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Ginsburg, Amy Sarah, Susanne May, Evangelyn Nkwopara, Gwen Ambler, Eric D. McCollum, Tisungane Mvalo, Ajib Phiri, and Norman Lufesi. "Clinical Outcomes of Pneumonia and Other Comorbidities in Children Aged 2-59 Months in Lilongwe, Malawi: Protocol for the Prospective Observational Study “Innovative Treatments in Pneumonia”." JMIR Research Protocols 8, no. 7 (July 29, 2019): e13377. http://dx.doi.org/10.2196/13377.
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Background Pneumonia is the leading infectious cause of death worldwide among children below 5 years of age. Clinical trials are conducted to determine optimal treatment; however, these trials often exclude children with comorbidities and severe illness. Conclusions Given the paucity of data from Africa, African-based research is necessary to establish optimal management of childhood pneumonia in malaria-endemic settings in the region. An expanded evidence base that includes children with pneumonia and other comorbidities, who are at high risk for mortality or have other complications and are therefore typically excluded from childhood pneumonia clinical trials, can contribute to future iterations of the World Health Organization Integrated Management of Childhood Illness guidelines. Methods The study enrolled 1000 children with pneumonia presenting to the outpatient departments of Kamuzu Central or Bwaila District Hospitals in Lilongwe, Malawi, who were excluded from concurrent randomized controlled clinical trials investigating fast breathing and chest indrawing pneumonia and who met the inclusion criteria for this prospective observational study. Each child received standard care for their illnesses per Malawian guidelines and hospital protocol and was prospectively followed up with scheduled study visits on days 1, 2 (if hospitalized), 6, 14 (in person), and 30 (by phone). Our primary objectives are to describe the clinical outcomes of children who meet the inclusion criteria for this study and to investigate whether the percentages of children cured at day 14 among those with either fast breathing or chest indrawing pneumonia and comorbidities such as severe malaria, anemia, severe acute malnutrition, or HIV are lower than those in children without these comorbidities in the standard care groups in concurrent clinical trials. This study was approved by the Western Institutional Review Board, Malawi College of Medicine Research and Ethics Committee, and the Malawi Pharmacy, Medicines and Poisons Board. Objective This prospective observational study aimed to assess the clinical outcomes of children aged 2-59 months with both pneumonia and other comorbidities in a malaria-endemic region of Malawi. Results The Innovative Treatments in Pneumonia project was funded by the Bill and Melinda Gates Foundation (OPP1105080) in April 2014. Enrollment in this study began in 2016, and the primary results are expected in 2019. International Registered Report Identifier (IRRID) DERR1-10.2196/13377
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Uwemedimo, Omolara T., Todd P. Lewis, Elsie A. Essien, Grace J. Chan, Humphreys Nsona, Margaret E. Kruk, and Hannah H. Leslie. "Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi." BMJ Global Health 3, no. 2 (March 2018): e000506. http://dx.doi.org/10.1136/bmjgh-2017-000506.
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BackgroundPneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi.MethodsData were obtained from the 2013–2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated with diagnostic sensitivity.Results3136 clinical visits for children 2–59 months old were observed at 742 health facilities. Healthcare workers completed an average of 30% (SD 13%) of IMCI guidelines in each encounter. 573 children met the IMCI criteria for pneumonia; 118 (21%) were correctly diagnosed. Advanced practice clinicians were more likely than other providers to diagnose pneumonia correctly (adjusted relative risk 2.00, 95% CI 1.21 to 3.29). Clinical quality was strongly associated with correct diagnosis: sensitivity was 23% in providers at the 75th percentile for guideline adherence compared with 14% for those at the 25th percentile. Contextual factors, facility structural readiness, and training or supervision were not associated with sensitivity.ConclusionsCare quality for Malawian children is poor, with low guideline adherence and missed diagnosis for four of five children with pneumonia. Better sensitivity is associated with provider type and higher adherence to IMCI. Existing interventions such as training and supportive supervision are associated with higher guideline adherence, but are insufficient to meaningfully improve sensitivity. Innovative and scalable quality improvement interventions are needed to strengthen health systems and reduce avoidable child mortality.
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Bloch, Evan M., Zakayo Mrango, Jerusha Weaver, Beatriz Munoz, Thomas M. Lietman, and Sheila K. West. "Causes of death after biannual azithromycin treatment: A community-level randomized clinical trial." PLOS ONE 16, no. 9 (September 24, 2021): e0250197. http://dx.doi.org/10.1371/journal.pone.0250197.
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The MORDOR study, a masked, community-level randomized clinical trial conducted in Niger, Malawi and Tanzania (2015 to 2017), showed that biannual administration of single-dose azithromycin to preschool children reduced all-cause mortality. We sought to evaluate its impact on causes of death in children aged 1–59 months in Tanzania. A random sampling of 614 communities was conducted in Kilosa District, Tanzania, with simple random assignment of communities to receive either azithromycin or placebo. In these communities, a census was carried out every 6 months and children aged 1–59 months received biannual (every 6 months), single-dose azithromycin (~20mg/kg) or placebo depending on community assignment, over a 2-year period. Mortality was determined at the time of the biannual census. For child deaths, a verbal autopsy was performed to ascertain the cause using a standardized diagnostic classification. A total of 190- (0.58 /100 person-years) and 200 deaths (0.59/100 person-years) were reported in the azithromycin and placebo arms, respectively. Malaria, pneumonia and diarrhea, accounted for 71% and 68% of deaths in the respective arms. Overall, the mortality was not different by treatment arm, nor were the distribution of causes of death after adjusting for community clustering. The cause-specific mortality for diarrhea/pneumonia was no different over time. In children aged 1–5 months, 32 deaths occurred in the placebo arm and 25 deaths occurred in the azithromycin arm; 20 (62.5%) deaths in the placebo- and 10 (40%) in the azithromycin arm were attributed to diarrhea or pneumonia. Neither differences in the number of deaths nor the diarrhea/pneumonia attribution was statistically significant after adjusting for community clustering. In conclusion, azithromycin was not associated with a significant decline in deaths by specific causes compared to placebo. The non-significant lower rates of diarrhea or pneumonia in children <6 months who received azithromycin merit further investigation in high-mortality settings. Trial registration: NCT02048007.
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Morton, Ben, Kondwani Jambo, Tarsizio Chikaonda, Jamie Rylance, Marc Y. R. Henrion, Ndaziona Peter Banda, Edna Nsomba, Joel Gondwe, Daniela Ferreira, and Stephen B. Gordon. "The influence of pneumococcal conjugate vaccine-13 on nasal colonisation in a controlled human infection model of pneumococcal carriage in Malawi: a double-blinded randomised controlled trial protocol." Wellcome Open Research 6 (September 20, 2021): 240. http://dx.doi.org/10.12688/wellcomeopenres.17172.1.
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Streptococcus pneumoniae is the leading cause of morbidity and mortality due to community acquired pneumonia, bacterial meningitis and bacteraemia worldwide. Pneumococcal conjugate vaccines protect against invasive disease, but are expensive to manufacture, limited in serotype coverage, associated with serotype replacement, and demonstrate reduced effectiveness against mucosal colonisation. For Malawi, nasopharyngeal carriage of vaccine-type pneumococci is common in vaccinated children despite national roll-out of 13-valent pneumococcal conjugate vaccine (PCV13) since 2011. Our team has safely transferred an established experimental human pneumococcal carriage method from Liverpool School of Tropical Medicine to the Malawi-Liverpool Wellcome Trust Clinical Research Programme, Malawi. This study will determine potential immunological mechanisms for the differential effects of PCV13 on nasal carriage between healthy Malawian and UK populations. We will conduct a double-blinded randomised controlled trial to vaccinate (1:1) participants with either PCV13 or control (normal saline). After a period of one month, participants will be inoculated with S. pneumoniae serotype 6B to experimentally induce nasal carriage using the EHPC method. Subsequently, participants will be invited for a second inoculation after one year to determine longer-term vaccine-induced immunological effects. Primary endpoint: detection of inoculated pneumococci by classical culture from nasal wash recovered from the participants after pneumococcal challenge. Secondary endpoints: local and systemic innate, humoral and cellular responses to PCV-13 with and without pneumococcal nasal carriage The primary objective of this controlled human infection model study is to determine if PCV-13 vaccination is protective against pneumococcal carriage in healthy adult Malawian volunteers. This study will help us to understand the observed differences in PCV-13 efficacy between populations and inform the design of future vaccines relevant to the Malawian population. Trial Registration: Pan African Clinical Trial Registry (REF: PACTR202008503507113)
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Sessions, Kristen L., Laura Ruegsegger, Tisungane Mvalo, Davie Kondowe, Mercy Tsidya, Mina C. Hosseinipour, Norman Lufesi, Michelle Eckerle, Andrew Gerald Smith, and Eric D. McCollum. "Focus group discussions on low-flow oxygen and bubble CPAP treatments among mothers of young children in Malawi: a CPAP IMPACT substudy." BMJ Open 10, no. 5 (May 2020): e034545. http://dx.doi.org/10.1136/bmjopen-2019-034545.
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ObjectiveTo determine the acceptability of bubble continuous positive airway pressure (bCPAP) and low-flow oxygen among mothers of children who had received either therapy.SettingA district hospital in Salima, Malawi.ParticipantsWe conducted eight focus group discussions (FGDs) with a total of 54 participants. Eligible participants were mothers of children 1 to 59 months of age with severe pneumonia and a comorbidity (HIV-infection, HIV-exposure, malnutrition or hypoxaemia) who, with informed consent, had been enrolled in a randomised clinical trial, CPAP IMPACT (Improving Mortality for Pneumonia in African Children Trial), comparing low-flow oxygen and bCPAP treatments (ClinicalTrials.gov, NCT02484183).Primary and secondary outcome measuresFGDs assessed mothers’ attitudes and feelings towards oxygen and bCPAP before and after therapy along with general community perceptions of respiratory therapies. Data was analysed using inductive thematic analysis to assess themes and subthemes of the transcripts.ResultsCommunity perceptions of oxygen and bCPAP were widely negative. Mothers recounted that they are told that ‘oxygen kills babies’. They are often fearful of allowing their child to receive oxygen therapy and will delay treatment or seek alternative therapies. Mothers report limiting oxygen and bCPAP by intermittently removing the nasal cannulas or mask. After oxygen or bCPAP treatment, regardless of patient outcome, mothers were supportive of the treatment their child received and would recommend it to other mothers.ConclusionThere are significant community misconceptions around oxygen and bCPAP causing mothers to be fearful of either treatment. In order for low-flow oxygen treatment and bCPAP implementation to be effective, widespread community education is necessary.
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Colbourn, Tim, Carina King, James Beard, Tambosi Phiri, Malizani Mdala, Beatiwel Zadutsa, Charles Makwenda, et al. "Predictive value of pulse oximetry for mortality in infants and children presenting to primary care with clinical pneumonia in rural Malawi: A data linkage study." PLOS Medicine 17, no. 10 (October 23, 2020): e1003300. http://dx.doi.org/10.1371/journal.pmed.1003300.
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Adamkiewicz, Tom, Adel Driss, Hyacinth I. Hyacinth, Jacqueline Hibbert, and Jonathan K. Stiles. "Determinants Of Mortality and Survival In Children With Sickle Cell Disease (SCD) In Sub Saharan Africa." Blood 122, no. 21 (November 15, 2013): 4676. http://dx.doi.org/10.1182/blood.v122.21.4676.4676.
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In Africa, the natural history of SCD is often assumed to be same to the African Diaspora in the US, Jamaica, Europe or Latin America. Yet the environment can be different, including different pathogen exposure, such as malaria. To help better understand this, over 2000 references were identified using the names of all current or past names of African continent countries and the truncated word sickl$, followed by secondary nested and cross reference searches. Six cases series describing causes of death were identified, representing 182 children (Ndugwa, 1973, Athale, 1994, Koko, 1998, Diagne, 2000, Rahimy, 2003, Van-Dunem, 2007). Gender was reported in 172, 73 were female (42%). Age was reported in 118, 52 were < 5 years (44%). Four studies described some impediment to care or arrival for care in extremis in1/4 to over ½ of patients that died. In Uganda, 9/12 (75%) patient died at home. In Gabon 6/23 (26%) patients died within 4 hours of reaching the hospital and 11/23 (48%) within 24 hours. In Benin 2/10 (20%) died of splenic sequestration diagnosed at home; 38/64 (53%) of patients in Mozambique that died, lived outside of the capital. Causes of death were identified in 146 individuals. These included: fever/sepsis: n=59 (40%), including meningitis: n=15 (10%) and pyelonephritis: n=2 (1%); acute anemia: n=43 (29%), including spleen sequestration: n=28 (19%) and aplastic anemia: n=8 (5%); pain: n=22 (15%); acute chest syndrome/pneumonia: n=18 (12%); CNS: n=8 (5%), including stroke: n=4 (3%), seizure/ coma: n=5 (3%); liver disease: n=5 (3%) including hepatitis: n=3 (2%); Other: n=19 (13%) including wasting/ malnutrition: n=7 (5%), heart failure/cardiomyopathy: n=4 (3%), diarrhea and vomiting: n=3 (2%), transfusion reaction: n=2 (1%). Infectious pathogens were identified in 26, including malaria: n=10 (38%), S. pneumoniae: n=3 (12%), Salmonella: n=2 (8%), H. influenza, Klebsiella and Citrobacter: n=1 (4%) each; viral agents were reported in n=8 (31%) including HBV: n=5 (19%), HIV: n=3 (12%). Reported general population hemoglobinopathy surveys after birth revealed the following Relative Risk (RR) of observing individuals with hemoglobin SS compared to Hardy Weinberg expected frequencies (some age cohorts overlap; Tanzania '56, Benin '09, Burkina Faso '70, Central African Republic'75, Gabon'65/'80, Gambia'56, Ghana '56/‘57/'00/'10, Kenya '04/'10, Malawi '72/'00/'04, Mozambique '86, Nigeria '56/'70/'79/'81/'84/'05, Senegal '69, Sierra Leone '56). Age 0-1 years, total n=2112 observed n=22 (1.0%), expected n=16.5 (0.8%), RR=1.3 (95% CI=0.7,2.5), p=0.441. Age 0-6 years, total n=4078; observed n=39 (1.0%); expected n=40.6 (1.0%); RR=1.0 (95% CI=0.6,1.5), p=0.925. Age 5-19 years, total n=1880; observed n= 5 (0.3%); expected n= 24.8 (1.3%); RR=0.2 (95% CI=0.1,0.5); p<0.001. Adults, total n=12814; observed n= 20 (0.2%); expected n= 118.9 (0.9%); RR=0.2 (95% CI=0.1,0.3), p<0.001. Pregnant, total n=5815; observed n= 19 (0.3%); expected n= 78.5 (1.3%), RR=0.2 (95% CI=0.1,0.4), p<0.001. Cohorts of children with SCD are indicated in the table. In summary, access to care, as well as acute anemias are a frequent cause of mortality. Along with viral pathogens and transfusion related deaths this indicates the importance of a safe blood supply. By adulthood, the observed frequency of individuals with SCD is only 1/5 of expected. However, reported clinic cohorts suggest similar if not better survival than in the general population, possibly due to lost to follow up, but also malaria/bacterial infection prevention and nutritional support. Careful prospective studies are needed.TableCohorts of children in Africa with Sickle Cell AnemiaCountryAge median years, (range)Death/TotalnFollow up yearsPatient-yearsDeaths/100 patient-yearsU5M/100 child-yrs♦Uganda, 735 -9, (0-20)12/6282--2.7Senegal, ‘008 (0-22)11/323710331.12.2Senegal, 03330/55612--2.2Benin,032.910/2361.5-6.59831.02.4Kenya,096 (0-13)2/1241.21181.72.7♦: Under five year old mortality 2009 (source: Unicef), divided by 5Prophylactic interventions: Uganda: chloroquine; Senegal: chloroquine (wet season), nets, penicillin prophylaxis <5 yrs, folic acid, parasite treatment & iron supplement as needed; Benin: chloroquine, nets, penicillin prophylaxis, antibiotics for fever, folic acid, nutritional support; Kenya; Proguanil, folic acid, nutritional support, parasite treatment & iron supplement as needed. Disclosures: No relevant conflicts of interest to declare.
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Garrido, David Israel. "Response to: Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador: Correspondence." Journal of Nepal Paediatric Society 40, no. 1 (August 10, 2020): 64–66. http://dx.doi.org/10.3126/jnps.v40i1.29062.
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Dear editor,
This letter is in response to Chaudhary, Shrestha, and Pathak, who highlighted various aspects of our previous manuscript "Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador." I want to respond to each point referred to in a similar extension as used by the authors.
We agreed on the fact that it is prompt to conclude in nutritional deficiencies as a risk factor to suffer pneumonia in Ecuadorian children that is why we express this conclusion as a possibility. Nevertheless, as evidenced in the meta-analysis presented by Jackson et al., the Odds Ratio (OR) meta-estimate for under nutrition as a risk factor for acute lower respiratory infections was 4.5 (95% CI 2.1-9.5)1. To add, in the same paper, the OR meta-estimate for anaemia, vitamin D deficiency, and zinc supplementation, was 3.9 (95% CI 2.4-6.3), 7.3 (95% CI 2.5 to 21.5), and 0.5 (95% CI 0.3 to 0.9), respectively 1.
Moreover, in a study conducted in Malawi including 9 533 children, severe malnutrition and moderate malnutrition were associated not only with a pneumonia risk but with an increased risk of inpatient mortality, with Odds Ratios (OR) of 4.63 (3.08, 6.97) and 1.73 (1.21, 2.48) respectively. Therefore, there is supporting evidence globally of the suggested risk 2.
I am glad that the authors in the letter bring to the table a discussion of pneumonia diagnosis. In our study, the evaluation of pneumonia started with the clinical assessment including parameters with an acceptable sensitivity (Sen%) or specificity (Spe%), such as; fever on examination (Sen% 47, Spe% 68), history of fever (Sen% 92, Spe% 21), tachypnoea (Sen% 13, Spe% 95), rhonchi (Sen% 26, Spe% 98), crackles (Sen% 43, Spe% 73), wheezing (Sen% 4, Spe% 98) (3). However, as referred to in the original paper, the evaluation was not limited to these factors "Hypoxemia, defined as a sustained saturation of peripheral oxygen (SpO2) <90 %, was used as criteria for hospitalization, along with criteria for respiratory distress, which includes: tachypnoea, dyspnoea, retractions (suprasternal, intercostal, or subcostal), grunting, nasal flaring, apnoea and altered mental status. Furthermore, CBC, acute-phase reactants and chest radiography were performed" (4). Nonetheless, I should remark two factors; firstly, pneumonia severity assessment is based on clinical parameters as presented in the New South Wales Government guideline (5). So, minimizing the utility of the clinical evaluation may be a mistake, especially in institutions without prompt access to the radiologic test. Secondly, even we knew that the patients included in this study were evaluated in other differential diagnoses like bronchiolitis, asthma or cardiac diseases which can mimic pneumonia, this was a cross-sectional study using retrospective data collection.
Regarding the exclusion criteria, concomitant conditions that could affect anthropometric measurements include any congenital disease, which compromises a normal growth independently of the nutritional intake (Examples; Down syndrome, achondroplasia). Conditions that could affect the haemoglobin measurement or other parameters in the complete blood count include haematological, infectious or any disease which physiopathology may influence the interpretation of these results in the context of our study (Examples; Sickle cell disease, thalassemia, haemolytic anaemia, solid tumour cancers, haematological neoplasm, paludism), and conditions that could predispose to pneumonia include diseases which may produce an increased risk of infections (Examples; haematological neoplasm, inherited and acquired immunodeficiencies, immunosuppressive therapy)
It is true that without specific evaluation of iron profile is not possible to establish with a high certainty iron deficiency. However, in our study are some relevant considerations; we excluded patients with a current diagnosis of other types of anaemia (haemolytic anaemia), chronic inflammatory conditions, cancer, and haematological neoplasms. All these factors reduce the possible causes of anaemia, and in the light that nutritional anaemia is the most frequent type in Latin America, it is reasonable to think that iron deficiency may be the leading cause in our patients. When we think about microcytic anaemia, as this was the most frequent type in our study, and as we excluded thalassemia, chronic inflammatory disease, and was no evidence of lead poisoning or newly diagnosed thalassemia in our patients, the possibility of iron deficiency increases. Although, at the end of our paper, we recommend the use of iron profile in new studies. I should highlight that we did not report cases of macrocytic anaemia.
The question regarding the use of nutritional supplements is interesting, especially considering that in Ecuador, the governmental normative of micronutrients supplementation with the product "Chis Paz" consider children between 6 and 24 months of age. In our study, there was no possibility to know if the patients receive any supplementation. But, it would be useful to include this variable in prospective studies.
Subclinical infections and iron deficiency anaemia have been described extensively in subclinical malaria, in other types of subclinical infections and even acute infections, there are still debate.
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Kisworini, Priyanti, Amalia Setyati, and Sutaryo Sutaryo. "Mortality predictors of pneumonia in children." Paediatrica Indonesiana 50, no. 3 (June 30, 2010): 149. http://dx.doi.org/10.14238/pi50.3.2010.149-53.
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Background Pneumonia is one of the main causes of death in children in developing countries. It is important to identify clinical signs, demographic factors, and laboratory data which can be used to predict children who have higher risk of mortality from pneumonia.Objective To find the clinical signs, demographic factors and laboratory data that can be used as predictors of mortality from pneumonia.Methods T his historical casecontrol study was carried out in Sardjito Hospital between January 2004 and December 2006. Data were obtained from medical records. Differential proportion between groups was analyzed with chi square. Regression analysis was used to identify clinical factors, demographic factors and laboratory factors that associated with mortality from pneumonia.Results Fiftyeight patients were enrolled in this study, 29 patients were dead (case group) and 29 patients were cured (control group). Baseline data between the two groups were similar in terms of gender and mean of age. Bivariate analyses show that the predictors of mortality in children with pneumonia were: age < 1 year (OR3.11, 95% CI 1.06 to 9.08), malnutrition (OR 7.30,95% CI 1.62- to 21.03), age of the mother < 20 years (OR 2.21,95%CI 1.64 to 2.97),t achycardia (OR 6.075,95% CI 1.18 to 31.24), and anemia (OR 5 .83, 95% CI 1.88 to 18.10). Logistic regression analysis shows that tachycardia (OR 6.04, 95% CI 1.01 to 36.17) and anemia (OR 4.41,95% CI 1.25 to 15.51) were predictor of mortality in children 'With pneumonia.Conclusions Tachycardia and anemia play as independent mortality predictors of pneumonia in children.
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King, Carina, Masford Banda, Naor Bar-Zeev, James Beard, Neil French, Charles Makwenda, Eric McCollum, et al. "Care-seeking patterns amongst suspected paediatric pneumonia deaths in rural Malawi." Gates Open Research 4 (December 4, 2020): 178. http://dx.doi.org/10.12688/gatesopenres.13208.1.
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Background: Pneumonia remains a leading cause of paediatric deaths. To understand contextual challenges in care pathways, we explored patterns in care-seeking amongst children who died of pneumonia in Malawi. Methods: We conducted a mixed-methods analysis of verbal autopsies (VA) amongst deaths in children aged 1-59 months from 10/2011 to 06/2016 in Mchinji district, Malawi. Suspected pneumonia deaths were defined as: 1. caregiver reported cough and fast breathing in the 2-weeks prior to death; or, 2. the caregiver specifically stated the child died of pneumonia; or 3. cause of death assigned as ‘acute respiratory infection’ using InterVA-4. Data were extracted from free-text narratives based on domains in the ‘Pathways to Survival’ framework, and described using proportions. Qualitative analysis used a framework approach, with pre-specified themes. Results: We analysed 171 suspected pneumonia deaths. In total, 86% of children were taken to a healthcare facility during their final illness episode, and 44% sought care more than once. Of children who went to hospital (n=119), 70% were admitted, and 25% received oxygen. Half of the children died within a healthcare setting (43% hospital, 5% health centre and 2% private clinics), 64 (37%) at home, and 22 (13%) in transit. Challenges in delayed care, transport and quality of care (including oxygen), were reported. Conclusions: Healthcare was frequently sought for children who died of suspected pneumonia, however several missed opportunities for care were seen. Sustained investment in timely appropriate care seeking, quick transportation to hospital and improved case management at all levels of the system is needed.
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King, Carina, Masford Banda, Naor Bar-Zeev, James Beard, Neil French, Charles Makwenda, Eric D. McCollum, et al. "Care-seeking patterns amongst suspected paediatric pneumonia deaths in rural Malawi." Gates Open Research 4 (May 6, 2021): 178. http://dx.doi.org/10.12688/gatesopenres.13208.2.
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Background: Pneumonia remains a leading cause of paediatric deaths. To understand contextual challenges in care pathways, we explored patterns in care-seeking amongst children who died of pneumonia in Malawi. Methods: We conducted a mixed-methods analysis of verbal autopsies (VA) amongst deaths in children aged 1-59 months from 10/2011 to 06/2016 in Mchinji district, Malawi. Suspected pneumonia deaths were defined as: 1. caregiver reported cough and fast breathing in the 2-weeks prior to death; or, 2. the caregiver specifically stated the child died of pneumonia; or 3. cause of death assigned as ‘acute respiratory infection’ using InterVA-4. Data were extracted from free-text narratives based on domains in the ‘Pathways to Survival’ framework, and described using proportions. Qualitative analysis used a framework approach, with pre-specified themes. Results: We analysed 171 suspected pneumonia deaths. In total, 86% of children were taken to a healthcare facility during their final illness episode, and 44% sought care more than once. Of children who went to hospital (n=119), 70% were admitted, and 25% received oxygen. Half of the children died within a healthcare setting (43% hospital, 5% health centre and 2% private clinics), 64 (37%) at home, and 22 (13%) in transit. Challenges in delayed care, transport and quality of care (including oxygen), were reported. Conclusions: Healthcare was frequently sought for children who died of suspected pneumonia, however several missed opportunities for care were seen. Sustained investment in timely appropriate care seeking, quick transportation to hospital and improved case management at all levels of the system is needed.
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Enarson, Penelope M., Robert P. Gie, Charles C. Mwansambo, Ellubey R. Maganga, Carl J. Lombard, Donald A. Enarson, and Stephen M. Graham. "Reducing Deaths from Severe Pneumonia in Children in Malawi by Improving Delivery of Pneumonia Case Management." PLoS ONE 9, no. 7 (July 22, 2014): e102955. http://dx.doi.org/10.1371/journal.pone.0102955.
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Gallagher, Joe, Master Chisale, Sudipto Das, Richard J. Drew, Nadezhda Gleseva, Dermot Michael Wildes, Cillian De Gascun, Tsung-Shu Joseph Wu, Mark T. Ledwidge, and Chris Watson. "Aetiology and severity of childhood pneumonia in primary care in Malawi: a cohort study." BMJ Open 11, no. 7 (July 2021): e046633. http://dx.doi.org/10.1136/bmjopen-2020-046633.
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ObjectiveTo determine the aetiology of community acquired pneumonia in children presenting to primary care in Northern Malawi, and to ascertain predictors for identification of children requiring hospitalisation.DesignThe BIOmarkers TO diagnose PnEumonia study was a prospective cohort study conducted from March to June 2016.SettingPrimary care in Northern Malawi.Patients494 children aged 2 –59 months with WHO defined pneumonia.Main outcome(s) and measure(s)Number of children with bacterial infection identified and the sensitivity/specificity of WHO markers of severity for need for hospitalisation.Results13 (2.6%) children had a bacterium consistent with pneumonia identified. A virus consistent with pneumonia was identified in in 448 (90.7%) of children. 56 children were admitted to hospital and two children died within 30 days. 442 (89.5%) received antibiotic therapy. Eleven children (2.6%) had HIV. WHO severity markers at baseline demonstrated poor sensitivity for the need for hospitalisation with a sensitivity of 0.303 (95% CI 0.188 to 0.441) and a specificity 0.9 (95% CI 0.868 to 0.926). A prediction rule to indicate the need for hospitalisation was developed.Conclusions and relevanceThe low rate of bacterial infection and high use of antibiotics in the setting of high immunisation rates highlights the changing profile of childhood pneumonia. Similarly, the markers of need for hospitalisation may have changed in the setting of extended immunisation. Further studies are required to examine this.
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Lenahan, Jennifer L., Evangelyn Nkwopara, Melda Phiri, Tisungane Mvalo, Mari T. Couasnon, Kali Turner, Chifundo Ndamala, Eric D. McCollum, Susanne May, and Amy Sarah Ginsburg. "Repeat assessment of examination signs among children in Malawi with fast-breathing pneumonia." ERJ Open Research 6, no. 2 (April 2020): 00275–2019. http://dx.doi.org/10.1183/23120541.00275-2019.
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BackgroundAs part of a randomised controlled trial of treatment with placebo versus 3 days of amoxicillin for nonsevere fast-breathing pneumonia among Malawian children aged 2–59 months, a subset of children was hospitalised for observation. We sought to characterise the progression of fast-breathing pneumonia among children undergoing repeat assessments to better understand which children do and do not deteriorate.MethodsVital signs and physical examination findings, including respiratory rate, arterial oxygen saturation measured by pulse oximetry (SpO2), chest indrawing and temperature were assessed every 3 h for the duration of hospitalisation. Children were assessed for treatment failure during study visits on days 1, 2, 3 and 4.ResultsHospital monitoring data from 436 children were included. While no children had SpO2 90–93% at baseline, 7.4% (16 of 215) of children receiving amoxicillin and 9.5% (21 of 221) receiving placebo developed SpO2 90–93% during monitoring. Similarly, no children had chest indrawing at enrolment, but 6.6% (14 of 215) in the amoxicillin group and 7.2% (16 of 221) in the placebo group went on to develop chest indrawing during hospitalisation.ConclusionRepeat monitoring of children with fast-breathing pneumonia identified vital and physical examination signs not present at baseline, including SpO2 90–93% and chest indrawing. This information may support providers and policymakers in developing guidance for care of children with nonsevere pneumonia.
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McCollum, Eric D., Carina King, Rashid Deula, Beatiwel Zadutsa, Limangeni Mankhambo, Bejoy Nambiar, Charles Makwenda, et al. "Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi." Bulletin of the World Health Organization 94, no. 12 (October 11, 2016): 893–902. http://dx.doi.org/10.2471/blt.16.173401.
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Nkwopara, Evangelyn, Robert Schmicker, Tisungane Mvalo, Melda Phiri, Ajib Phiri, Mari Couasnon, Eric D. McCollum, and Amy Sarah Ginsburg. "Analysis of serious adverse events in a paediatric fast breathing pneumonia clinical trial in Malawi." BMJ Open Respiratory Research 6, no. 1 (September 2019): e000415. http://dx.doi.org/10.1136/bmjresp-2019-000415.
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IntroductionPneumonia is the leading infectious killer of children. We conducted a double-blind, randomised controlled non-inferiority trial comparing placebo to amoxicillin treatment for fast breathing pneumonia in HIV-negative children aged 2–59 months in Malawi. Occurrence of serious adverse events (SAEs) during the trial were examined to assess disease progression, co-morbidities, recurrence of pneumonia and side effects of amoxicillin.MethodsEnrolled children with fast breathing for age and a history of cough <14 days or difficult breathing were randomised to either placebo or amoxicillin for 3 days, and followed for 14 days to track clinical characteristics and outcomes. Medical history, physical exam, laboratory results and any chest radiographs collected at screening, enrolment and during hospitalisation were evaluated. All SAE reports were reviewed for additional information regarding hospitalisation, course of treatment and outcome.ResultsIn total, 102/1126 (9.0%) enrolled children with fast breathing pneumonia were reported to have a SAE. Seventy-five per cent (n=77) of SAEs were pneumonia-related (p<0.01). Children<2 years of age represented the greatest proportion (61/77, 79.2%) of those with a pneumonia-related SAE. In the amoxicillin group, there were 46 SAEs and 5 (10.9%) cases were identified as possibly related to study drug (4 gastroenteritis and 1 fever). There were no life-threatening pneumonia SAEs or deaths in either group, and by the time of exit from the study, all children recovered without sequelae.DiscussionIn this fast breathing pneumonia clinical trial, SAEs occurred infrequently in both the amoxicillin and placebo groups, and amoxicillin was well tolerated.Trial registration numberNCT02760420. https://clinicaltrials.gov/ct2/show/NCT02760420?term=ginsburg&rank=9.
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Stevenson, Anna Clare, Christopher Edwards, Josephine Langton, Collins Zamawe, and Neil Kennedy. "Fear of oxygen therapy for children in Malawi." Archives of Disease in Childhood 100, no. 3 (April 25, 2014): 288–91. http://dx.doi.org/10.1136/archdischild-2013-305469.
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BackgroundAlthough pneumonia is a common cause of death in children in Malawi, healthcare staff frequently encounter patients or carers who refuse oxygen therapy. This qualitative study documents factors that influence acceptance or refusal of oxygen therapy for children in Malawi.MethodsNine group interviews involving 86 participants were held in community and hospital settings in rural and urban Malawi. Eleven in-depth interviews of healthcare staff providing oxygen were held in a central hospital. Thematic analysis of transcripts of the audio recordings was carried out to identify recurring themes.ResultsSimilar ideas were identified in the group interviews and in-depth staff interviews. Past experiences of oxygen use (direct and indirect, positive and negative) had a strong influence on views of oxygen. A recurrent theme was fear of oxygen, often due to a perceived association between death and recent oxygen use. Fears were intensified by a lack of familiarity with equipment used to deliver oxygen, distrust of medical staff and concerns about cost of oxygen.ConclusionsThis study identifies reasons for refusal of oxygen therapy for children in a low-income country. Findings from the study suggest that training of healthcare staff to address fears of parents, and information, education and communication (IEC) approaches that improve public understanding of oxygen and provide positive examples of its use are likely to be helpful in improving uptake of oxygen therapy in Malawi.
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Hooli, Shubhada, Tim Colbourn, Norman Lufesi, Anthony Costello, Bejoy Nambiar, Satid Thammasitboon, Charles Makwenda, Charles Mwansambo, Eric D. McCollum, and Carina King. "Predicting Hospitalised Paediatric Pneumonia Mortality Risk: An External Validation of RISC and mRISC, and Local Tool Development (RISC-Malawi) from Malawi." PLOS ONE 11, no. 12 (December 28, 2016): e0168126. http://dx.doi.org/10.1371/journal.pone.0168126.
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Dhingra, Dhulika, Amitabh Singh, and Anirban Mandal. "Pneumocystis jirovecii Pneumonia in Children." Journal of Pediatric Infectious Diseases 13, no. 01 (July 20, 2017): 002–9. http://dx.doi.org/10.1055/s-0037-1604337.
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Abstract Pneumocystis jirovecii (previously known as Pneumocystis carinii), a yeast-like, atypical fungus, is an important human pathogen especially in the immunocompromised hosts. It primarily causes pneumonia (P. jirovecii pneumonia or PJP), but rarely can infect other extrapulmonary sites, such as lymph nodes, spleen, liver, and bone marrow. Though an early age of colonization/infection has been documented even in healthy children, children with human immunodeficiency virus (HIV) infection, those with immunosuppression secondary to malignancies, cancer chemotherapy, and other immunosuppressive agents, and primary immunodeficiency are the ones primarily affected with the disease. The mode of presentation is variable depending on the underlying disease, immune status, and age of the patient, but clinical features of PJP are largely nonspecific. Though diffuse, perihilar predominant, bilaterally symmetrical interstitial infiltrates with apical sparing is characteristically seen in pulmonary imaging, it is very difficult to differentiate between PJP and other causes of pneumonia in immunocompromised hosts. The growth of the organism being extremely difficult in the laboratory, direct demonstration of the organism or its DNA in pulmonary secretions (induced sputum, bronchoalveolar lavage [BAL], etc.) by either direct stains or polymerase chain reaction (PCR) is the predominant mode of diagnosis. Chemoprophylaxis is indicated for HIV-infected infants and other children with profound immunosuppression. Co-trimoxazole is the drug of choice for both prophylaxis and therapy in children with PJP; pentamidine, atovaquone, dapsone, and clindamycin/primaquine are other alternatives. Following the advent of highly active antiretroviral therapy (HAART) for the treatment of HIV disease and co-trimoxazole prophylaxis, both the incidence of PJP and associated mortality have decreased dramatically in the developing regions. Developing countries still have very high morbidity and mortality with PJP, especially in HIV-infected children.
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Fadlinda, Herza, Adi Utomo, and Henni Djuhaeni. "Cyanosis as Mortality Risk among Children with Severe Pneumonia." Althea Medical Journal 3, no. 2 (June 2016): 186–89. http://dx.doi.org/10.15850/amj.v3n2.799.
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Axelsson, Inge, and Sven Arne Silfverdal. "Pneumonia mortality among children in Brazil: a success story." Jornal de Pediatria 87, no. 2 (April 14, 2011): 85–86. http://dx.doi.org/10.2223/jped.2080.
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Fernández-Mormontoy, Jorge, Alberto Estremadoyro-Gallardo, and Oscar F. Vargas. "Mortality predictive scores for community-acquired pneumonia in children." Pediatric Pulmonology 52, no. 9 (April 11, 2017): 1119–20. http://dx.doi.org/10.1002/ppul.23706.
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Patwari, A. K. "Risk factors for mortality in children hospitalized with pneumonia." Indian Pediatrics 49, no. 11 (November 2012): 869–70. http://dx.doi.org/10.1007/s13312-012-0210-6.
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Aston, Stephen J., Antonia Ho, Hannah Jary, Jacqueline Huwa, Tamara Mitchell, Sarah Ibitoye, Simon Greenwood, et al. "Etiology and Risk Factors for Mortality in an Adult Community-acquired Pneumonia Cohort in Malawi." American Journal of Respiratory and Critical Care Medicine 200, no. 3 (August 2019): 359–69. http://dx.doi.org/10.1164/rccm.201807-1333oc.
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Havens, Deborah, Duolao Wang, Jonathan Grigg, Stephen Gordon, John Balmes, and Kevin Mortimer. "The Cooking and Pneumonia Study (CAPS) in Malawi: A Cross-Sectional Assessment of Carbon Monoxide Exposure and Carboxyhemoglobin Levels in Children under 5 Years Old." International Journal of Environmental Research and Public Health 15, no. 9 (September 5, 2018): 1936. http://dx.doi.org/10.3390/ijerph15091936.
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Household air pollution is estimated to cause half a million deaths from pneumonia in children worldwide. The Cooking and Pneumonia Study (CAPS) was conducted to determine whether the use of cleaner-burning biomass-fueled cookstoves would reduce household air pollution and thereby the incidence of pneumonia in young children in rural Malawi. Here we report a cross-sectional assessment of carbon monoxide (CO) exposure and carboxyhemoglobin (COHgB) levels at recruitment to CAPS. Mean (SD; range) 48-h CO exposure of 1928 participating children was 0.90 (2.3; 0–49) ppm and mean (SD; range) COHgB level was 5.8% (3.3; 0–20.3). Higher mean CO and COHgB levels were associated with location (Chikhwawa versus Chilumba) (OR 3.55 (1.73–7.26)); (OR 2.77 (1.08–7.08)). Correlation between mean CO and COHgB was poor (Spearman’s ρ = 0.09, p < 0.001). The finding of high COHgB levels in young children in rural Malawi that are at levels at which adverse neurodevelopmental and cognitive effects occur is of concern. Effective approaches for reducing exposure to CO and other constituents of air pollution in rural sub-Saharan African settings are urgently needed.
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Hooli, Shubhada, Tim Colbourn, Norman Lufesi, Anthony Costello, Bejoy Nambiar, Satid Thammasitboon, Charles Makwenda, Charles Mwansambo, Eric D. McCollum, and Carina King. "Correction: Predicting Hospitalised Paediatric Pneumonia Mortality Risk: An External Validation of RISC and mRISC, and Local Tool Development (RISC-Malawi) from Malawi." PLOS ONE 13, no. 2 (February 22, 2018): e0193557. http://dx.doi.org/10.1371/journal.pone.0193557.
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Ashorn, P. "Male biased mortality among 1-2 year old children in rural Malawi." Archives of Disease in Childhood 87, no. 5 (November 1, 2002): 386–87. http://dx.doi.org/10.1136/adc.87.5.386.
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Lin, Jody L., Joseph Rigdon, Keith Van Haren, MyMy Buu, Olga Saynina, Jay Bhattacharya, Douglas K. Owens, and Lee M. Sanders. "Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality." Journal of Child Neurology 36, no. 9 (March 22, 2021): 727–34. http://dx.doi.org/10.1177/08830738211000179.
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Background: Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. Methods: We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. Results: A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Conclusion: Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.
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M Buss, Imogen. "Validating a novel index (SWAT-Bp) to predict mortality risk of community-acquired pneumonia in Malawi." Malawi Medical Journal 30, no. 4 (December 31, 2018): 230. http://dx.doi.org/10.4314/mmj.v30i4.4.
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Setyoningrum, Retno Asih, and Hedi Mustiko. "Risk Factors of Very Severe Pneumonia Incidence in Children." Jurnal Respirologi Indonesia 40, no. 4 (October 29, 2020): 243–50. http://dx.doi.org/10.36497/jri.v40i4.147.
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Background: Childhood pneumonia is a significant cause of mortality and morbidity in developing countries. About 7-13% of childhood pneumonia present with very severe pneumonia with a high risk of mortality. Identification of risk factors is necessary for early intervention and better management.
Methods: Analytic observational study with a cross-sectional approach was conducted with subjects of pneumonia patients aged 2-59 months admitted in Respirology Ward and PICU Department of Pediatrics Dr. Soetomo Surabaya from January 2017 to December 2018.
Results: A total of 253 were roled in this study. Group with very severe pneumonia are 140 patients and 113 patients with severe pneumonia. Independent risk factors were analysed by chi-square test and Continuity Correction. Independent risk factors that intluence the incidence of very severe pneumonia in infants and children are patient's age (PR=1.365;P=0.009;95% confidence interval (CI)=1.089-1.712), low birth weight (PR=1.380;P=0.010;95% CI=1.115-1,708), prematurity (PR=1,412;P=0.007;95% CI=1,141-1,747), exclusive breastfeeding (PR=1,434;P=0.007;95% CI=1,093-1,880), nutritional status (PR=2,412;P
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Oleinik, Nina A., and Fedor P. Romanyuk. "Follow-up Study A Children Who Are Disordered Pneumonia." Pediatrician (St. Petersburg) 7, no. 3 (September 15, 2016): 128–35. http://dx.doi.org/10.17816/ped73128-135.
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Pneumonia is one of significant problems among infections of low airways in children. Morbidity of common-acquired pneumonia (CAP) continues to go in last year’s. Data available in the literature show, that pneumonia with empyema possibly associated with high risk of chronic obstructive pulmonary diseases, asthma and recurrent case of pneumonia in last life. Fatal pneumonia or developing chronic obstruction lung diseases occur mainly in children after severe and complicated forms of pneumonia, this information is presented in native and foreign literature. Currently pneumonia with the heavy and complicated current is a major cause of infant mortality or promotes development of a chronic obstruction lung diseases. Mortality from pneumonia is 3-19% according to different authors. The risk of respiratory diseases in the 3-6 months after pneumonia increased in children who underwent pneumonia. After complicated CAP the complete resolution of the inflammatory happens on 6-9 month. After not complicated САР forms at 10-30% of children radiological changes within 2-6 weeks were noted. In one research it is reported that the full recovery from slow resolving pneumonia at 96% of children has come on 6-8 month of the dispensary period. Some authors in the scientific works use immunomodulators and vaccinations to reduce the residual variation in the lungs and improve recovery time dramatically of pneumonia. In follow up study the important task is a identifying and elimination of risk factors for improvement of treatment and dispensary period for slow resolving pneumonia, recurrent case of pneumonia, sever pneumonia.
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Reid, Trista, Joanna Grudziak, Nidia Rodriguez-Ormaza, Rebecca G. Maine, Nelson Msiska, Carolyn Quinsey, and Anthony Charles. "Complications and 3-month outcomes of children with hydrocephalus treated with ventriculoperitoneal shunts in Malawi." Journal of Neurosurgery: Pediatrics 24, no. 2 (August 2019): 120–27. http://dx.doi.org/10.3171/2019.2.peds18325.
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OBJECTIVEHydrocephalus is the most common pediatric neurosurgical condition, with a high prevalence in low- and middle-income countries. Untreated, hydrocephalus leads to neurological disability or death. The epidemiology and outcomes of hydrocephalus treated by ventriculoperitoneal (VP) shunts in Sub-Saharan Africa are not well defined and vary by region. The aim of the present study was to examine the mortality and morbidity rates and predictors of mortality in children treated by VP shunt placement for hydrocephalus at Kamuzu Central Hospital in Lilongwe, Malawi.METHODSThis is a prospective study of 100 consecutive children presenting with hydrocephalus who were treated with VP shunt placement from January 2015 to August 2017. Demographics, nutritional status, maternal characteristics, developmental delay, shunt complications, readmissions, and in-hospital and 3-month mortality data were collected. Multivariate logistic regression was used to identify predictors of death within 3 months of surgery.RESULTSOverall, 46% of participants were female, with an average age of 5.4 ± 3.7 months at the time of surgery. The majority of patients were term deliveries (87.8%) and were not malnourished (72.9%). Only 10.8% of children were diagnosed with meningitis before admission. In-hospital and 3-month mortality rates were 5.5% and 32.1%, respectively. The only significant association with mortality was maternal age, with older maternal age demonstrating decreased odds of 3-month mortality (OR 0.9, 95% CI 0.8–1.0, p = 0.045).CONCLUSIONSSurgical management of hydrocephalus with VP shunts portends a high mortality rate in Malawi. The association of younger maternal age with mortality is likely a proxy for social determinants, which appear to contribute as much to mortality as patient factors. VP shunting is inadequate as a sole surgical management of hydrocephalus in resource-limited settings.
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Khulu, Chris, and Shaun Ramroop. "Determinants of Malnutrition in Under-five Children in Angola, Malawi and Senegal." Open Public Health Journal 13, no. 1 (March 20, 2020): 55–61. http://dx.doi.org/10.2174/1874944502013010055.
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Introduction: Malnutrition is one of the leading causes of under-five mortality globally. With the estimated target of reducing mortality in this age group by 2030, understanding and determining the factors contributing to child mortality are critical. Methods: The current study used Demographic Health Survey (DHS) data from Angola (2016), Malawi (2016) and Senegal (2016). The DHS data for under-five children from these three countries were then combined in this study to create a pooled sample. This method allows for a comparison and generalization of the results across countries and has also been used in previous studies. The dependent variables (severely nourished, moderately nourished and nourished) were developed by using calculated Weight-for-age Z-scores (WAZ) from DHS data. The exploratory analysis was conducted by performing a gamma measure and chi-square test of independence to evaluate the association between malnutrition status and covariates. Results & Discussion: Based on the generalized linear mixed model, the type of residence, sex of the child, age of the child, mother’s level of education, birth interval, wealth index and the birth order are correlated to malnutrition in Angola, Malawi and Senegal. Children who are from rural communities, poor households, with a mother having attained primary education, are female and are between the age of 24 and 59 months are associated with malnutrition. The results of the study suggest that children from these three countries who reside with mothers who have attained only primary education are at the highest risk of being affected by malnutrition. Conclusion: The results show the necessity of collaboration among the three countries in order to achieve the Sustainable Development Goal (SDG) target.
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Ramamoorthy, Kannan, and Agora Shivan Shanmuga Sundaram. "Detection of Chlamydia pneumonia and Mycoplasma pneumonia in hospitalised children with community acquired pneumonia." International Journal of Contemporary Pediatrics 5, no. 4 (June 22, 2018): 1310. http://dx.doi.org/10.18203/2349-3291.ijcp20182076.
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Background: Mycoplasma pneumoniae and Chlamydia pneumoniae are atypical pathogens responsible for community acquired pneumonia (CAP) and are a leading cause of morbidity and mortality in low income countries. The study objective was to determine the prevalence of C. pneumoniae and M. pneumonia in hospitalized children with CAP.Methods: This study was performed on ninety-four children admitted with radiologically confirmed diagnosis of pneumonia in Government Rajah Mirasudar Hospital, Thanjavur, during the period of July 2005 to April 2006. The diagnosis of infections with C. pneumonia and M. pneumonia was determined by detection of IgM antibody by using ELISA method. In this study clinical and radiological feature of these infections were also looked for.Results: Among 94 children, 9 children (9.6%) were detected positive for M. pneumonia and 8 children (8.5%) were detected positive for C. pneumonia. Infection rate was highest among 5-12 years and least among 1 month to 24 months age group. The most common symptoms observed in patients with these pathogens are cough, fever, crepitations and rhonchi. Pulmonary infiltrates were the most common chest X-ray features of both C. pneumoniae pneumonia and M. pneumoniae pneumonia.Conclusions: This study has shown that C. pneumonia and M. pneumonia play a significant role in paediatric CAP. Identification and confirmation of these organisms by IgM ELISA helps in better management that would decrease the need for hospitalization and IV antibiotics.
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Odeyemi, A. O., A. O. Oyedeji, O. J. Adebami, A. O. Odeyemi, and E. Agelebe. "Complications of pneumonia and its associated factors in a pediatric population in Osogbo, Nigeria." Nigerian Journal of Paediatrics 47, no. 4 (August 28, 2020): 318–23. http://dx.doi.org/10.4314/njp.v47i4.4.
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Introduction: Pneumonia is one of the leading causes of morbidity and mortality in underfive children. Nigeria still has a high burden of child death due to pneumonia. Many of these deaths result from the development of complications. This study was done to determine the pattern of pneumonia complications and its associated factors amongst underfive children with pneumonia.
Methods: It was a hospital-based cross-sectional observational study involving 129 children aged 1 - 60 months with a diagnosis of pneumonia. The participants were recruited over a nine-month period. Clinical signs were recorded, and a confirmatory chest radiograph was obtained within 24hours of admission.
Result: Of the129 subjects studied, 70 (54.3%) had complications. Children less than 24 months had a higher frequency of complications at presentation. Heart failure and anemia occurred more commonly. Other complications were pleural effusion, empyema, pneumatocele and pneumothorax. More than half (57.1%) of those with complication were hypoxaemic at presentation. Complicated pneumonia was significantly associated with prolonged hospital stay and risk of mortality.
Conclusion: Complication is common among children hospitalized for pneumonia in Osogbo. Heart failure was the most common complication. Presence of pneumonia complications and hypoxaemia are important contributors to mortality in this environment.
Keywords: Pneumonia, complication, under-fives, Nigeria.
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Ayieko, Philip, Emelda A. Okiro, Tansy Edwards, Rachel Nyamai, and Mike English. "Variations in Mortality in Children Admitted with Pneumonia to Kenyan Hospitals." PLoS ONE 7, no. 11 (November 5, 2012): e47622. http://dx.doi.org/10.1371/journal.pone.0047622.
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Farrukh, Riffat, Amber Naseer, Shaheen Masood, Ibrahim Shakoor, Farhina Nasir, and Sarwat Sultana. "Mortality Rate and Causing Factors in Ventilator Associated Pneumonia in Children." Pakistan Journal of Medical and Health Sciences 15, no. 6 (June 30, 2021): 1917–20. http://dx.doi.org/10.53350/pjmhs211561917.
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Aim: To estimate the incidence of ventilator-associated pneumonia (VAP) and to identify causing microbiological organismsand VAP related mortality rate in children admitted to the ICU. Study design: This was a Cross-sectional and an observational study. Study place and duration: In the Pediatric department of Abbasi Shaheed Hospital, Karachi, for one-year duration from May 2020 to May 2021. Methodology: All admitted children to the pediatric ICU (PICU) and ventilated were selected and observed for any features suggestive of VAP. All suspected children have Partial septic signs. A VAP will be categorized ifchild remains on ventilator for more than 48 hours and when a patient had 2 of these signs of nosocomial infection - TLC <4,000 or> 15,000 mm3 , fever> 101 ° F, CRP> 48 mg / L, neutrophils> 85% or a new chest X-rayexhibited pneumonia withradiological sign of progressive, persistent or new infiltrates. The chi-square test was used for comparison of percentages with a value of Less than 0.05 p. Results: Of all the cases admitted, the average length of ICU stay was 8.65 ± 6.45 per day. Children who needed VAP required 14.2 ±9.5 days of ventilation and 7.5± 5.2 days for children who have not VAP progression. Of 100 cohort of children necessitating ventilation, 22 died and 2 were left without advice or serious illness, with a total mortality of 22%. Conclusion: The VAP incidence in this study was 22%. Features related with a higher incidence of ventilator-associated pneumonia include age <1-year, continuous intravenous sedation and unplanned intubation in emergency situation. Features suggestive of underlying VAP encompassed, CRP> 48 mg / L, purulent tracheal secretions, positive tracheal culture of aspirate and positive X-ray results. Key words: Ventilator-associated pneumonia (VAP), Nosocomial infections,PICU and Children.
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Nkwopara, Evangelyn, Robert Schmicker, Tisungane Mvalo, Susanne May, and Amy Sarah Ginsburg. "Geographically linked risk factors for enrolment into a fast breathing child pneumonia trial in Lilongwe, Malawi: an Innovative Treatments in Pneumonia (ITIP) secondary analysis." BMJ Open Respiratory Research 6, no. 1 (April 2019): e000414. http://dx.doi.org/10.1136/bmjresp-2019-000414.
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BackgroundPneumonia is the leading infectious killer of children less than 5 years of age worldwide. In addition to vaccines that help prevent pneumonia, understanding the environmental and socioeconomic risk factors for child pneumonia is critical to further prevention.MethodsData from children with fast breathing pneumonia enrolled in a non-inferiority clinical trial assessing the effectiveness of 3-day placebo versus antibiotic treatment in Lilongwe, Malawi were used to examine environmental and socioeconomic characteristics within the study population. Location of residence was collected for enrolled children, and spatial enrolment rates were compared across Lilongwe using a spatial scan statistic.ResultsData from 1101 children were analysed. Three urban subdistricts (locally known as ‘Areas’) (Areas 24, 36 and 38) out of 51 were identified with higher than expected enrolment. These three areas were associated with higher rates of poverty (37.8% vs 23.9%) as well as informal settlements and poorer sanitation (42.4% vs 7.4%) than other areas. Parents of enrolled children from these areas also had lower rates of secondary education compared with parents of children enrolled from other areas (55% vs 67% (p<0.01) among fathers; 47% vs 54% (p<0.01) among mothers).ConclusionIn Lilongwe, areas with higher rates of poverty, informal settlements and poor sanitation contributed higher than expected enrolment of children to our fast breathing child pneumonia clinical trial when compared with other areas. Additional research is needed to evaluate the impact of environmental and socioeconomic risk factors, along with vaccination status, on the incidence of fast breathing pneumonia in children living in this region.
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Zhang, Yin, Jilei Lin, Qingxia Shi, Chulin Li, Jingyue Liu, and Jihong Dai. "Diagnostic accuracy of time to first positivity of blood cultures for predicting severe clinical outcomes in children with pneumonia-related bacteremia." Journal of Investigative Medicine 68, no. 7 (August 26, 2020): 1241–49. http://dx.doi.org/10.1136/jim-2020-001473.
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Early recognition of severe clinical outcomes in children with pneumonia-related bacteremia is vitally important because of the high mortality. This study aims to explore risk factors for severe clinical outcomes in children with pneumonia-related bacteremia and evaluate the value of time to first positive blood cultures (TTFP) in predicting prognosis. Children with pneumonia-related bacteremia in Children’s Hospital of Chongqing Medical University were included (January 2013–May 2019), respectively. TTFP and clinical parameters were collected and analyzed. The area under the curve (AUC)-receiver operating characteristic was used to evaluate the discrimination ability of TTFP. Multivariate logistic regression tests were performed to evaluate the association between TTFP and severe clinical outcomes. A total of 242 children with pneumonia-related bacteremia were included. The least absolute shrinkage and selection operator (LASSO) regression analysis identified TTFP, serum albumin (ALB) and lactic dehydrogenase (LDH) as predictors of in-hospital mortality. Multivariate logistic regression analysis showed that shorter TTFP (OR 0.94; 95% CI 0.89 to 0.97; p<0.01), lower ALB level (OR 0.93; 95% CI 0.89 to 0.98; p<0.01) and higher LDH level (OR 1.001; 95% CI 1.000 to 1.001; p<0.01) were risk factors for in-hospital mortality in children with pneumonia-related bacteremia. AUC of TTFP for predicting in-hospital mortality was 0.748 (95% CI 0.668 to 0.829). Shorter TTFP (≤16 hours) was associated with in-hospital mortality and septic shock. TTFP plays an important role in predicting severe clinical outcomes in children with pneumonia-related bacteremia.
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Trokhimchuk, V. V., and O. I. Belyaeva. "Analysis of the pneumonia morbidity in children in order to optimize pharmaceutical aid." Farmatsevtychnyi zhurnal, no. 5 (January 24, 2019): 5–10. http://dx.doi.org/10.32352/0367-3057.5.16.01.
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To analyze the health of the child population used statistical incidence, disease prevalence, their gender features and age characteristics, mortality. According to WHO, among the major causes of child mortality, the share of pneumonia accounts for 19% of all deaths. In Ukraine in the structure of infant mortality pneumonia ranked third.The aim of the work was to study the structure of child morbidity with respiratory diseases and pneumonia in Ukraine and separately of Southern region.
The material of the study are the data of medical statistics. The study used informational, statistical and graphical methods.
The study found that respiratory diseases occupy a leading place in the structure of child morbidity in Ukraine, with a 67.1% share. It was found that the share of children (0–17 years) in 2015 accounted for 65 411 cases of pneumonia (32%). The analysis showed that the incidence of pneumonia is characterized by age and regional differencies. Thus, the highest rates are observed in children aged 0–14 years and of urban children. According to the statistical analysis of the Southern region, in the Kherson region incidence rate of pneumonia was significantly higher than the national average. Conducted analysis of normative documents regulating the treatment of pneumonia in children. It turned out that in documents there are groups of drugs without a specific medication lists. It is necessary to conduct pharmacoeconomic analysis of rational choice of drugs and rational use of healthcare resources.
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Pinto, Elisabeth Ataíde E., and JoãO Guilherme Alves. "The causes of death of hospitalized children in Angola." Tropical Doctor 38, no. 1 (January 2008): 66–67. http://dx.doi.org/10.1258/td.2006.006352.
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Angola currently has the second mortality rate for children in the world. A cross-sectional study was performed containing 1322 random selected children of the 10288 hospitalized from December 2004 to May 2005 at the Hospital Pediátrico David Bernardino, the largest hospital in Angola and health reference centre located in the capital city of Luanda. Hospital mortality was 18% and the main causes of death were:malaria (22.4%), undernutrition (21.5%), pneumonia (11.8%), neonatal affections (9.3%) and meningitis (8.0%). Programmes must be rapidly implemented to eradicate undernutrition, improve perinatal care and control infections, especially malaria, pneumonia and meningitis.
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Ginsburg, Amy Sarah, Tisungane Mvalo, and Susanne May. "Repeat assessment of physical examination findings among HIV-uninfected children in Malawi with chest-indrawing pneumonia." International Journal of Infectious Diseases 110 (September 2021): 371–73. http://dx.doi.org/10.1016/j.ijid.2021.07.073.
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Iddrisu, Abdul-Karim, Abukari Alhassan, and Nafiu Amidu. "Survival Analysis of Birth Defect Infants and Children with Pneumonia Mortality in Ghana." Advances in Public Health 2019 (July 1, 2019): 1–7. http://dx.doi.org/10.1155/2019/2856510.
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Despite the global decline in infant and child mortality rate, Ghana has failed to record any substantial improvement. In this study, we investigated the effects of some selected risk factors on infant and child survival in Ghana. This study used data from Komfo Anokye Teaching Hospital. 295 infants and children were followed up and time to first occurrence of death was recorded for each infant and child. The life table and Kaplan-Meier methods and the Cox proportional model were used for statistical analyses. The log-rank test statistic was used to test for difference in the survival curves. The results showed that the risk of death among those with birth defects or pneumonia was relatively higher and there is statistically significant difference in the risk of dying between infants with birth defects and those with no birth defects. Also, there is statistically significant difference in the risk of death between children with pneumonia and those with no pneumonia. Our analyses showed that birth defects, preterm birth, accidents, and pregnancy complications are significant risk factors of infant survival. Also, pneumonia, preterm birth, accidents, and diarrhoea are significant risk factors of child survival. Maternal care services should be made available and accessible and mothers should be educated on the importance of maternal care services utilization in order to reduce or mitigate the risk of infant and child mortality. Also, initiating the immunization activities with PCV-13 and Rota-Virus Vaccines, which will reduce Pneumonia and diarrhoea and will improve survival of infants and children under five, should be encouraged or implemented.
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Purcell, Laura N., Meghan Prin, John Sincavage, Clement Kadyaudzu, Michael R. Phillips, and Anthony Charles. "Outcomes Following Intensive Care Unit Admission in a Pediatric Cohort in Malawi." Journal of Tropical Pediatrics 66, no. 6 (May 15, 2020): 621–29. http://dx.doi.org/10.1093/tropej/fmaa025.
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Abstract Introduction The burden of critical illness in low- and middle-income countries (LMICs) is high; however, there is a paucity of data describing pediatric critical care outcomes in this setting. Methods We performed a prospective observational study of the pediatric (≤18 years) intensive care population in Malawi, from August 2016 to May 2018. Data collected include patient demographics and clinical data, admission criteria and outcome. A multivariate Poisson regression was performed to determine risk factors for mortality. Results Over the study period, 499 patients were admitted to the intensive care unit (ICU) and 105 (21.0%) were children. The average age was 10.6 ± 5.4 years. Primary indications for ICU admission were sepsis (n = 30, 30.3%) and traumatic brain injury (TBI, n = 23, 23.2%). Of those who died, sepsis (n = 18, 32.7%), acute respiratory failure (n = 11, 20.0%) and TBI (n = 11, 20.0%) were the primary admission diagnoses. Overall, ICU mortality was 54.3% (n = 57). Multivariate regression for increased ICU mortality revealed: age ≤5 years [risk ratio (RR) 1.96, 95% CI 1.10–2.26, p < 0.001], hemoglobin < 10 g/dl (RR 1.58, 95% CI 1.08—2.01, p = 0.01) and shock requiring epinephrine support (RR 2.76, 95% CI 1.80–4.23, p < 0.001). Conclusions Pediatric ICU mortality is high. Predictors of mortality were age ≤5 years, anemia at ICU admission and the need for epinephrine support. Training of pediatric intensive care specialists and increased blood product availability may attenuate the high mortality for critically ill children in Malawi.
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ZAMAN, S. M. A., J. COX, G. C. ENWERE, C. BOTTOMLEY, B. M. GREENWOOD, and F. T. CUTTS. "The effect of distance on observed mortality, childhood pneumonia and vaccine efficacy in rural Gambia." Epidemiology and Infection 142, no. 12 (February 24, 2014): 2491–500. http://dx.doi.org/10.1017/s0950268814000314.
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SUMMARYWe investigated whether straight-line distance from residential compounds to healthcare facilities influenced mortality, the incidence of pneumonia and vaccine efficacy against pneumonia in rural Gambia. Clinical surveillance for pneumonia was conducted on 6938 children living in the catchment areas of the two largest healthcare facilities. Deaths were monitored by three-monthly home visits. Children living >5 km from the two largest healthcare facilities had a 2·78 [95% confidence interval (CI) 1·74–4·43] times higher risk of all-cause mortality compared to children living within 2 km of these facilities. The observed rate of clinical and radiological pneumonia was lower in children living >5 km from these facilities compared to those living within 2 km [rate ratios 0·65 (95% CI 0·57–0·73) and 0·74 (95% CI 0·55–0·98), respectively]. There was no association between distance and estimated pneumococcal vaccine efficacy. Geographical access to healthcare services is an important determinant of survival and pneumonia in children in rural Gambia.
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Yusuf, Yusuf, Indah Kartika Murni, and Amalia Setyati. "Irrational use of antibiotics and clinical outcomes in children with pneumonia." Paediatrica Indonesiana 57, no. 4 (August 31, 2017): 211. http://dx.doi.org/10.14238/pi57.4.2017.1152.
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Background Pneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia.Obejctive To determine the prevalence of the irrational use of antibiotics and clinical outcomes in children with pneumonia.Methods We conducted a cross-sectional study in children with pneumonia who were admitted to the Pediatric Ward or PICU at Dr. Sardjito Hospital, Yogyakarta, from December 2010 to February 2013. Data were obtained from subjects’ medical records. Children with malnutrition, congenital heart defects, sepsis, shock, central nervous system disorders, syndromes, or other concomitant infections were excluded.Results Of 46 children who fulfilled the inclusion criteria, 13 (28.3%) used antibiotics irrationally and 7 (15.2%) died. Most subjects were aged less than 1 year (25 subjects, 54.3%) and 1 - < 5 years (18 subjects, 39.1%). The female to male ratio was 1:1. Most cases were referred from other hospitals (23 subjects, 50%). Twenty-eight (60.9%) subjects stayed in hospital > 7 days. Ampicillin was the most common first-line, empirical antibiotic used (32 subjects, 69.6%). Blood cultures were obtained in 20 (43.5%) patients, yielding no growth in 16 subjects, coagulase-negative staphylococci (CONS) in 3 subjects, and Pseudomonas aeruginosa in 1 subject. The irrational use of antibiotics was significantly associated with mortality in a univariate analysis [PR 6.35; (95%CI 1.40 to 28.69); P=0.006]. Conclusion The irrational use of antibiotics is common among children with pneumonia and is significantly associated with mortality.
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Yusuf, Yusuf, Indah Kartika Murni, and Amalia Setyati. "Irrational use of antibiotics and clinical outcomes in children with pneumonia." Paediatrica Indonesiana 57, no. 4 (August 31, 2017): 211. http://dx.doi.org/10.14238/pi57.4.2017.211-5.
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Background Pneumonia is a major cause of morbidity and mortality in children under five. Antibiotic treatment must be started immediately in children with pneumonia. The irrational use of antibiotics may increase morbidity and mortality in children with pneumonia.Obejctive To determine the prevalence of the irrational use of antibiotics and clinical outcomes in children with pneumonia.Methods We conducted a cross-sectional study in children with pneumonia who were admitted to the Pediatric Ward or PICU at Dr. Sardjito Hospital, Yogyakarta, from December 2010 to February 2013. Data were obtained from subjects’ medical records. Children with malnutrition, congenital heart defects, sepsis, shock, central nervous system disorders, syndromes, or other concomitant infections were excluded.Results Of 46 children who fulfilled the inclusion criteria, 13 (28.3%) used antibiotics irrationally and 7 (15.2%) died. Most subjects were aged less than 1 year (25 subjects, 54.3%) and 1 - < 5 years (18 subjects, 39.1%). The female to male ratio was 1:1. Most cases were referred from other hospitals (23 subjects, 50%). Twenty-eight (60.9%) subjects stayed in hospital > 7 days. Ampicillin was the most common first-line, empirical antibiotic used (32 subjects, 69.6%). Blood cultures were obtained in 20 (43.5%) patients, yielding no growth in 16 subjects, coagulase-negative staphylococci (CONS) in 3 subjects, and Pseudomonas aeruginosa in 1 subject. The irrational use of antibiotics was significantly associated with mortality in a univariate analysis [PR 6.35; (95%CI 1.40 to 28.69); P=0.006]. Conclusion The irrational use of antibiotics is common among children with pneumonia and is significantly associated with mortality.
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Saha, Haimanti, Lubaba Shahrin, Monira Sarmin, Tahmeed Ahmed, and Mohammod Jobayer Chisti. "Bacteremia in Diarrheal Children With Severe Pneumonia." Global Pediatric Health 6 (January 2019): 2333794X1986246. http://dx.doi.org/10.1177/2333794x19862462.
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Objectives. Diarrhea and pneumonia are the leading causes of under-5 childhood mortality. However, there is limited information on bacterial etiology of severe pneumonia in children with diarrhea. We analyzed bacterial pathogens from the blood of children under the age of 5 years. Methods. In this retrospective cross-sectional study, we studied all children having severe pneumonia with or without diarrhea admitted to the icddr,b (International Centre for Diarrheal Disease Research, Bangladesh) who had their blood culture done during January 2014 to December 2014. Results. Among a total of 159 study children, 118 had diarrhea. There were 13 bacterial isolates, and predominant organisms were gram-negative bacteria (11/13, 85%). Children with diarrhea coexisting with severe pneumonia proportionately had higher bacteremia (12/141 [10.16%] vs 1/41 [2.43%]), but the difference was not statistically insignificant ( P = .186). Conclusion. We recognized that the coexistence of diarrhea and severe pneumonia had proportionately higher bacteremia, especially gram-negative bacteria compared with those without diarrhea. The results emphasize the trend of bacterial etiology of pneumonia in children with diarrhea and may warrant revised antibiotics guideline for their management.
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Shanmugam, Sakthivel, and Senthil Kumar Kandasamy. "Clinical Profile and Risk Factors of Pneumonia in Children - A Study from Rural Kerala." Journal of Evidence Based Medicine and Healthcare 7, no. 42 (October 19, 2020): 2425–29. http://dx.doi.org/10.18410/jebmh/2020/502.
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BACKGROUND Pneumonia remains an important cause of morbidity and mortality in both industrialized and developing countries. It is one of the leading causes of underfive child death. This study was conducted to assess the clinical profile and to identify the risk factors of pneumonia in children between 2 months and 5 years of age. METHODS This is a prospective study conducted among 90 children in the age group of 2 months to 5 years, with clinical features of fast breathing and chest retractions as per ARI control programme who got admitted in paediatric wards of Karuna Medical College and Hospital from January 2018 to September 2019. RESULTS 2 - 12 months old children were most commonly admitted in the hospital (46.6 %). Bronchopneumonia (75.5 %) was the common diagnosis made at admission clinically. According to ARI control programme, 26.6 % had pneumonia, 62.2 % had severe pneumonia and 11.1 % had very severe pneumonia. Among the risk factors, 86.6 % had malnutrition, 58.8 % had overcrowding. Lower socioeconomic status was found in 92.2 % of patients. CONCLUSIONS Childhood pneumonia is one of the important causes of morbidity and mortality. Protein energy malnutrition, overcrowding and low socioeconomic status were found to be the risk factors for pneumonia. KEYWORDS Children, Malnutrition, Pneumonia, Risk Factors
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Peralta, Katia, Soraya Araya, Gabriela Sanabria, Julia Acuña, Dolores Lovera, and Antonio Arbo. "Prognostic factors of mortality in community-acquired pneumonia in children requiring hospitalization." Revista del Instituto de Medicina Tropical 12, no. 1 (July 30, 2017): 10–13. http://dx.doi.org/10.18004/imt/201712110-13.
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