptability, improved asthma knowledge, confidence and behaviour among teachers, supporting further large-scale evaluation in Malaysia.

09 - Klang RESPIRE 2 REACT Asthma Care Kit and Asthma Registry

Authors: Rizawati Ramli1, Hooi Chin Beh1, Norita Hussein1, Siti Nurkamilla Ramdzan1, Chin Hai Teo1,2, Ping Yein Lee2, Adina Abdullah1, Hani Salim3, Ai Theng Cheong3, Shariff Ghazali Sazlina3, Norimichi Hirahara2,4, Zienna Zufida Zainol Rashid5, Siti Fairus Asahar6, Azainorsuzila Mohd Ahad7, Yong Kek Pang8, Chee Kuan Wong8, Asiah Kassim9, Karuthan Chinna10, Jurgen Schwarze11, Ee Ming Khoo1, Nik Sherina Hanafi1, Hilary Pinnock11.
1Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
2UM eHealth Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
3Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
4School of Management, Ritsumeikan Asia Pacific University, Beppu, Oita, Japan
5Pandamaran Health Clinic, Klang, Ministry of Health, Malaysia
6Bukit Kuda Health Clinic, Klang, Ministry of Health, Malaysia
7Port Dickson Health Clinic, Port Dickson, Ministry of Health, Malaysia
8 Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
9 Clinical Research Centre and Paediatric Department, Hospital Tunku Azizah, Kuala Lumpur, Ministry of Health, Malaysia
10 International Medical University, Kuala Lumpur, Malaysia
11 Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom

Abstract: Introduction
Despite available evidence-based asthma guidelines, the RESPIRE Klang Asthma Cohort (KAC) Study identified important gaps in asthma care within primary care settings in Klang, Malaysia. It also highlighted the lack of systematic and sustainable monitoring of the quality of asthma care. We developed and piloted two digital interventions for healthcare providers in two primary care clinics operating with an electronic medical record (EMR) system: the (1) KAC Kit, a resource website to facilitate asthma review, and a (2) KAC registry to support longitudinal surveillance.
Methods
We used mixed methods to assess the pilot implementation of both interventions.
Results
Both interventions were well accepted and usable, enhancing primary care doctors' knowledge and skills in evidence-based asthma care. However, use during consultations was limited by time pressures due to high patient workload, particularly in general outpatient clinics (as opposed to dedicated asthma clinics), warranting a better contextual and workflow fit.
Stakeholder engagement and future directions (KAC Registry)
The KAC Registry Dissemination Workshop brought together stakeholders from the Ministry of Health (MOH), Family Medicine Specialists, and digital health experts to share the study findings and discuss its future directions. The workshop reached a broad consensus that establishing an asthma registry is well justified. Several priorities were identified for its successful and sustainable implementation: (1) clear asthma care governance at the MOH level, (2) consideration of an integrated registry incorporating hospital-based asthma care, and (3) a system that integrates seamlessly with the primary care workflow.
Conclusion
Continuous engagement with the key stakeholders throughout the design, development, implementation, and evaluation phases has fostered stakeholder ownership and a promising intervention refinement.

10 - Enablers and Challenges of delivering in school-Based Asthma Programme for Bangladesh, Indonesia, and Pakistan

Authors: Dr Siti Nurkamilla Ramdzan1, Dr Hareem Fatima2, Professor Dr Cissy Kartasasmita3, Dr Farzana Khan4, Dr Hana Mahmood5, Professor Dr Jürgen Schwarze6, Professor Dr Nik Sherina Hanafi1, Associate Professor Dr Norita Hussein1, Dr Rina Triasih7, Professor Dr Sajid Soofi2, Associate Professor Dr Shabina Ariff2, Professor Ee Ming Khoo1, Professor Dr Hilary Pinnock6
1 Department of Primary Care Medicine, Universiti Malaya, Malaysia
2 Aga Khan University, Pakistan
3 Department of Child Health, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
4 Fasiuddin Khan Research Foundation, Bangladesh
5 Neoventive Solutions, Islamabad, Pakistan
6 NIHR Global Health Research Unit on Respiratory Health, University of Edinburgh, United Kingdom
7 Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia

Abstract: Background
The World Health Organization recommends that school health services provide asthma self-management support for children with asthma and asthma first aid training for school staff. However, many low- and middle-income countries lack structured school-based asthma programmes.
Objective
To identify the contextual enablers and implementation challenges of adapting and implementing a school-based asthma programme in Bangladesh, Indonesia, and Pakistan.
Methods
This mixed-methods study comprised three phases: (1) qualitative exploration with key stakeholders to identify contextual needs and implementation barriers; (2) co-adaptation of an evidence-based school asthma programme; and (3) feasibility testing in participating schools to evaluate programme delivery, acceptability, and implementation challenges. This abstract reports findings from Phase 3.
Results
Phase 3 demonstrated that the adapted programme could be successfully delivered in schools across all three countries. Key implementation enablers included support from government and education authorities, endorsement by healthcare professionals, integration with existing school health services, and repeated brief messages using videos, posters, and printed materials. Major implementation challenges included community stigma, poor retention of asthma knowledge among school staff, reliance on nebulisation rather than inhaled reliever therapy, teachers’ reluctance to administer asthma first aid because of perceived medico-legal risks, limited access to prescribed inhalers, hierarchical decision-making within schools, and the absence of written asthma action plans for students.
Conclusion
Successful implementation of school-based asthma programmes in LMICs requires adaptation to local health systems, policies, and cultural practices. Repeated brief messages, improved access to inhalers and written asthma action plans, and engagement of education and health authorities are essential for sustainable implementation.

11 - School-based intervention feasibility study in four countries – AdAPT + TtT for school-based asthma guideline - MAHAN

Authors: Ashish R Satav¹, Vibhawari Dani¹, Shubhada Khirwadkar¹, Dhananjay Raje¹, Niteen Wairagkar², Radha Munje³, Dipti Jain⁴, Kavita Satav¹, Sanjay Zodpey⁵, Abhishek Madura6, Siti Nurkamilla Ramdzan7, Milind Sovani8, Jürgen Schwarze9, Harry Campbell9 , Hilary Pinnock9
1 MAHAN Trust, Mahatma Gandhi Tribal Hospital, Karmagram, Utavali, Dharni, Amravati District, Maharashtra, India   2 Independent global health and vaccine epidemiology consultant, Pune, India   3 Department of Pulmonary Medicine, Indira Gandhi Government Medical College, Nagpur, India   4 Department of Paediatrics, Arihant hospital, Nagpur, India   5 Public Health Foundation of India, New Delhi, India   6  Department of Paediatric pulmonology, AIIMS, Nagpur, India, 7. Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia   8 Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK   9 NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, UK

Abstract: Abstract
Background. Asthma is the most common non-communicable disease of childhood, yet in remote, low-resource settings it is frequently unrecognised and untreated. In the tribal Melghat region of central India there is no equivalent word for asthma in the local Korku language, and wheezy children are commonly managed as having recurrent pneumonia. School-based asthma programmes improve outcomes but remain rare in low- and middle-income countries (LMICs) and have not been tailored to Indian tribal communities. Within the NIHR Global Health Research Unit on Respiratory Health (RESPIRE) collaboration, we set out to adapt an evidence-based, culturally tailored school asthma programme originally developed in Malaysia for this context.
Methods. Using the ADAPT process model, we conducted a formative mixed-methods study at a tribal residential (ashram) school in Dharni block, Amravati District, Maharashtra.  Detailed clinical examination of children aged 6–18 years were conducted for obstructive airway disease also using impulse oscillometry (IOS). Qualitative data were generated through a staff focus group, large-group awareness sessions, structured focus-group discussions and clinical interviews with students, and semi-structured caregiver interviews, complemented by non-participatory observation and document review. Audio recordings were transcribed, de-identified and analysed thematically; findings were mapped onto specific adaptations of the original intervention.
Results. Of approximately 560 children screened, 34 had clinical and IOS findings suggestive of mild obstructive airway disease; almost all were previously undiagnosed and minimally symptomatic. Five themes captured a trajectory “from unawareness to preparedness”: near-absent asthma literacy; asthma as a hidden, unexpected illness masked by normalised symptoms and a dominant pneumonia paradigm, supporting quotes: "I have heard about it, but I do not know what it is.”   "Nothing at all. I knew absolutely nothing about it." Asthma was non significantly more prevalent in girls (P = 0.079). School staff  told that no asthma emergency policy existed; recurring misconceptions were that inhalers are addictive and traditional herbal remedies permanently curative.  Emotional uncertainty coupled with high trust in clinicians; receptiveness to physician-led education and inhaler therapy; and willingness to build family–school shared responsibility. These findings drove concrete adaptations, including active IOS-based case-finding, inclusion of village health workers and residential-school staff, locally relevant trigger content (biomass smoke, flowering-season pollen, tobacco), and de-stigmatising delivery linked to free hospital care.
Conclusions. Substantial undiagnosed childhood asthma coexists with very low awareness in tribal Melghat. Systematic, theory-driven adaptation produced a contextually grounded school asthma programme that is now ready for feasibility testing.
Keywords: asthma; child; school health; tribal population; India; intervention adaptation; impulse oscillometry; low- and middle-income countries; qualitative research

12 - Translating Trial Evidence into Practice: Stakeholder Engagement and Multi-Level Dissemination of a Pictorial-Personalised Asthma Action Plan

Authors: Ai Theng Cheong 1, Sazlina Shariff Ghazali1, 2, Poh Ying Lim3, Hani Salim1, Fadzilah Mohamad1, Ping Yein Lee4, Norita Hussein5, Nik Sherina Hanafi5, Siti Nurkamilla Ramdzan5, Rizawati Ramli5, Siow Foon Tan6, Norasnita Nordin7, Fazlina Mohamed Yusoff8, Zuzana Aman9, Chee Kuan Wong10, Ee Ming Khoo5, Hilary Pinnock11.
1 Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
2 Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Malaysia
3  Department of Commnity Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
4UMeHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia.
5 Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
6 Port Klang Health Clinic, Klang District, Ministry of Health Malaysia
7Kapar Health Clinic, Klang District, Ministry of Health Malaysia
8Anika Health Clinic, Klang District, Ministry of Health Malaysia
9Meru Health Clinic, Klang District, Ministry of Health Malaysia
10Department of Medicine, Faculty of Medicine, Universiti Malaya
11 Usher Institute, The University of Edinburgh, UK
 

Abstract: Background: Following a randomised controlled trial demonstrating the non-inferior effectiveness of a pictorial-personalised asthma action plan (pictorial-PAAP) over a text-based plan, stakeholder engagement activities were conducted to explore clinical implementation and policy integration of the pictorial-PAAP.
Methods: Multi-level engagement strategies were executed locally and internationally. In November 2025, a regional capacity-building workshop trained 47 healthcare providers across five health districts in Kuala Lumpur and Putrajaya. In July 2026, findings were presented to policy makers from the Ministry of Health Malaysia (Family Health Development Division, Lung Health Initiative Team, and Selangor NCD Unit) and family medicine specialists from Klang District, the state of Selangor. Internationally, supported by the Mackay Capacity Building Fund, collaborative partnerships were established with two institutions in India (Christian Medical College and KEM Hospital Research Centre) to contextualise and pilot-test the pictorial-PAAP.
Results: The workshop had triggered echo training sessions at two health clinics in Kuala Lumpur and integrated into Asthma Right Care workshop at district level. Policy makers expressed strong interest in adopting pictorial-PAAP; however, financial barriers such as mass colour printing were identified, and digital platforms were put forward as a potential solution. Internationally, both partner institutions in India had successfully adapted and initiated pilot testing of the pictorial-PAAP in their local populations.
Conclusion: Active engagement with clinicians, policy decision-makers, and international partners has laid promising groundwork for translating pictorial-PAAP trial evidence into practice. Strong interest was shown among stakeholders but full-scale implementation hinges on addressing barriers, in particular resource constraints.

13 - 4CCORD Photovoice: From lived experience to action across South and Southeast Asia

Authors: Hani Salim 1, Nik Sherina Hanafi 2, Dhiraj Agarwal 3, Rutuja Patil 3, Biswajit Paul 4, Paul Jebaraj 4, Ashish Satav 5, Dhananjay Raje 5, Mohammad Shahidul Islam6, Samin Huq6, Osman M Yusuf7, Ramsha Baig7, Ee Ming Khoo 2, Hilary Pinnock 8.
1Universiti Putra Malaysia, Malaysia (UPM); 2Universiti Malaya (UM), Malaysia; 3KEM Hospital Research Centre, India; 4Christian Medical College (CMC), India; 5 MAHAN Trust, India; 6 Child Health Research Foundation (CHRF), Bangladesh; 7Allergy and Asthma Institute, Pakistan; 8 Usher Institute, University of Edinburgh.

Abstract: Background: Chronic respiratory diseases (CRDs) are often quantified through prevalence and clinical outcomes, while their human burden remains under-recognised. 4CCORD Photovoice explored lived experience across Bangladesh, India, Malaysia and Pakistan and translated community narratives into engagement and action.
Methods: People living with CRDs photographed and captioned everyday experiences. Site teams at CHRF; CMC Vellore, MAHAN Trust and KEMHRC; UPM/UM; and AAIP used adapted Photovoice approaches, involving communities, patient and public involvement (PPI) partners, health professionals and decision-makers in interpretation and dissemination.
Results: Across settings, narratives reframed burden beyond symptoms, revealing environmental and occupational exposures, disrupted work and daily life, treatment and access barriers, psychosocial effects, family support and adaptation. In Malaysia, 14 participants and PPI partners shaped recruitment, thematic validation, exhibitions, a photobook and a policy brief, connecting communities, clinicians and policymakers. CMC delivered three village- and state-level exhibitions and workshops, culminating in consensus to develop guidance and recommendations for Tamil Nadu CRD policy. MAHAN returned findings to tribal communities and trained counsellors to support wider use of Photovoice. KEMHRC generated community recommendations, a public exhibition and a toolkit. CHRF engaged 14 PPI members and 12–15 community members in discussing and disseminating photo-stories. In Pakistan, nine adults produced 34 photographs; six sessions reached 60–90 people and used bilingual, consultation-focused materials, although practice uptake remains unassessed.
Conclusion: 4CCORD Photovoice demonstrated that supported visual participation can engage diverse and low-literacy communities, convert lived experience into locally relevant evidence, strengthen empathy and co-ownership and create pathways from community voice to research, practice and policy dialogue.

14 - Enhancing Chronic Respiratory Disease Care Through Capacity Building and Upskilling - A feasibility trial in the government primary care health system in rural Tamil Nadu, India

Authors: Biswajit Paul¹, Paul Jebaraj¹, Udhayakumar P¹, Manoj Jacob Dhinagar¹, Richa Gupta¹, Balaji BV¹, Niruban¹, Rita Isaac², David Weller³, Hilary Pinnock³
¹Christian Medical College, Vellore, India  ·  ²Karkinos Foundation and Mandiram Hospital, India  ·  ³Usher Institute, University of Edinburgh, UK
 

Abstract: Background: Chronic respiratory diseases (CRDs) are a leading cause of morbidity in South Asia, yet rural government primary health centres lack capacity for spirometry-based diagnosis and protocol-driven management. This one-group, pre–post feasibility trial upskilled providers across two rural blocks of Tirupattur district, Tamil Nadu, to deliver guideline-based CRD care through the government system. We report feasibility and patient outcomes to date.
Methods: After facility strengthening and training of medical officers, therapists, and community health workers in the GINA/GOLD guidelines, community health education, screening, referral, spirometry, and protocol-based inhaler therapy were delivered through the primary care system. Adherence was assessed using the Test of Adherence to Inhalers (TAI) and quality of care by a 13-item patient exit interview.
Results: Across two blocks, 1141 people attended community health-education melas; 224 were screened for CRD, 177 screened positive and 173 seen by PHC doctors. Spirometry was performed in 119 patients, and 100 patients were diagnosed with CRD and enrolled on inhaler therapy (COPD 90%, asthma 10%). Of these, 87 (87%) completed a 3-month review and 18 an early 6-month review to date (2 deaths). Airflow obstruction was moderate (GOLD II) in 64% and severe/very-severe in 26%. Symptom prevalence fell from baseline to 3 months — wheezing 63%→14%, breathlessness 87%→63% and cough 61%→40%. Inhaler adherence was high (mean TAI-10 48.8/50; 97% good/intermediate; technique correct in 100%). In the exit interview, ≥97% of patients reported quality standards met, except for influenza/pneumonia vaccination (3%).
Conclusions: This upskilling model was feasible within the rural government primary care system, achieving spirometry-confirmed diagnosis, high inhaler adherence and marked symptom improvement. Integrating vaccination is a priority; continued follow-up will confirm the durability of the benefit and inform scale-up.

15 - Acceptability and Perceived Feasibility of Introducing Spirometry into Rural Primary Healthcare Following Healthcare Provider Upskilling in Rural India

Authors: Sayali Kasture1, Eesha Chawan1, Radhika Nimkar2, Rutuja Patil 1,2, Anand Kawade 2, Girish Dayma1,2, Hilary Pinnock3, Dhiraj Agarwal2
1Community Health Research Unit, KEM Hospital and Research Centre, Pune, 2Vadu Rural Health Program, KEM Hospital and Research Centre, Pune, 3Usher Institute, University of Edinburgh – Edinburgh, United Kingdom
 

Abstract:

Background-
Chronic respiratory diseases (CRDs) are a major cause of morbidity and mortality in India. The revised NP-NCD operational guidelines emphasis strengthening CRD diagnosis at the primary healthcare level. However, limited availability of spirometry and inadequate healthcare provider training continue to impede timely diagnosis and management in rural primary care settings.
Method-
A mixed-methods study was conducted across 4 purposively selected Primary Health Centers in Junnar block, Pune, Maharashtra. 16 healthcare providers, including Medical Officers (MOs), Auxiliary Nurse Midwives (ANMs), Accredited Social Health Activists (ASHAs) and Health Attendants (HAs), were purposively recruited. Baseline data were collected using structured Knowledge, Attitude and Practice (KAP) and Situational Questionnaires (SQ) and analysed descriptively. In-depth interviews (IDIs) explored perceptions of spirometry and were analysed using rapid analysis.
Results-
Quantitative findings from the KAP showed that 83.3% of participants demonstrated positive attitudes towards CRD management, while all participants exhibited high readiness to introduce spirometry into primary healthcare. The SQ identified inadequate training, lack of spirometry equipment, and workforce constraints as the major perceived barriers, whereas hands-on training, and technical support were recognised as key facilitators. Preliminary IDIs revealed that only MOs had prior knowledge of spirometry, whereas ANMs, ASHAs and HAs reported little or no awareness. Across all cadres, spirometry was perceived as an acceptable tool for strengthening early CRD diagnosis, provided adequate training, equipment and health-system support were available.
Conclusion-
The findings suggest that healthcare provider upskilling, together with addressing identified health-system barriers, may enhance the acceptability and perceived feasibility of introducing spirometry into rural primary healthcare.

16 - Developing and evaluating a mobile phone-based alert system using high-resolution air quality forecasts: the RESPIRE AQA pilot randomised control trial in Malaysia.

Authors: Adina Abdullah1, Wei Leik Ng1, Norita Hussein1, Chee Sun Liew2, Wee Cheah3, Chun Lin4 , Chng Saun Fong5, Ping Yein Lee6, Darwish Mohd Isa7, Afifah Tahar3, Chin Hai Teo1,6, Norimichi Hirahara6, 8, Chee Kuan Wong9, Nasrin Aghamohammadi10, Mohd Talib Latif11,12, Maggie Chel Gee Ooi12, Amy Stidworthy13, Chris Johnson13, Nik Sherina Hanafi1, Siti Nurkamilla Ramdzan1, Rizawati Ramli1, Ai Theng Cheong14, Sazlina Shariff Ghazali14, Poh Ying Lim15, Hani Salim14, Jay Evans4, Bee Kiau Ho16, Hilary Pinnock4, Ee Ming Khoo1
1Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
2Department of Smart Computing and Cyber Resilience, Faculty of Engineering and Technology, Sunway University, Malaysia
3Institute of Ocean and Earth Sciences, Universiti Malaya, Malaysia
4NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, United Kingdom
5Institute for Advanced Studies, Universiti Malaya, Malaysia
6UM eHealth Unit, Faculty of Medicine, Universiti Malaya, Malaysia
7Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
8Department of International Management, Ritsumeikan Asia Pacific University, Japan
9Department of Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
10 School of Design and Built Environment, Curtin University Sustainability Policy Institute, Perth Australia.
11Department of Earth Sciences and Environment, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Malaysia
12Center for Tropical Climate Change System, Institute of Climate Change, Universiti Kebangsaan Malaysia, Malaysia
13Cambridge Environmental Research Consultants, United Kingdom
14Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
15Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
16Botanik Health Clinic, Klang District, Ministry of Health, Malaysia
 

Abstract: Introduction:
In Malaysia, previous research established a strong correlation between poor air quality and asthma exacerbations. We conducted a pilot randomised controlled trial (RCT) in Klang, Malaysia, to evaluate feasibility of RESPIRE Air Quality App (AQA) for asthma self-management.
Methods:
We co-designed the AQA app with key stakeholders to deliver 48-hour air-quality forecasts for the Klang District in Malaysia, using the Atmospheric Dispersion Modelling System Urban (ADMS-Urban). The app has three main features: a forecast dashboard with preventive recommendations, asthma control assessment and diary, and air pollution index (API) mapping. Sixty adults receiving usual asthma care from Klinik Kesihatan Botanik were randomised (1:1) to use the AQA intervention or not, and assessments were done at baseline, 1, 3, 6, and 12 months. The primary outcome was to evaluate the feasibility of the intervention System Usability Score (SUS) and qualitative interviews. The secondary outcomes included asthma control assessed using GINA questionnaires. Data were analysed across different time points using Generalized Estimating Equations. A purposive sample of 20 participants were interviewed using qualitative approach.
Results:
Users reported marginal acceptable user experience (mean SUS=62.8). During qualitative interviews, users mentioned the app was easy to use, increased their awareness of air pollution and supported self‑management. However, technical issues (data gaps, lack of alerts) reduced usage. The intervention group had higher odds of achieving well controlled asthma at Month 3 (OR 5.71, 95%CI 1.73–18.80, p=0.004), Month 6 (OR 3.55, 95%CI 1.14–11.01, p=0.029), and Month 12 (OR 3.82, 95%CI 1.19–12.21, p=0.024).
Conclusion:
The RESPIRE AQA is feasible to be tested in a fully powered RCT and displayed positive effect on asthma control.

17 - Respire 2 Sri Lanka Indoor Air Quality Study

Authors: Duminda Yasaratne¹; Dushantha Madegedara2; Gayan Bowatte¹; Sampatha Goonewardena3; Thamara Amarasekara3; Himansu Waidyasekera3; Pathum Dissanayake¹; Lalindra Kaththiriarachchi⁴; Dulshan Jayasinghe⁵; Anoja Wimalasekera3; Chanaka Karunarathne⁵; Akindra Kariyawasam⁶;  Ridma Thilakaratna⁶; Vishwa Kumarasiri¹; Damkith Kumaranathunga¹; Hashini Wijayasinghe¹; Fathima Rishadha¹; Janindu Chandrasekara¹; Madusshica Rajshankar3; Priyanga Paramsothy3; Chun Lin⁷; Jurgen Schwarze⁷; Savithri Wimalasekera3
¹University of Peradeniya; 2 National Hospital, Kandy, 3 University of Sri Jayewardenepura; ⁴General Sir John Kotelawala Defence University; ⁵ Wayamba University of Sri Lanka; ⁶ Kaatsu International University; ⁷ University of Edinburgh

Abstract: Introduction: Indoor air pollution from household biomass combustion poses severe health risks in developing countries. This study assesses fine particulate matter (PM₂.₅) exposure and its effects on respiratory, nutritional, developmental, and maternal outcomes in pregnant women, infants, and children under five.
Methodology: A prospective longitudinal analytical study with qualitative inputs was conducted in urban and rural MOH areas in Colombo and Kandy. Pregnant women, infants, and children aged 2–5 were followed. Household PM₂.₅ was measured using TSI BlueSky monitors. Data collection included questionnaires, observations, respiratory assessments, oscillometry, FeNO, exhaled CO, anthropometry, cognitive tests, maternal health questionnaires, and qualitative interviews. Data were analysed using SPSS 24 and jamovi. Ethical approval was obtained from National Hospital, Kandy, and University of Sri Jayewardenepura. The study recruited 455 pregnant mothers, 343 preschoolers, and 234 newborns.
Results: Interim analyses included 201 pregnant women, 139 preschoolers, 86 women for QoL, and 54 preschoolers for oscillometry. Firewood resulted in higher PM₂.₅ than LPG (44.43 vs. 34.59 μg/m³; p=0.1697); cooking periods recorded significantly higher PM₂.₅ than non-cooking periods (37.17 vs. 29.74 μg/m³; p<0.0001). Household smoke exposure increased maternal respiratory symptoms (OR=8.17, p=0.049). Biomass fuel increased PM₂.₅ by 11.22 μg/m³ (95% CI: 2.56–19.88; p=0.013), and PM₂.₅ negatively predicted all QoL domains (p≤0.014). Oscillometry was feasible; no significant lung function differences occurred between fuel groups.
Conclusion: Biomass use and smoke exposure increase indoor PM₂.₅, respiratory symptoms, and reduce maternal quality of life. Continued follow-up will support interventions and policies for reducing household air pollution risks in Sri Lanka.
Keywords: Indoor air pollution; Biomass fuel; PM₂.₅; Respiratory health; Lung function; Preschool Children; Pregnant women; Sri Lanka.

18 - Mobile Health (mHealth) Versus Face-to-Face Behavioural Interventions for Smoking Cessation in People  with Tuberculosis: A Cluster Randomized Clinical Trial

Authors: Kamran Siddiqi PhD, Maham Zahid, Ph.D., Fahmidur Rahman, BSS, Mahmoud Danaee, Ph.D., Shakhawat Hossain Rana, MSS, Asiful Chowdhury, MSc, Saeed Ansaari, MS.CS., Ai Keow Lim, Ph.D., Amina Khan, MPH, Rumana Huque, Ph.D,
 

Abstract: Importance: Behavioural interventions support smoking cessation among people with tuberculosis (TB), but whether mobile health (mHealth) delivery is as effective as face-to-face support remains uncertain.
Objective: To determine whether mHealth was non-inferior to face-to-face behavioural support for achieving self-reported continuous tobacco abstinence at 6 months, verified biochemically, within a prespecified non-inferiority margin of −8%.
Design, Setting, and Participants: This multicenter, cluster-randomized clinical trial was conducted from April 8, 2025, to April 27, 2026, across 36 TB clinics in Bangladesh and Pakistan. Of 11,349 patients assessed, 1,764 smokers with TB who were willing to quit, provided written consent, and had access to a mobile phone were enrolled and randomized equally to mHealth (n=882) or face-to-face support (n=882). Follow-up was 6 months.
Interventions: The mHealth group received cessation text messages throughout TB treatment, daily for 2 months followed by monthly messages for 4 months. The face-to-face group received two structured behavioural support sessions on days 0 and 5, with additional support at week 5.
Main Outcomes and Measures: The primary outcome was self-reported continuous abstinence at 6 months, verified by carbon monoxide breath testing. Secondary outcomes included point abstinence, TB treatment adherence and outcomes, and mortality.
Results: Among randomized participants, 1,614 (91%) completed follow-up. Continuous abstinence was achieved by 35.9% (317/882) in the mHealth group versus 62.1% (548/882) in the face-to-face group (risk difference, −33.5%; 95% CI, −44.2% to −19.1%). The observed margin was −14%, exceeding the prespecified −8% margin. TB treatment success and mortality were similar between groups.
Conclusions and Relevance: mHealth did not demonstrate non-inferiority to face-to-face behavioural support and was substantially less effective for smoking cessation among people with TB.

19 - Association of Air Quality Index and Particulate Matter With Acute Respiratory Infections Among Children Under Five in Islamabad

Authors: Syed Yahya Sheraz
 

Abstract: Abstract
Background: Ambient air pollution is an important environmental health concern, particularly for young children vulnerable to respiratory illness. However, Evidence on the short-term relationship between air quality fluctuations and acute respiratory infections (ARIs) in Pakistan remains limited. This study assessed the association between outdoor air quality and outpatient ARI presentations among children under five in Islamabad, Pakistan.
Methods: A prospective ecological study was conducted over ten months at two healthcare facilities representing urban and peri-urban populations: Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS), and Rural Health Centre, Tarlai. Children under five presenting to outpatient departments with ARIs were enrolled following informed consent. Clinical and sociodemographic data were collected using standardized case report forms. Daily air quality, measured by the Air Quality Index (AQI), PM₂.₅, and PM₁₀, was assessed in relation to ARI presentations.
Results: A total of 1,469 children were enrolled; 815 (55.5%) were male and 654 (44.5%) female. Nasopharyngitis was the most common diagnosis (43.1%), followed by pneumonia (22.9%) and pharyngitis (15.4%). Mean AQI was 126.8 ± 66.2 (median 110). PM₂.₅ and PM₁₀ exceeded recommended safe limits on 96.2% and 85.9% of days, respectively. AQI and PM₂.₅ showed weak but statistically significant positive correlations with ARI presentations. AQI associations were significant at 1–3-day lag periods, with strongest correlations at 1–2 days. Temperature was negatively correlated with ARI presentations.
Conclusion: Short-term fluctuations in air quality may contribute to increased ARI presentations among children under five. Continued air-quality monitoring and further research are recommended to inform public health interventions.
Keywords: Air pollution; Air Quality Index; Acute respiratory infections; Children under five

20 - Identifying Vulnerable Communities and Respiratory Health Impacts of Climate Change: A Phenomenological Study in Vellore District, Tamil Nadu, India
 

Authors: Manoj Jacob Dhinagar, Biswajit Paul, Paul Jebaraj, Udhayakumar P, Rakesh Kumar, Dharani K, Sarah TM,  Mythry Ravichandran, Balaji BV, Niruban, Murali M - Rural Unit for Health and Social Affairs, Christian Medical College, Vellore
Harry Campbell, Hilary Pinnock - University of Edinburgh
 

Abstract: This study aimed to identify vulnerable communities in Vellore district and document lived experiences of people with respiratory health impacts to co-design mitigation strategies and inform policy. community engagement and mitigation strategies.
Methods and Materials: This qualitative, phenomenological study combined an innovative in-house vulnerability matrix with participatory rural appraisal (PRA) techniques to identify and validate vulnerable groups across five community development blocks in Vellore district. Using the phenomenological approach, we explored lived experiences of people with respiratory conditions affected or aggravated by climate change. Multiple IDIs and FGDs were conducted within 2-3 villages in each taluk in order to obtain a wide range of relevant information and the data was then analyzed.
Preliminary Results
Key themes identified: (1) Perceived increase in respiratory symptoms following extreme summer heat, heavy winter and unseasonal rain; (2) Household air pollution from firewood smoke, domestic burning of waste). Participants who had homes close to the roads also complained about increased exposure to vehicle exhaust; (3) Occupational vulnerability (4) Barriers to care including transport disruption during floods and limited local health services; (5) Adaptive strategies such as stricter control on burning plastics and trash improving health care access during severe weather episodes.
Preliminary Conclusions
This phenomenological study demonstrates that climate change-related events in Vellore district are perceived by community members to worsen respiratory health through multiple pathways. Findings support integrating climate resilience into local respiratory health programs and highlight the need for context-specific mitigation

21 - Prevalence of Chronic Respiratory Diseases (Bhutan CRD Survey) and Quality of Care in Bhutan

Authors: Thinley Dorji1, Tshering Penjor2, Mongal Singh Gurung3
1Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan (thinleydorji@nms.gov.bt)
2Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
3Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
 

Abstract: Background: Chronic respiratory diseases (CRD) are an important public health concern in Bhutan. This project aimed to generate baseline population-level data on CRD prevalence and risk factors, assess quality of life and quality of care among patients with CRD, and explore the impact of climate change on CRD.
Methods: Part A of the project was a national cross-sectional survey using multistage cluster sampling (target sample 1,152) to assess CRD symptoms and spirometry-defined respiratory conditions. Part B was an observational study of quality of life and quality of care among patients with CRD. Part C was a qualitative study exploring the effects of climate change on CRD symptoms, risk factors, and access to care.
Results: Among 1,037 participants, the response rate was 90.0%; 1,021 (88.6%) underwent spirometry and 996 (86.5%) completed pre- and post-bronchodilator spirometry. At least one CRD symptom was reported by 42.5%, including chronic cough (39.8%), chronic phlegm (33.7%), and exertional shortness of breath (33.0%). Spirometry-defined CRD was identified in 16.5%, including COPD (26.1%), asthma (8.0%), and restrictive lung disease (58.1%). Firewood exposure was reported by 49.7%, biomass exposure by 35.6%, and regular environmental smoke exposure by 42.4%. Patients with CRD had a 5.8-point lower Physical Component Summary score and a 1.1-point lower Mental Component Summary score. Qualitative participants reported concerns about unpredictable weather, environmental exposures from road construction, and household vulnerability, alongside transitions towards cleaner energy sources.
Conclusion: This project provides baseline evidence on CRD burden, environmental exposures, quality of life, and climate-related concerns in Bhutan.

22 - Indoor and Outdoor Household Particulate Matter Concentration and Meteorological Conditions and Their Association with Lung Function Among Adults Aged ≥40 years in Urban and Rural Sylhet, Bangladesh: A Community-Based Cross-Sectional Study

Authors: Authors: Salahuddin Ahmed¹, Rezwana Tabassum¹, Fahmida Hoque Rimti¹, Zannatul Ferdush¹, Sazzadul Haque¹, Abrarul Haque Asif¹, Nighat Sultana¹, A.S.M Tarik Hasan¹, Md. Shafiqul Islam¹, Md. Ashraful Islam¹, Ahad Mahmud Khan¹
Affiliation: 1. Projahnmo Research Foundation, Dhaka, Bangladesh
 

Abstract: Background: Particulate matter and meteorological conditions may influence respiratory function, but evidence among adults in Bangladesh remains limited. We examined household PM₂.₅ and PM₁₀, meteorological conditions and their associations with lung function across urban and rural settings in Sylhet.
Methods: We conducted a community-based cross-sectional study among 760 adults aged ≥40 years in Sylhet city and rural Zakiganj from September 2025 to March 2026. Indoor and outdoor PM₂.₅ and PM₁₀ were measured once per household; meteorological variables were assigned by site and date. Pre-bronchodilator spirometry followed the International Primary Care Respiratory Group Quick Guide to Spirometry. Multivariable linear regression adjusted for demographic, anthropometric and behavioural covariates and site, with exposure-by-site interaction tests.
Results: Abnormal spirometry was more frequent in Sylhet city than rural Zakiganj (69.2% vs 54.2%; p<0.001), while FEV₁/FVC was higher (85.7% vs 83.7%; p<0.001). Outdoor PM₂.₅ was higher in Zakiganj (33.0 vs 27.0 µg/m³), while indoor concentrations were similar (38.5 vs 42.0 µg/m³). Particulate concentrations were not associated with lung function overall. Indoor PM₂.₅ was associated with lower FEV₁ in Sylhet city (−0.0232 L per 10 µg/m³; 95% CI: −0.0388, −0.0076), but not Zakiganj (p-interaction=0.015). Temperature was associated with higher FEV₁ in Sylhet city (0.0238 L per 1°C; 95% CI: 0.0117, 0.0359), and rainfall with higher FEV₁/FVC overall (0.87 percentage points per 10 mm/day; 95% CI: 0.38, 1.36).
Conclusions: Abnormal spirometry was more frequent at the urban site, where indoor particulate and temperature associations were stronger. Findings indicate site-level heterogeneity and support longitudinal studies with repeated exposure measurement.

23 - Weather variability, physiological responses, and adaptation strategies among persons with CRDs in Vadu HDSS

Authors: Veeresh Ravindra1, Dipali Dhamdhere1, Parag Khatavkar1, Anand Kawade1, Jacques Prioux2, Joy Monteiro3, Hilary Pinnock4 , Dhiraj Agarwal1
1Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India, 2 Ecole Normale Supérieure in Rennes, France,  3Departments of Earth and Climate Science and Data Science at the Indian Institute of Science Education and Research, Pune, India, 4NIHR Global Health Research Unit on Respiratory Health, University of Edinburgh

Abstract: Weather variability, physiological responses, and adaptation strategies among persons with CRDs in Vadu HDSS
Abstract
Background: Climate change is increasing the frequency and severity of extreme weather events, including heatwaves, with substantial implications for health—particularly among individuals with chronic respiratory diseases (CRDs). Heat exposure can intensify respiratory symptoms, reduce physical activity, and increase morbidity. However, little empirical evidence exists on physiological and behavioral responses to heat among CRD populations in rural Indian settings, where environmental exposures, socio-economic vulnerability, and limited adaptive capacity may further exacerbate risks. Understanding how individuals with and without CRDs respond to heat exposure is essential for informing context-appropriate public health strategies.
Objectives: The primary objective of this study is to measure the relationship between heat stress and strain in persons with and without CRD. Additionally, the study aims to record quantitative and qualitative metrics of heat strain and the corresponding changes in physical activity (PA). It also seeks to estimate the compounding effect of air quality on PA and heat-related strain, and to use qualitative methods to assess behavioural adaptation strategies adopted by the participants against extreme weather conditions.
Methods: This mixed-methods exploratory study will be conducted in 22 villages of the Vadu Health and Demographic Surveillance System (HDSS), Pune, India. Forty adult participants (20 with CRDs and 20 healthy controls) will be recruited with equal gender and age representation. Physiological measures—including heart rate, oxygen saturation, body/skin temperature, and physical activity—will be assessed bi-weekly over six months across cold and warm seasons. Environmental measurements of temperature, humidity, and air quality will be continuously recorded. In-Depth Interviews (IDIs) will complement quantitative findings by exploring adaptation behaviors and socio-cultural perceptions related to weather and health.
Expected Results: The study will provide quantitative evidence on physiological strain across varying heat exposures and identify how air quality and temperature influence physical activity. Qualitative findings will reveal coping mechanisms, perceived risk, and sociocultural barriers to adaptation.
Conclusion: Findings will support the development of early warning systems, heat-health action plans, and locally relevant adaptation strategies to protect heat-vulnerable populations, particularly individuals with CRDs, in rural South Asia.

24 - Association Between Temperature and Acute Respiratory Infection Among Under-Five Children in Bangladesh: A Pooled Analysis of Three BDHS Rounds

Authors: Ahad Mahmud Khan, Shafiqul Islam, M Z E M Naser Uddin Ahmed, Rezwana Tabassum, Sazzadul Haque, Salahuddin Ahmed
Affiliation: Projahnmo Research Foundation, Dhaka, Bangladesh

Abstract: Background: Temperature may influence childhood acute respiratory infection (ARI), but evidence from Bangladesh remains limited. We examined the association between daily mean temperature and ARI among children aged under five years.
Methods: We conducted a pooled cross-sectional analysis of the 2014, 2018, and 2022 Bangladesh Demographic and Health Surveys. The analysis included 17,475 children from six administrative divisions, of whom 570 had ARI. ARI was defined as caregiver-reported cough accompanied by short, rapid breathing due to a chest-related problem during the two weeks preceding the survey. Survey data were linked with daily mean temperature records from the Bangladesh Meteorological Department. A distributed lag nonlinear model estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) across the temperature range over lag periods of 1–14 days. Models were adjusted for child age and sex, maternal age, household wealth quintile, administrative division, and survey year.
Results: The overall prevalence of ARI was 3.3%. The cumulative temperature–ARI relationship was nonlinear. Compared with the reference temperature of 26.9°C, the median, ARI prevalence was significantly higher at temperatures from 22°C (aPR 1.52; 95% CI 1.02–2.27) to 26°C (aPR 1.11; 95% CI 1.01–1.22). Conversely, ARI prevalence was significantly lower at temperatures from 28°C (aPR 0.86; 95% CI 0.76–0.99) to 32°C (aPR 0.45; 95% CI 0.22–0.95).
Conclusion: Cooler daily mean temperatures were associated with a higher prevalence of ARI among Bangladeshi children. Further analyses incorporating additional BDHS rounds and other environmental exposures are warranted.

25 - Climate Change and Respiratory Health in South Asia: A Scoping Review

Authors: Rezwana Tabassum¹, M Z E M Naser Uddin Ahmed¹, Nighat Sultana¹, Shohana Shahreen¹, Bipasha Akhter¹, Tajkia Rumman¹, Sifat Binte Ibrahim¹, Madhurima Nundy², Marylene Wamukoya², Ruth McQuillan², Marshall Dozier², Salahuddin Ahmed¹, Ahad Mahmud Khan¹
1 Projahnmo Research Foundation, Dhaka, Bangladesh; 2 University of Edinburgh, Edinburgh, UK
 

Abstract: Background
Climate change is a growing public health emergency, with South Asia facing substantial climate-related health risks. Across this region, climate-induced environmental changes have significantly increased the burden of respiratory diseases. This study aimed to summarise existing evidence on climate events and respiratory disease outcomes in South Asia.
Methods
This scoping review followed the Joanna Briggs Institute (JBI) approach and PRISMA-ScR guidelines. A comprehensive search of peer-reviewed and grey literature was conducted using terms related to climate change or extreme weather events, respiratory health conditions and South Asia. Studies were selected based on predefined eligibility criteria focusing on climate exposures and respiratory outcomes within South Asia.
Results
22 studies from four South Asian countries (Bangladesh, India, Pakistan, and Sri Lanka) were included. Floods were the most frequently reported climate event, followed by droughts and climate variability; storms, cyclones and tidal waves were less frequently reported. Acute respiratory infections (ARI) were the predominant respiratory outcome, followed by pneumonia, respiratory disease-related mortality, chronic respiratory disease (COPD, bronchitis, and tuberculosis) and other acute respiratory illnesses. Flood-related studies demonstrated increased ARI followed by pneumonia and chronic respiratory diseases across all age groups, particularly among children. Drought and climate variability were mainly associated with increased respiratory mortality and chronic respiratory conditions.
Conclusions
Climate variability & extreme weather events are linked to increased respiratory morbidity and mortality in South Asia. There is an urgent need for climate-resilient respiratory health strategies and more robust country-level research to address further knowledge gaps with target-specific mitigation and adaptation strategies.

26 - Healthcare Providers' Knowledge, Competencies and Practice Gaps in Climate Change and Respiratory Health: A Scoping Review

Authors: Paul Jebaraj1, Manoj Jacob Dhinagar1, Udayakumar1, Mythry Ravichandran1, Sadiq Basha1, Nadege Atkins2, Marshall Dozier3, Ruth McQuillan2, Biswajit Paul1
1RUHSA Department, Christian Medical College, Vellore, 2Usher Institute, University of Edinburgh, UK, 3University of Edinburgh, UK.

Abstract: Introduction:
Healthcare providers (HCPs) play a vital role in addressing the health impacts of climate change, particularly the challenges to respiratory health. This scoping review examined the current knowledge, skills, competencies, and gaps among HCPs regarding climate change and respiratory health.
Methods:
The review followed JBI scoping review guidelines and the PRISMA-ScR framework. A comprehensive search strategy was applied across the MEDLINE (PubMed), CINAHL, Web of Science, Cochrane Library, Global Health, and SCOPUS databases. Peer-reviewed articles published between 2000 and 2024 in any language were considered. Studies were imported into Covidence, and two reviewers independently screened titles, abstracts, and full texts.
Results:
A total of 7,620 articles were screened, of which 111 underwent full-text assessment. Sixty-two studies met the inclusion criteria and were synthesised narratively. Findings revealed that HCPs generally have limited knowledge of climate change and its effects on respiratory health in high- and middle-income countries, with no data from low-income countries. Many HCPs reported relying on inadequate information sources and highlighted the need for climate-health content within undergraduate and postgraduate medical and health professional curricula. Recommended strategies include self-education, recognition of vulnerable populations, integration of climate perspectives into clinical care, tailored patient education, climate-conscious prescribing, medication adaptation and medication safety, and active advocacy.
Conclusion:
This scoping review provides valuable insights for developing a toolkit for HCPs and strengthening the preparedness of health systems for climate-related events. These measures can help mitigate the effects of future climate-related events and improve patient outcomes in the face of respiratory challenges.

27 - Building research capacity through the RESPIRE e-Postgraduate programme in epidemiology: From learning to public health impact

Authors: Anuj Kumar Pandey, King George's Medical University, Lucknow, India
Shally Awasthi, King George's Medical University, Lucknow, India
Shubhada Khirwadkar, Mahan Trust, Maharashtra, India

Abstract: Abstract
Background: Strengthening epidemiological capacity is fundamental to improving public health research and evidence-based decision-making in low- and middle-income countries. Through the Global Health Research Unit on Respiratory Health (RESPIRE), I was awarded a scholarship to undertake the one-year e-Postgraduate programme in Epidemiology at the Indian Institute of Public Health (PHFI), Delhi. The programme was designed to enhance competencies in epidemiological methods and their application to public health practice.
Learning experience: The programme combined online lectures, self-directed learning, assessments, and faculty-led discussions covering epidemiological study designs, biostatistics, communicable and non-communicable diseases, disease surveillance, scientific writing, and critical appraisal of research. It strengthened my understanding of epidemiological concepts, statistical measures, bias, confounding, and evidence synthesis while enhancing my scientific writing and analytical skills.
Impact: Following completion of the programme, I integrated the knowledge and skills into my role as a biostatistician by applying epidemiological and biostatistical methods to study design, statistical analysis, interpretation of findings, and evidence generation for public health research. The programme also strengthened my ongoing PhD research in statistics by enhancing my ability to integrate epidemiological principles with advanced statistical methods in addressing public health research questions. The competencies acquired have improved the quality of my research contributions, fostered interdisciplinary collaboration, and enhanced my capacity to support evidence-informed public health programmes and research.
Conclusion: The RESPIRE-supported e-Postgraduate Programme has significantly strengthened my research capacity and professional development. The skills acquired continue to influence my work in epidemiology and biostatistics, enabling me to contribute more effectively to high-quality public health research and ultimately support improvements in population health.

28 - Detection of Anti-Aspergillus fumigatus Antibodies in Patients with Pulmonary Tuberculosis and Their Association with Clinical Outcomes

Authors: Muh Arya Prahmana(1), Intan Mauli Warma Dewi(1,3), Yunisa Pamela(1), Chrysanti(1), Prayudi Santoso(2)
1. Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
2. Internal Medicine Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
3. Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia

Abstract: Background and Objective: Chronic pulmonary aspergillosis (CPA) is a fungal infection associated with poorer clinical outcomes in tuberculosis (TB), with elevated immunoglobulin G (IgG) against Aspergillus fumigatus as one of its biomarker. Currently the role of anti-Aspergillus IgG as a predictor of clinical outcomes in pulmonary TB remains scarcely studied, this study assessed changes in anti-Aspergillus IgG titers before and after TB treatment and evaluated their association with clinical outcomes.
Methods: A retrospective cohort study used plasma samples and secondary data from the "Post TB Lung Disease" study. Ninety-one samples were included: 34 at TB treatment initiation (baseline), 25 at treatment end, 20 at 6 months post-completion, and 12 healthy household-contact controls. Anti-Aspergillus IgG titers were measured by ELISA.
Results: Anti-Aspergillus IgG titers increased in 64% of participants at month 6, though not statistically significantly (p = 0.397). Across all regression models, titers were not significantly associated with clinical outcomes, though FEV1 was consistently negatively correlated with titers. Factors associated with outcomes included baseline BMI (pulmonary function impairment and fibrosis at month 6), baseline HbA1c (FEV1 at months 6 and 12), and baseline sputum smear AFB (FEV1 at month 6).
Conclusion: Baseline BMI, HbA1c, and AFB smear results may influence pulmonary TB outcomes. Anti-Aspergillus IgG titers tended to increase individually but not significantly, showing no significant association with clinical outcomes—possibly due to a relatively mild TB patient profile and limited titer rise.

29 - Oropharyngeal Carriage and Density of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in Adolescents With and Without Asthma

Authors: Raeni Dwi Putri1, Chrysanti Murad2, Kuswandewi Mutyara3
1Master Study Program of Biomedical Sciences, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
2Department of Biomedical Sciences, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
3Department of Public Health, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia

Abstract: Background: Asthma may influence upper-airway bacterial colonization and is linked to infection risk such as pneumonia. Globally, evidence quantifying carriage density in asthmatic adolescents remains very limited.
Objective: To compare carriage prevalence and density of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in adolescents with asthma compared with non-asthma controls, and to identify factors associated with carriage within the asthma group.
Methods: A cross-sectional study (December 2024–December 2025) was conducted at Ciumbuleuit Primary Health Center and SMPN 52 Bandung, enrolling 120 adolescents aged 10–18 years (matched asthma compared to controls). Participants were interviewed and underwent oropharyngeal swabbing. Detection and quantification used singleplex qPCR targeting lytA, hpd, and copB. Density was expressed as log10 genome equivalents (GE)/mL.
Results: Overall carriage prevalence was 30% for S. pneumoniae, 30% for H. influenzae, and 20% for M. catarrhalis, with no significant differences between asthma and non-asthma groups (p=0.220, 0.072, 0.344). Median densities were also not significantly different (all p>0.05). In the asthma group, exacerbation and antibiotic use within the prior 3 months were associated with lower odds of single-bacterium carriage (aOR 0.03 and 0.02). Species-specific analyses showed reduced carriage of H. influenzae and M. catarrhalis with recent exacerbation (aOR 0.17 and 0.16), while recent antibiotic use reduced carriage of S. pneumoniae and M. catarrhalis (aOR 0.13 and 0.18).
Conclusion: Asthma status was not associated with differences in carriage prevalence or density among Bandung adolescents. Recent exacerbations and antibiotic exposure may transiently suppress colonization.
Keywords: asthma, Streptococcus pneumoniae, Haemophilus influenzae, carriage, upper respiratory tract

30 - Tackling Household Air Pollution: Advancing Paediatric Respiratory and Cognitive Assessments in Sri Lanka

Authors: Dulshan Jayasinghe1,3, Chanaka Karunarathne1,3, Ridma Thilakarathna2,4, Akindra Kariyawasam1,4, Madusshica Rajshankar1, Priyanga Paramsothy1, Damkith Kumaranathunga2, Hashini Wijayasinghe2, Lalindra Kaththiriarachchi1, Himansu Waidyasekera1,Thamara Amarasekara1, Chun Lin5, Gayan Bowatte2, Sampatha Goonewardena1, Pathum Dissanayake2, Duminda Yasaratne2, Dushantha Madegedara3, Savithri Wimalasekera1, Jurgen Schwarze5
1University of Sri Jayewardenepura, Sri Lanka
2University of Peradeniya, Sri Lanka
3Wayamba University of Sri Lanka
4Kaatsu International University, Sri Lanka
5University of Edinburgh, UK
 

Abstract: Background and Key Findings: As a RESPIRE student, my research evaluates the impacts of exposure to household PM₂.₅ from biomass fuel smoke on paediatric health in Sri Lanka. An interim analysis of 130 preschoolers (mean age 4.05±0.99 years) reported the following respiratory symptoms: cough (43.8%), runny nose (36.9%), and sore throat (9.2%). The study demonstrated the feasibility of using lung oscillometry to assess pulmonary function. Among the initially recruited 54 preschoolers, 75.3% were willing and able to perform the test, and 89.3% of those reports were acceptable. The Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) was translated, culturally adapted, and administered, achieving a 96.38% successful completion rate (n=80/83) in an interim cohort.
Training and Achievements: My fellowship facilitated extensive capacity-building, including a Pulmonary Function Testing Fellowship in Pune and statistics training in Malaysia. Translating expertise into dissemination, I served as a resource person for paediatric allergy and adult COPD management workshops for medical officers and postgraduate trainees, and delivered a lecture on Photovoice methodology. I also presented at international conferences, co-authored 21 abstracts (three as first author), and contributed to the "Breathing Clean Air" educational booklet.
Impact on Policy and Practice: This research proved the feasibility of oscillometry and the WPPSI-IV while establishing regional baseline data. I raised community and policymaker awareness through Environment Day programs, a children's art competition, and national tobacco cessation roundtable discussions. These efforts were conducted in collaboration with Sri Lanka College of Pulmonologists, local NGOs, Ministry of Health, and the WHO.

31 - From capacity building to impact: A RESPIRE-supported journey in household air pollution and maternal respiratory health research in Sri Lanka

Authors: Chanaka Karunarathne¹‚²
Dulshan Jayasinghe¹‚²
Ridma Thilakarathna²,⁴
Akindra Kariyawasam¹,⁴
Madusshica Rajshankar¹
Priyanga Paramsothy¹
Janindu Chandrasekara²
Vishwa Kumarasiri²
Gayan Bowatte²
Thamara Amarasekara¹
Lalindra Kaththiriarachchi¹
Himansu Waidyasekera¹
Pathum Dissanayake²
Sampatha Goonewardena¹
Dushantha Madegedara³
Chun Lin⁵
Jurgen Schwarze⁵
Duminda Yasaratne²
Savithri Wimalasekera¹
1 University of Sri Jayewardenepura
2 University of Peradeniya
3 Wayamba University of Sri Lanka
4 Kaatsu International for Undergraduate Studies
5 University of Edinburgh

Abstract: Background and Aims
This study investigated associations between household air pollution and maternal respiratory mechanics in Sri Lanka. We evaluated how primary cooking fuel use and cumulative indoor fine particulate matter (PM2.5) derived from continuous monitoring correlate with respiratory function during pregnancy, utilising lung oscillometry to measure airway impedance.
Key Findings
Multivariable regression evaluated 149 pregnant women. After controlling for confounders, neither cumulative PM2.5 (p>0.200) nor cooking fuel type (p=0.897) independently correlated with airway resistance. Conversely, anthropometry was strongly associated with outcomes: maternal height inversely correlated with resistance (p<0.001), while increased weight was positively associated with high peripheral (R5-R19) and central airway resistance (R19) (p<0.001). Geographic residency emerged as a major independent covariate; peripheral resistance was significantly higher in Kandy (OR=4.603, p<0.001). R5-R19 predictive model yielded an AUC of 0.781.
Achievements and Impact
Supported by the NIHR RESPIRE programme, a fellowship in India provided hands-on lung function training. We subsequently served as resource persons for oscillometry training at a paediatric allergy and asthma workshop (University of Peradeniya) and a training workshop on respiratory function assessment (University of Sri Jayewardenepura). An advanced statistics workshop in Malaysia laid a strong foundation for data analysis. This capacity-building facilitated 22 co-authored abstracts (two as first author), international presentations, and contributions to the “Breathing Clean Air” booklet.
Conclusion
These findings highlight the complexity of isolating environmental associations from baseline physiological and geographic respiratory determinants. Through RESPIRE, we strengthened local capacity, translating epidemiological insights into clinical training, academic discourse, and community health awareness across Sri Lanka.

32 -  My RESPIRE Journey in Household Air Pollution (HAP) and Maternal Health in Sri Lanka

Authors: Akindra Kariyawasam, University of Sri Jayewardenepura, Sri Lanka
Ridma Thilakarathna, University of Peradeniya, Sri Lanka
Dulshan Jayasinghe, University of Sri Jayewardenepura, Sri Lanka
Chanaka Karunarathne, University of Sri Jayewardenepura, Sri Lanka
Priyanga Paramsothy,  University of Sri Jayewardenepura, Sri Lanka
Madusshica Rajshankar, University of Sri Jayewardenepura, Sri Lanka
Fathima Rishada, University of Peradeniya, Sri Lanka
Lalindra Kaththiriarachchi, University of Sri Jayewardenepura, Sri Lanka
Pathum Dissanayake, University of Peradeniya, Sri Lanka
Gayan Bowatte, University of Peradeniya, Sri Lanka
Jurgen Schwarze, Child Life and Health, Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, UK
Chun Lin, Usher Institute, University of Edinburgh, UK
Dushantha Madegedara, Wayamba University of Sri Lanka, Sri Lanka
Sampatha Goonewardena, University of Sri Jayewardenepura, Sri Lanka
Thamara Amarasekara, University of Sri Jayewardenepura, Sri Lanka
Duminda Yasaratne, University of Peradeniya, Sri Lanka
Savithri Wimalasekera, University of Sri Jayewardenepura, Sri Lanka

Abstract: Title: My RESPIRE Journey in Household Air Pollution (HAP) and Maternal Health in Sri Lanka
Key findings (interim): PM₂.₅ monitoring, validated instruments and qualitative interviews were used to assess the effects of HAP on the health status, nutritional status, and quality of life of pregnant women in Colombo and Kandy districts of Sri Lanka.
Psychological status: among 172 mothers (41.3% biomass-exposed), stove type was associated with stress (p=0.014), anxiety (p=0.004) and depression (p<0.001).
Quality of life: biomass use raised indoor PM₂.₅ by 11.22 µg/m³ over LPG (p=0.013), and PM₂.₅ negatively predicted all WHOQOL-BREF domains.
Sleep: Elevated 48-hour PM₂.₅ predicted poorer sleep quality (p=0.003) and prolonged latency (p=0.016).
Mothers described firewood as "traditional", tastier and "more affordable compared to gas". A public health midwives highlighted poorly ventilated homes, uncleaned chimneys, and stoves traditionally kept alight all day for convenience.
Achievements: The scholarship and the RESPIRE Capacity Building Fellowship (PURE, Pune) group award supported my postgraduate studies. Training spanned spirometry, lung oscillometry, cognitive assessment, qualitative research and air-quality monitoring, with advanced statistics and photovoice workshops in Malaysia. I have co-authored 21 abstracts, three as first author, and contributed to the "Breathing Clean Air" educational booklet.
Engagement: With the Sri Lankan team, I organized the "Clean Air, Healthy Lives" art competition at Lady Ridgeway Hospital for Children, delivered World Environment Day sessions, and shared findings with mothers, health care professionals during fieldworks.
Impact: A planned PhD upgrade will co-develop a photovoice-guided intervention promoting household air quality to improve maternal wellbeing in Sri Lanka

33 - Strengthening Advanced Statistical Analysis Skills for Global Health Research: Outcomes of an NIHR GHR SPARC Placement

Authors: Saeed Ansari

Abstract: The NIHR Global Health Research Short Placement Award for Research Collaboration (GHR SPARC), hosted by the University of Edinburgh within the NIHR Global Health Research Unit on Respiratory Health (RESPIRE-2), provided an opportunity to strengthen advanced quantitative research and statistical analysis skills for global health research.
The placement focused primarily on strengthening practical and theoretical expertise in advanced regression analysis. This included participation in an Advanced Regression Analysis module and specialist training in Stata, linear regression and logistic regression. The combination of structured training, expert mentorship and hands-on application strengthened the ability to select, apply and interpret statistical methods for complex health research data.
An important aspect of the placement was applying these skills to ongoing research within RESPIRE-2, enabling statistical learning to move beyond formal training into practical research application. Collaboration with experienced researchers also strengthened understanding of research methodology, interpretation of findings and, secondarily, scientific writing and communication.
The placement demonstrates how targeted training in advanced statistical methods, combined with mentorship and application within an international research collaboration, can strengthen analytical capacity for addressing global health challenges. The skills developed are now contributing to ongoing analyses and research outputs within RESPIRE-2, while providing a stronger foundation for future quantitative health research.

34 - Leading with Heart and Mind: Building Research Leadership in LMICs

Authors: Hana Mahmood, Syed Yahya Sheraz, Zakiuddin Ahmed

Abstract: Background. Leadership is rarely taught explicitly within global health research training, yet early-career researchers in low- and middle-income countries (LMICs) are routinely expected to lead teams, projects and institutional change. Through the NIHR Global Health Research Cohort Academic Development Award (GHR CADA, Round 3; GHR CADA-R3-009), the NIHR GHR Unit on Respiratory Health (RESPIRE-2) delivered a leadership programme jointly with the NIHR GHR Centre for Improving Mental and Physical Health Together (IMPACT).
Methods. A three-day residential workshop, Leading with Heart and Mind: Integrating Design Thinking, Innovation and Emotional Intelligence, was held in Colombo, Sri Lanka (24–26 February 2025) with two facilitators (Hana Mahmood and Zakiuddin Ahmed). Modules covered strategic planning, design thinking fundamentals and application, compassion, empathy and emotional intelligence, three models of leadership, and systems leadership. Pre- and post-tests and a virtual follow-up session (21 March 2025) assessed learning and progress.
Results. Fourteen Academy members participated (nine women; twelve LMIC nationals) from seven countries, spanning pre-doctoral (n=5) and doctoral (n=9) stages; nine from RESPIRE and five from IMPACT. Participants reported greater confidence leading diverse teams and applied learning in practice: embedding collaborative leadership in a clinical trial team (India), leadership teaching videos (Sri Lanka), a community engagement initiative (Bangladesh), a leadership resource library (UK), and cascade design-thinking training (Pakistan). Cross-country peer networks were established and the programme was delivered under budget.
Conclusion. A short, cross-programme cohort intervention pairing design thinking with emotional intelligence is feasible and low-cost, with early evidence of cascade training and institutional uptake across diverse LMIC settings.

35 - The PuRe programme of work: an example of a multi-national RESPIRE team working together to develop the evidence for pulmonary rehabilitation in LMICs.

Authors: Hilary Pinnock, Dhiraj Agarwal, Julia Engkasan, Monsur Habib, Biswajit Paul, Vicky Hammersley, Roberto Rabinovich, Ee Ming Khoo, and the teams from Bangladesh Primary Care Respiratory Society, Christian Medical College Vellore, KEM Hospital Research Centre Pune, Universiti Malaya and the University of Edinburgh.

Abstract: Pulmonary rehabilitation is a guideline-recommended intervention that improves the quality-of-life of people with chronic respiratory disease. The RESPIRE PuRe programme aimed to generate evidence of how PR can be adapted and embedded effectively in diverse LMIC healthcare settings:
• Monsur Habib (Khulna, Bangladesh) studied PR in his RESPIRE PhD.  His systematic review revealed that the few studies on PR in LMICs were at high risk-of-bias.
• RESPIRE researchers from Bangladesh, India and Malaysia completed a systematic review showing that Home-PR was as effective as Centre-PR.
• Feasibility studies in Bangladesh (BPCRS), India (CMC and KEM) and Malaysia (UM) confirmed practicability, acceptability and potential utility of PR in low-resource settings.
• The team secured MRC funding for a three-arm, ‘Hybrid-1’ implementation trial testing clinical and cost effectiveness of Centre-PR, Home-PR and Usual Care over 6-months including a process evaluation in the four centres.
• Colleagues from the four centres wrote the PuRe Manual for PR therapists and designed the PuRe Pack which uses behavioural change techniques to support patients.
• Capacity building includes three PhD students: Diksha Singh (KEM) studying psychological component of PR; Soo Chin Chan (UM) studying implementation in Malaysia and Paul Jebaraj (CMC) studying PR for long-COVID.
• Community engagement ensures the research reflects local healthcare needs and supports sustainability.
Recruitment is complete (n=465) and the PuRe trial will report in summer 2027. Three RESPIRE feasibility studies (Bhutan; Cox’s Bazar, Bangladesh; Pakistan) will add further insights into PR delivery in LMICs.  On-going national/global stakeholder engagement will optimise relevance to LMIC settings and promote global dissemination.

36 - Greening Urban Slums for Green Healthcare: A Mixed-Methods Feasibility Study for Chronic Respiratory Disease in Bangladesh

Authors: Farzana Khan, Hasina Karim, Kazi Sarmad Karim

Abstract: Background: Chronic respiratory diseases (CRDs) are a growing public-health burden in densely populated urban informal settlements, where environmental exposures, poor air quality and limited green space may worsen symptoms and disease progression. Community-driven, nature-based interventions may offer a feasible, low-cost response while strengthening community engagement.
Aim: To assess the feasibility, acceptability and early impact of community-based greening for CRDs in urban informal settlements in Bangladesh.
Objectives: To assess changes in environmental perceptions, respiratory wellbeing, and community practices; explore community engagement and sustainability; and identify lessons for future scale-up.
Methods: A community-based mixed-methods feasibility study was conducted in two urban informal settlements in Dhaka. Approximately 100 participants and stakeholders were engaged, including adults living with CRDs, community members and caregivers, young people, volunteers and Community Health Facilitators. The intervention combined locally adapted greening activities with community engagement and respiratory-health awareness. Quantitative and qualitative data explored feasibility, acceptability, environmental perceptions, participation, implementation barriers, facilitators, sustainability and lessons for scale-up.
Results: The intervention was implemented in both settlements. Participation was supported by locally adapted activities, Community Health Facilitators, residents and youth volunteers. Flexible scheduling around work and caregiving responsibilities facilitated involvement. Key enablers included community ownership, participatory design, alignment with daily routines and informal leadership. Challenges included limited space and resources, competing livelihood priorities, the need for continuous motivation and reliance on ongoing community engagement.
Conclusion: Community-level greening is feasible and potentially valuable for supporting respiratory health in urban informal settlements. Sustainability requires local leadership, continued participation and integration with wider public-health strategies.

37 - Strengthening Research Governance and Equity in Malaysia: A Collaborative Initiative

Authors: Jayakayatri Jeevajothi Nathan, Mohammad Nur Eman Nazlan, Mohamad Faizal Ibrahim, Nur Bahiyah Sujana, Hsiao Wei Tan, Soo Chin Chan, Hilary Pinnock, Dominique Balharry, Ee Ming Khoo

Abstract:
Background: International research partnerships provide opportunities for capacity strengthening, knowledge exchange and innovation, but inequities in decision-making, institutional processes and research support can challenge fair and sustainable collaboration. This project explored governance and operational challenges within Malaysian research-intensive institutions and sought practical approaches to strengthen equitable international research partnerships.
Methods: A collaborative, multi-phase approach was undertaken, comprising a review of institutional governance structures and practices; stakeholder engagement with researchers, research managers and administrators, university leadership, and ethics, finance and legal teams; and a knowledge-exchange visit to the University of Edinburgh. Stakeholder workshops and dissemination activities were used to discuss findings, co-develop recommendations and refine practical strategies for the Malaysian context.
Results: The project highlighted opportunities to improve coordination across institutional functions, strengthen research management capacity, increase clarity and consistency of governance processes, and embed equity throughout the research partnership lifecycle. Learning from the different project phases was consolidated into A Practical Toolkit for Universities and Research Institutions: Strengthening Research Governance and Equity in Malaysia, providing practical guidance to support institutions, research offices and research teams in developing more equitable and enabling governance practices.
Impact: The project moved beyond identifying governance challenges towards translating stakeholder experiences and international learning into practical institutional guidance. The toolkit provides a resource to support reflection, institutional capacity strengthening and improvements in research governance practice. The project also established a foundation for continued dialogue among researchers, research management professionals and institutional stakeholders towards more proportionate, equitable and sustainable international research partnerships.

38 - Challenges of conducting a house-to-house survey: Experiences from the RESPIRE-4CCORD Study (4CCORD- For Caring about ChrOnic Respiratory Diseases)

Authors: Nik Sherina Hanafi1, Liong Siok Fuang1, Chong Karleen1, Norita Hussein1, Siti Nurkamilla Ramdzan1, Rizawati Ramli1, Pang Yong Kek2, Wong Chee Kuan2, Ho Bee Kiau3, Salbiah Mohamed Isa4, Karuthan Chinna5, Khoo Ee Ming1, Osman M Yusuf6, Ahmad Kakakhail6, Dhiraj Agarwal7, Hilary Pinnock8
1Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
2 Department of Medicine, Faculty of Medicine, Universiti Malaya, Malaysia
3Section 7 Shah Alam Health Clinic, Petaling District, Ministry of Health Malaysia
4Pandamaran Health Clinic, Klang District, Ministry of Health Malaysia
5International Medical University, Kuala Lumpur, Malaysia
6The Allergy and Asthma Institute, Pakistan (AAIP), Islamabad, Pakistan
7Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
8NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, United Kingdom

Abstract: Background: Chronic respiratory diseases like asthma and COPD are major global health issues. We conducted a house-to-house survey to estimate the burden of CRDs in two communities in Malaysia and Pakistan.
Methodology: House-to-house surveys of adults were conducted in Klang, Malaysia and Islamabad, Pakistan using a piloted questionnaire and spirometry testing from September 2025 to August 2026. Data analysis is currently ongoing. Field logs, stakeholder meetings, and enumerator debriefing sessions were reviewed to record the challenges during data collection.
Results: The Malaysian site had an initial list of 2,475 address. 15.6% were ineligible due to being non-residential or vacant properties, or because they met the exclusion criteria. Out of 2090 eligible households in Klang, Malaysia, a total of 469 households were recruited (22.4% response rate). The high non-response and refusal rates in Klang, Malaysia, were multifactorial and may reflect a combination of individual, community and environmental factors. Residents were wary of strangers at their houses and feared being scammed or robbed despite enumerators having official credentials and documents. High-security guarded neighbourhoods limited access to selected houses.  Weather conditions with heavy rain and flooding made house-to-house visits challenging. Unfamiliarity with spirometry and inhaled bronchodilators made a few respondents decline participating.
Conclusion: Conducting house-to-house surveys is a major research challenge, primarily due to heightened public anxiety and distrust. Future community research initiatives must adopt flexible, multi-layered strategies including significant community engagement and tailored approach based on local cultures.

39 - Community Engagement and Involvement in Tuberculosis Prevention Among Marginalised High-Burden Communities in Sabah: The AMASSMENT Study

Authors: 1. Chee Kuan Wong, Division of Respiratory Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
2. Wai Khew Lee, Luyang Health Clinic, Kota Kinabalu, Sabah, Malaysia
3. Sarah Jane Jia Chyi Chan, Manggatal Health Clinic, Kota Kinabalu, Sabah, Malaysia
4. Suhashini Sivasegaran, Sandakan Health Clinic, Sandakan, Sabah, Malaysia
5. Jayakayatri Jeevajothi Nathan, Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
6. Nursyuhada Sukri, Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
7. Scholastica Mui Yung Lee, Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
8. Ee Ming Khoo, Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia

Abstract: Background: Marginalised, high-TB-burden communities in Sabah face stigma, misconceptions, poverty and barriers to healthcare. The AMASSMENT study embedded Community Engagement and Involvement (CEI) to strengthen research participation, improve TB awareness and develop community-responsive care pathways.
Methods: CEI was implemented in Kampung Lok Kurai and Kampung Bahagia, with health teams, community leaders and volunteers using a four-step model: awareness and mobilisation, research participation, community dialogue and care-pathway mapping. Twenty community volunteers were recruited and trained to recognise TB symptoms, promote screening and support treatment. Follow-up CEI included dissemination of study findings, open dialogue, active case detection and a 54-participant knowledge-attitude-practice survey.
Results: Mean knowledge score was 5.54/9 (SD 1.56; median 6); 88.9% demonstrated a positive attitude and 66.7% reported correct cough-etiquette practice. Ten volunteers in Lok Kurai continued visiting symptomatic residents, accompanying patients to clinics and supporting treatment. Major challenges included persistent TB misconceptions and stigma, transport and healthcare costs, loss of income, fear related to undocumented status, limited volunteer referral and ownership, staffing constraints, and weak community-facility monitoring. In Kampung Bahagia, a major fire displaced approximately 9,000 residents, further disrupting healthcare access and treatment continuity.
Impact: CEI transformed communities from research participants into partners, strengthened community-health service links, and generated actionable recommendations for mobile outreach, community-based sputum collection and stronger referral support. Engagement with Non-Government Organisation (SABATA and MAPTB) also created a pathway for AMASSMENT evidence and lived experience to inform Sabah’s proposed TB Roadmap, linking research with policy and practice.

40 - Patient Advocates Raising Asthma Awareness Among Rural Women in Pakistan

Authors: Ramsha Tariq Baig- The Allergy & Asthma Institute, Pakistan
Osman Yusuf- The Allergy & Asthma Institute, Pakistan
Genevie Fernandes- RESPIRE- University of Edinburgh

Abstract: Background: Asthma affects an estimated 4.3% of Pakistan's population, and 61% of people live in rural areas where health information rarely reaches women. Around Islamabad and Rawalpindi, paper mulberry pollen peaks each spring and triggers exacerbations. Restricted mobility, cultural norms and few female health workers leave rural women with little access to asthma education.
Aim: To test whether female patient advocates could raise asthma awareness among rural women, and to explore the feasibility and acceptability of a peer-led model.
Approach: Three female patient advocates — women living with asthma or caring for someone with it — were drawn from the advocate network built during RESPIRE I, where they were already active in awareness work. Working through trusted community gatekeepers, they delivered three awareness sessions in three rural communities across Islamabad and Rawalpindi, engaging 60 women. Each session used a documentary and animation produced under RESPIRE I, followed by open group discussion.
Outcomes: Women participated actively, sharing what they already knew about asthma and allergy. Several identified themselves as caregivers and asked to learn more about preventive measures. Participants reported that information was more credible coming from women from their own communities. Advocates described feeling empowered; one community appointed three volunteers, and advocates continue raising awareness informally.
Conclusion: This proof-of-concept demonstrates feasibility, acceptability and reach rather than measured change. Peer-led, culturally grounded delivery shows promise for reaching women whom facility-based services do not, and warrants evaluation with pre- and post-session measures.

41 - Breathing life: Using photovoice to amplify community voices for chronic respiratory disease in Klang

Authors: Hani Salim1, Jayakayatri Jeevajothi Nathan2, Nursyuhada Sukri2.
1Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
2Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia

Abstract: and emotional wellbeing, yet lived experiences are often absent from service and policy discussions. The SML Award supported Breathing Life, a community initiative in Klang, Malaysia, to amplify community voices and translate them into action.
Approach: Fourteen adults recruited through five public primary care clinics photographed and narrated issues around breathlessness, environmental triggers, treatment burden, social support and adaptation. Patient and public involvement partners reviewed materials, advised culturally appropriate recruitment and contributed to interpretation. Participants co-curated nine exhibition themes, a bilingual photobook and displays. Engagement included a mall exhibition with screening and spirometry, a climate-awareness workshop, a photo-walk with 30 healthcare providers and district stakeholder dialogue.
Outcomes and achievements: Participants became community curators, co-facilitators and advocates, showing confidence and ownership. Exhibitions highlighted haze, smoking, occupational exposure, psychosocial needs and barriers to care. The mall event screened over 100 people; 66 underwent spirometry. Healthcare providers reported renewed empathy and identified gaps in patient-centred care, medicine access, referral pathways and psychosocial support. Stakeholders co-produced a policy brief with recommendations.
Impact: The project built partnerships among patients, researchers, healthcare providers and district health authorities, embedding lived experience in interpretation, dissemination and policy dialogue. It informed service improvement and local respiratory health planning. A patient partner and District Health Office collaborator co-authored a peer-reviewed publication describing the involvement process [1].
Conclusion: Breathing Life demonstrates that Photovoice can move beyond documentation to empower communities, inform healthcare professionals, influence local policy and foster sustainable partnerships for respiratory health.

42 - CONNECT, CO-CREATE, COLLABORATE: Embedding PPI Across the TB Research Cycle in Bangladesh

Authors: Abdullah Muhammad Rafi, Samina Huque, Rumana Huque

Abstract: Background: Tobacco cessation support within tuberculosis (TB) care must address stigma, gender norms, nicotine dependence, limited health literacy and service constraints. Patient and Public Involvement (PPI) was embedded alongside the Quit4TB Trial so support reflected priorities and lived realities of people affected by TB.
Methodology: Thirty-four people affected by TB or survivors, caregivers, frontline providers and NGO staff participated across three urban sites in Bangladesh. Through the Connect–Co-create–Collaborate model, participants identified treatment, cessation, caregiving and service-delivery concerns; reviewed messages and visuals; and refined materials through PPI forums, validation and member-checking.
Outcomes: PPI influenced intervention design and communication. Limited understanding of the relationship between smoking and TB recovery led to simpler visual explanations. Participants challenged fear-based messages that could reinforce stigma, prompting supportive, non-judgmental communication. Their contributions identified practical roles for caregivers, informed coping strategies for cravings and withdrawal, and encouraged brief counselling suitable for time-constrained clinical encounters. These insights were translated into co-designed brochures and flyers, provider scripts, caregiver prompts, patient coping strategies and a policy brief. The process broadened understanding of real-world barriers, improved practice tools, and enabled community members to contribute as knowledge partners. Findings and materials were shared with Bangladesh’s Mycobacterial Disease Control unit, opening discussion about possible integration within the national TB programme.
Conclusion: Meaningful PPI depends on continuity. Its value came from sustained involvement across problem identification, design, testing, refinement and dissemination. PPI should be treated as a partnership through which lived experience can influence research decisions, practical tools and pathways towards policy engagement.

43 - Fighting Pneumonia, Shaping Policy: Using Documentary Storytelling to Translate RESPIRE Evidence into Policy Influence in Pakistan

Authors: Hana Mahmood

Abstract: Childhood pneumonia remains a leading cause of under-five mortality in Pakistan, yet research evidence on burden, care-seeking behaviour, and health system readiness rarely reaches policymakers in a form that compels action. This project, delivered under the Professor Tabish Hazir Award for health research communication for respiratory policy influence, aimed to translate RESPIRE-generated evidence into an accessible, emotionally resonant communication resource for decision-makers.
The methodology comprised a structured review of RESPIRE research outputs, development of a concise narrative script, curation of relevant field footage, voice-over recording, and professional editing to produce a short documentary film. The film synthesises findings on pneumonia burden, caregiver perceptions, and health system gaps, combining research insights with the voices of a mother, a Lady Health Worker, a clinician, and a researcher to ensure the evidence remained human-centred and policy-relevant.
The primary output is the completed documentary, complemented by a policy brief. The film foregrounds late care-seeking, gaps in primary care readiness, and inconsistent case management, positioning these as actionable policy priorities.
The project met its stated objectives within budget. Its central lesson is that evidence alone seldom shifts decision-making: relatable narrative, credible stakeholder voices, and tribute to respected figures such as Professor Tabish Hazir strengthen uptake. Recommended next steps include provincial adaptations, infographics, short social clips, and sustained digital advocacy content for year-round policymaker engagement.

44 - Acceptability of Respiratory Syncytial Virus (RSV) Vaccine: A Qualitative Study in Pakistan

Authors: Shabina Ariff (tentative)

Abstract: Background & Objective: With the anticipated 2027 rollout of a maternal RSV vaccine through GAVI, this study explored the acceptability of RSV immunization among pregnant women and infants among community and health-system stakeholders in Pakistan.
Methods: This exploratory qualitative study was conducted in Karachi (urban) and Matiari (rural) areas of Sindh province, Pakistan. The interview guides were based on the Theoretical Framework of Acceptability. Data were collected through 28 FGDs and 35 IDIs, including community members (parents and other decision-influencers, such as mothers-in-law and political/religious figures) and health-system stakeholders (community and fixed-site health workers, doctors, policy advisors, and government officials). Analysis was conducted using deductive and inductive coding.
Key Findings:
There were 232 participants (118 from Karachi and 114 from Matiari; 57.3% female; average age 38.8 ± 10.7 years). Of these, 34.9% held a graduate degree or higher. Participants included 154 community members (118 [76.6%] parents) and 78 health-system stakeholders (52 [66.7%] community health workers).
Awareness of RSV pneumonia and upcoming immunization products was low among community members and most health-system participants, including public health personnel and physicians, who showed limited familiarity. Despite this, the acceptability of a maternal RSV vaccine or an infant monoclonal antibody was high, reflecting recognition of their value in reducing pneumonia-related morbidity and mortality, as well as economic and caregiver burden. A year-round schedule was preferred over seasonal delivery, and free, near-home access was seen as key to facilitating uptake, while both injectable immunization products for mothers or neonates were considered acceptable, preferable was maternal vaccination. Health-system stakeholders, including policy advisors, stressed the need for robust burden-of-disease data to justify introduction, citing resource constraints and competing priorities within an already strained EPI system, and drew cautionary lessons from low coverage of maternal tetanus and HPV vaccination. Doctors flagged counseling burden, especially in the public sector, as a major implementation barrier. Community acceptance was conditioned on vaccine safety, efficacy, and well-informed vaccinators, with concerns about existing counseling gaps, especially on post vaccine side effects (e.g., fever management), pregnancy-related misinformation and causal misattribution of adverse events; Physicians, community health workers, and traditional birth attendants were identified as trusted, influential sources for education.
Potential Impact: These findings will support advocacy for introducing an RSV vaccine in Pakistan and inform the design of future vaccine trials and implementation research on maternal vaccine uptake, provider workload, and engagement of formal and informal health cadres.
Engagement Activities: Planned engagement includes briefings for Federal Directorate of Immunization and EPI officials within the Ministry of National Health Services; presentations of findings and discussions with the Pakistan Paediatric Association and the Pakistan Society of Obstetricians & Gynaecologists; and development of culturally tailored messaging for health workers and communities.

45 - From Exposure to Action: My RESPIRE Journey in Understanding Household Air Pollution and Child Health in Sri Lanka

Authors: Ridma Thilakarathna

Abstract: Key findings (interim): Among 211 children, the mean Pediatric Sleep score was 0.09±0.12, and 5.2% screening positive for sleep-related breathing disorders. Children spent an average of 21.2 hours daily at home. Positive sleep-disorder screening was higher among children from biomass-fuel households than LPG-using households (10.6% vs. 3.8%), although the association was not statistically significant. Time spent in the kitchen was the only significant independent predictor of sleep quality (β = .373, 95% CI: .008–.024, p < .001), indicating that longer kitchen exposure was associated with higher risk for sleep-disordered breathing.
Qualitative interviews revealed that cooking fuel choices were driven by affordability, cultural preferences, and family traditions. Parents described firewood as “cheaper” and producing “tastier food,” while some reported difficulties changing long-standing family practices. Healthcare professionals highlighted challenges in reducing exposure among families living in limited housing spaces and emphasized the importance of proper ventilation and smoke-removal systems.
Achievements: RESPIRE supported my development as a postgraduate researcher and MPhil candidate at the University of Peradeniya. I received the RESPIRE Capacity Building Fellowship, co-authored 16 conference abstracts and contributed to the Breathing Clean Air educational booklet.
Engagement & Impact: Research findings were shared with mothers, healthcare professionals, and public health staff through awareness programmes and scientific conferences. With the Sri Lankan RESPIRE team, I contributed to the Clean Air, Healthy Lives art competition, World Environment Day programmes, tobacco cessation initiatives, and community awareness. Ongoing publications and a systematic review aim to strengthen evidence for healthier homes and child wellbeing in Sri Lanka.

46 - Pulmonary Rehabilitation for Patients With Chronic Respiratory Diseases In Bangladesh, Bhutan, and Pakistan: A Feasibility Study In a Low-Resource Setting

Authors: Monsur Habib1, Farzana Khan,2 Nazim Uzzaman3 Mimi Lhamu Mynak,4 Gaki Nima,4 Karma Phuntsho,4 Rubina Aman,6,7 Muhammad Furqan Ahmed,7 Siddiqui Zara Khalid,7 Sana Bashir,7 Muhammad Furqan Hassan,7 Ramsha Tariq Baig,6  Muhammad Ehab  Azim,7 Saqib Mustafa6 Shahida Ashraf,6 Osman Mohammad Yusuf.6

Abstract: Background
Pulmonary rehabilitation (PR) is highly effective for chronic respiratory diseases (CRDs), yet remains poorly accessible in low- and middle-income countries (LMICs). We evaluated the feasibility of delivering a context-adapted PR programme across three contrasting low-resource settings in Bangladesh, Bhutan and Pakistan.
Methods
We conducted multi-country before-and-after feasibility studies with embedded quantitative and qualitative process evaluation. Adults with CRDs undertook an 8-week PR programme comprising exercise training, respiratory physiotherapy, education and supported self-management, adapted to local resources while preserving core PR components. Outcomes included functional exercise capacity, health-related quality of life, breathlessness and psychological morbidity. Recruitment, attendance, completion, resource requirements and practical delivery challenges were documented. Interviews with patients, providers and stakeholders explored acceptability, barriers, facilitators and implementation experiences.
Results
A total of 103 participants were recruited: Bangladesh (n=50), Bhutan (n=30) and Pakistan (n=23). Interim analyses showed improvements following PR in endurance exercise capacity (ESWT), breathlessness (mMRC), health status (CAT) and anxiety/depression (HADS). Implementation required substantial contextual adaptation. Major challenges included affordability and access, particularly transport, distance and caregiver dependency; gender and privacy concerns; weak referral linked to professional inertia and additional workload; limited infrastructure; insufficient staffing and therapist skills; balancing research with clinical responsibilities; patients’ initial unfamiliarity with PR; and interruptions caused by intercurrent illness. Integration with existing physiotherapy services emerged as a practical approach to minimise additional infrastructure requirements.
Important facilitators were strong teamwork and organisational capacity, development of therapist skills, local adaptation of delivery, and increasing patient acceptance once benefits became apparent. The early weeks represented a critical threshold: participants who experienced improvement became increasingly engaged and motivated. Therapists described patient progress as exceeding expectations and found patients’ recognition of the programme’s value particularly rewarding. The study also strengthened teams’ confidence in patient and community engagement.
Conclusion
PR was feasible across three diverse low-resource settings when core components were retained but delivery was adapted to context. Successful implementation depended on workforce development, teamwork, flexible use of existing resources, patient engagement and locally responsive solutions. These multi-country experiences provide practical lessons for scaling PR in resource-constrained settings.

47 - Pulmonary Rehabilitation in a Humanitarian Setting: From Evidence to Practice in Cox’s Bazar, Bangladesh

Authors: Farzana Khan, Kazi Sarmad Karim, Monsur Habib

Abstract: Background: Pulmonary rehabilitation (PR) is highly effective for chronic respiratory disease (CRD), yet remains largely inaccessible in low-resource and humanitarian settings. As part of a wider three-country PR implementation study, the Fasiuddin Khan Research Foundation (FKRF) implemented and evaluated a contextually adapted PR programme in Cox’s Bazar, Bangladesh, including Rohingya refugee communities.
Methods: Adults with CRD participated in an eight-week programme comprising 16 supervised sessions integrating individually prescribed exercise, breathing techniques, education, psychosocial support and self-management. Community health workers supported implementation and follow-up, while patients, families, healthcare professionals and humanitarian stakeholders contributed to programme delivery and evaluation.
Outcomes and Achievements: Of 91 people screened, 50 enrolled and all completed the programme, with 98% retained at six-month follow-up. Participants demonstrated improvements in exercise capacity, breathlessness, health status, anxiety and depression. Qualitative findings highlighted improved physical functioning, confidence, self-management and participation in everyday and family roles.
Impact: The project strengthened local rehabilitation capacity and demonstrated that structured PR can be delivered using locally available resources within a complex humanitarian health system. It generated implementation evidence from an under-represented population and practical learning for integrating rehabilitation into CRD and primary healthcare pathways.
Conclusion: The FKRF experience demonstrates that effective rehabilitation can be adapted and delivered successfully in resource-constrained humanitarian settings, providing a foundation for wider implementation, scale-up and policy engagement.

48 - Feasibility and acceptability of tele-pulmonary rehabilitation for people with chronic respiratory diseases in Bangladesh

Abstract: Background: Pulmonary rehabilitation (PR) improves symptoms, exercise capacity and quality of life in chronic respiratory diseases (CRDs). However, distance, travel costs, mobility limitations and scarce PR facilities sometimes restrict access to centre-based programmes in Bangladesh. Tele-rehabilitation may help overcome these barriers.
Aim: We aim to assess the feasibility and acceptability of delivering PR remotely to people with CRDs.
Methods: We are using snowball sampling to recruit 30 adults aged ≥18 years with a clinician-confirmed CRD and persistent respiratory symptoms despite optimised pharmacological therapy, defined as a modified Medical Research Council dyspnoea score ≥2. Participants must be clinically stable, considered safe to exercise at home and have access to a device and internet connection for video calls. We exclude people with conditions that interfere with PR and those who have participated in PR within the previous 18 months. We provide an eight-week programme comprising twice-weekly, remotely supervised sessions. The programme includes individualised exercise training, education, and self-management support. We assess recruitment, retention, attendance, exercise adherence, completion of assessments, technical difficulties and adverse events. We collect feedback from participants and therapists to assess acceptability and identify barriers to implementation.
Results: We have recruited seven participants so far. Preliminary findings indicate that remotely supervised PR is feasible, although digital access, internet connectivity, adherence and safety are to be assessed as recruitment and programme delivery progress.
Conclusion: Our ongoing study will provide preliminary evidence on the feasibility and acceptability of delivering PR remotely in Bangladesh and identify practical issues that may inform future research.

49 - Barriers to and enablers of tuberculosis diagnosis, notification and intervention for designing customized intervention package to minimize ‘missing millions’ in tribal communities of India – Systematic review

Authors: Ashish Satav1, Dhananjay Raje 1, Vibhawari Dani1, Radha Munje2, Shraddha Kumbhare1, Sanjay Zodpey3, Manasi Shelgaonkar1, Genevie Fernandes4, Hilary Pinnock5, Helen R. Stagg6  and Harish Nair7
1MAHAN Trust, Dharni, Amaravati, Maharashtra, India
2Department of Pulmonary, IGGMCH, Nagpur, Maharashtra, India
3Public Health Foundation of India, New Delhi, India
4International Primary Care Respiratory Group (IPCRG), Edinburgh, UK
5Primary Health Care Respiratory Medicine, University of Edinburgh, Edinburgh, UK
6Department of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
7Paediatrics Infectious Diseases and Global Health, University of Edinburgh, Edinburgh, UK

Abstract: Background: Tribal communities in India bear a high burden of tuberculosis (TB), with substantial gaps in diagnosis and notification, partly because of geographical remoteness. We conducted a systematic review to identify barriers and enablers of TB diagnosis and notification and to inform the development of contextually relevant strategies to find the ‘missing millions’ among tribal populations.
Methods: PubMed, Embase, and Web of Science were searched for studies published between 2000 and 2023 that examined TB diagnosis, notification, barriers, enablers, or interventions in low- and lower-middle-income countries (LICs and LMICs). Qualitative and quantitative studies were appraised using the Critical Appraisal Skills Programme and Newcastle-Ottawa Scale, respectively. Findings were synthesised narratively and thematically, with the socio-ecological model (SEM) used to categorise barriers and enablers and the Consolidated Framework for Implementation Research (CFIR) used to identify implementation considerations.
Results: Thirty-four studies from 15 LICs and LMICs were included. At the community level, key barriers included limited TB knowledge, illiteracy, stigma, geographical inaccessibility, and financial constraints. At the health-system level, active case finding was the most commonly reported intervention; however, inadequate diagnostic facilities, shortages of trained staff, insufficient incentives, weak counselling, and limited funding constrained TB diagnosis and notification. Community awareness activities, family and TB survivor support, mobilisation of human resources, regular capacity-building, and financial incentives for health workers were identified as important enablers.
Conclusions: Gaps in TB diagnosis and notification arise from interconnected barriers at both community and health-system levels. Addressing these gaps will require multifaceted, context-specific approaches that combine meaningful community engagement with strengthened diagnostic and health-system capacity. Such strategies may help improve TB detection and notification among underserved tribal populations.

50- Healthy People Healthy Planet: How can we do better?

Authors: Hotlin Ompusunggu, DDS, Founder/Director Healthy Planet Indonesia (HePI)
Eric Septian Prawira, MD, Staff Physician Alam Sehat Lestari (ASRI)

Abstract: Indonesia’s forests are among the world’s most important ecosystems, supporting biodiversity, regulating climate and water, and sustaining millions of people. Deforestation and forest degradation remain important environmental and social challenges. Forest loss, land-use change, and forest and peat fires can increase exposure to smoke and particulate air pollution, contribute to climate change, and affect food security, livelihoods, and community well-being. These environmental changes have important consequences for human health, including respiratory health.
Preventing deforestation requires action that goes beyond law enforcement. In many Indonesian landscapes, local communities play a critical role as custodians, users, and protectors of forests. However, communities may also face economic pressures that contribute to participation in illegal logging and forest conversion. Addressing these underlying drivers is essential for conserving the forest and improving human health.
This presentation explores a multi-faceted community-led, integrated approach to improving human and forest health. Communities are supported to participate in forest conservation and community-based forest monitoring. Training is provided for alternative livelihoods including sustainable organic agriculture, home gardening, agroforestry and small enterprises, improving household nutrition and reducing chemical exposure and monoculture farming. Wildlife consumption and trade are reduced through integrated farming and livestock production. These approaches can help build healthier, more resilient people, communities and ecosystem while decreasing extrinsic health risks including smoke from forest fires.
Preventing deforestation is an investment in public health. By empowering communities to protect forests while creating sustainable livelihood opportunities, Indonesia can advance both forest conservation and respiratory health—moving toward Healthy People and a Healthy Planet.

51 - Healthy Environment, Healthy Lungs: Community Posters by FKRF

Authors: Farzana Khan, Kazi Sarmad Karim, Khaled Mohammad Arafat, Hasina Karim

Abstract: Background: People living in urban informal settlements in Bangladesh face multiple environmental threats to respiratory health, including air pollution, household and road dust, unmanaged waste, waste burning, poor drainage, overcrowding and limited green space. The Fasiuddin Khan Research Foundation (FKRF), through the Greening Urban Slums for Green Healthcare (GUS) Study, explored how practical environmental action could be integrated with community-based respiratory health promotion.
Approach: FKRF worked with people living with or at risk of chronic respiratory diseases, young volunteers, caregivers and trusted local stakeholders in two informal settlements in Dhaka. Activities included environmental clean-up, safe waste disposal, tree planting and care, and awareness sessions on air pollution, ventilation and respiratory health. Established community health workers were unavailable and therefore pharmacy owners, shopkeepers and other trusted local people were engaged as Community Health Facilitators. Four illustrated posters were developed to communicate the programme’s messages in an accessible, culturally relevant format.
Key messages: Communities are encouraged to plant trees, use dustbins, keep homes and drains clean, avoid burning waste and plastics, improve ventilation, and reduce exposure to smoke, dust and harmful fumes. The posters also highlight cough, breathlessness, wheeze, chest tightness and fatigue, encouraging people to seek medical help when needed.
Conclusion: Community-friendly visual communication can connect environmental improvement, respiratory health awareness and collective action. Small, locally achievable actions can provide a practical foundation for cleaner, greener and healthier communities across urban Bangladesh.