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Alemu W, Argaw D, Adimasu M, Ewunie TM. Predictors of mortality among severe acute malnourished children. A multi-center prospective follow-up study. Clin Nutr ESPEN 2023; 53:165-169. [PMID: 36657909 DOI: 10.1016/j.clnesp.2022.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/22/2022] [Accepted: 12/08/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Severe acute malnutrition (SAM) is a public health problem in developing countries including Ethiopia, because of the high risk of death, most severely malnourished children are managed in hospitals. Hence, the aim of this study was to assess the predictors of mortality among severely malnourished children admitted in Gedeo zone hospitals, Southern Ethiopia. METHODS Multicenter institution-based prospective follow-up study was conducted among 568 severely malnourished children with age <5 years in Gedeo zone hospitals from December 2018 to April 2020. Survival analysis with Cox proportional hazard model was conducted to determine factors associated with mortality rate. Variables with a p-value <0.05 in multivariate regression were considered statistically significant. RESULTS From a total of 568 children admitted with SAM; 54(9.5%), 306(53.9%), 179(31.5%) and 29(5.1%) died, recovered, transferred out and defaulted respectively. Over the study period, the rate of mortality was eight per 1000 person-days. Comorbidity after admission (Adjusted hazard ratio (AHR) = 2.96; 95% CI 1.35, 6.47), being HIV reactive (AHR = 1.31; 95% CI 1.12, 1.72), hospital stay for more than one week (AHR = 1.78; 95% CI 1.03, 3.12), no formal education of the mother (AHR 2.25; 95% CI 1.24, 4.08) and Nasogastric (NG) tube (AHR = 1.87; 95% CI: 1.562-2.37) given were the significant predictors of mortality. CONCLUSIONS Maternal/caregiver educational status, co-morbidity after admission, being HIV reactive, vaccination status, hospital stay for more than one week and NG tube given were found as significant determinant factors of mortality rate. Hence, the government of Ethiopia and stakeholders should implement strong interventions focusing on these predictors.
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Affiliation(s)
- Wagaye Alemu
- Department of Epidemiology and Biostatistics, Collage of Medicine and Health Science, Dilla University, Ethiopia
| | - Dirshaye Argaw
- Department of Human Nutrition, Collage of Medicine and Health Science, Dilla University, Ethiopia
| | - Mebrate Adimasu
- Department of Midwifery, Collage of Medicine and Health Science, Dilla University, Ethiopia
| | - Temesgen Muche Ewunie
- Department of Human Nutrition, Collage of Medicine and Health Science, Dilla University, Ethiopia.
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Maisa A, Lawal AM, Islam T, Nwankwo C, Oluyide B, Fotso A, Roggeveen H, van der Kam S, Ariti C, Bil K, Lenglet A. Exploring factors influencing patient mortality and loss to follow-up in two paediatric hospital wards in Zamfara, North-West Nigeria, 2016-2018. PLoS One 2021; 16:e0262073. [PMID: 34972177 PMCID: PMC8719718 DOI: 10.1371/journal.pone.0262073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/16/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Child mortality has been linked to infectious diseases, malnutrition and lack of access to essential health services. We investigated possible predictors for death and patients lost to follow up (LTFU) for paediatric patients at the inpatient department (IPD) and inpatient therapeutic feeding centre (ITFC) of the Anka General Hospital (AGH), Zamfara State, Nigeria, to inform best practices at the hospital. METHODS We conducted a retrospective cohort review study using routinely collected data of all patient admissions to the IPD and ITFC with known hospital exit status between 2016 and 2018. Unadjusted and adjusted rate ratios (aRR) and respective 95% confidence intervals (95% CI) were calculated using Poisson regression to estimate the association between the exposure variables and mortality as well as LTFU. RESULTS The mortality rate in IPD was 22% lower in 2018 compared to 2016 (aRR 0.78; 95% CI 0.66-0.93) and 70% lower for patients coming from lead-affected villages compared to patients from other villages (aRR 0.30; 95% CI 0.19-0.48). The mortality rate for ITFC patients was 41% higher during rainy season (aRR 1.41; 95% CI 1.2-1.6). LTFU rates in ITFC increased in 2017 and 2018 when compared to 2016 (aRR 1.6; 95% CI 1.2-2.0 and aRR 1.4; 95% CI 1.1-1.8) and patients in ITFC had 2.5 times higher LTFU rates when coming from a lead-affected village. CONCLUSIONS Our data contributes clearer understanding of the situation in the paediatric wards in AGH in Nigeria, but identifying specific predictors for the multifaceted nature of mortality and LTFU is challenging. Mortality in paediatric patients in IPD of AGH improved during the study period, which is likely linked to better awareness of the hospital, but still remains high. Access to healthcare due to seasonal restrictions contributes to mortalities due to late presentation. Increased awareness of and easier access to healthcare, such as for patients living in lead-affected villages, which are still benefiting from an MSF lead poisoning intervention, decreases mortalities, but increases LTFU. We recommend targeted case audits and qualitative studies to better understand the role of health-seeking behaviour, and social and traditional factors in the use of formal healthcare in this part of Nigeria and potentially similar settings in other countries.
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Affiliation(s)
- Anna Maisa
- Médecins Sans Frontières (MSF), Sokoto, Nigeria
| | | | | | | | | | | | | | | | - Cono Ariti
- Cardiff University, School of Medicine, Cardiff, United Kingdom
| | - Karla Bil
- MSF, Operational Centre Amsterdam, Amsterdam, Netherlands
| | - Annick Lenglet
- MSF, Operational Centre Amsterdam, Amsterdam, Netherlands
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Zewdu D, Wondwosen M, Chufamo M, Eanga S, Aga A, Ewnte B, Hunie M, Teshome D. The practice of foreign body removal from the ear, nose, and upper esophageal in children in Ethiopia: A retrospective descriptive study. Laryngoscope Investig Otolaryngol 2021; 6:1316-1320. [PMID: 34938868 PMCID: PMC8665465 DOI: 10.1002/lio2.688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/24/2021] [Accepted: 10/18/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Ear, nose, and upper esophageal foreign body (FB) impaction in children is a common emergency in-hospital service. There are no clear guidelines regarding the management of ingested FBs. This study aimed to determine the FB in terms of type, anatomic site, management outcome, and associated complications. METHODS Retrospective study of children with ear, nose, and upper esophageal FB managed under general anesthesia (GA) at operating room of Wolkite Hospital in the southern part of Ethiopia between January 2019 and February 2021. Data were collected from the medical chart of the patients using a prepared checklist. The parameters included were age, sex, FB anatomic site, type, management outcome, and associated complications related to FB or procedure modalities. RESULTS A total of 169 (31.4%) study subjects were required GA for the removal of FBs. The mean age was 4.45 ± 3.20 years. Under 5 years old children comprises 61.5% of total cases. The most common anatomic site of FB impaction was in the ear 97 (57.4%). The most commonly found type of FB was cereals or seeds, which constituted 102 (60.35%). The complication rate was 18.35%. Epistaxis was the commonest complication (6.51%) from the nose while canal abrasion (5.92%) was common from the ear. CONCLUSION Ear, nose, and upper esophageal FBs were found more frequently in younger children. The ear was the most common anatomic site of FB impaction followed by the nose and upper esophageal. The most common type of FB was cereals or seeds. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Dereje Zewdu
- Department of Anesthesia, College of Medicine and Health ScienceWolkite UniversityWolkiteEthiopia
| | - Mekete Wondwosen
- Department of Surgery, College of Medicine and Health ScienceWolkite UniversityWolkiteEthiopia
| | - Mulatu Chufamo
- Department of Surgery, College of Medicine and Health ScienceWolkite UniversityWolkiteEthiopia
| | - Shamill Eanga
- Department of Anesthesia, College of Medicine and Health ScienceWolkite UniversityWolkiteEthiopia
| | - Abdisa Aga
- Department of AnesthesiaHarar College of Health ScienceHararEthiopia
| | - Biniam Ewnte
- Department of Surgery, College of Medicine and Health ScienceDebre Tabor UniversityDebre TaborEthiopia
| | - Metages Hunie
- Department of Anesthesia, College of Health ScienceDebre Tabor UniversityDebre TaborEthiopia
| | - Diriba Teshome
- Department of Anesthesia, College of Health ScienceDebre Tabor UniversityDebre TaborEthiopia
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Angaw DA, Ali R, Tadele A, Shumet S. The prevalence of cardiovascular disease in Ethiopia: a systematic review and meta-analysis of institutional and community-based studies. BMC Cardiovasc Disord 2021; 21:37. [PMID: 33461482 PMCID: PMC7814574 DOI: 10.1186/s12872-020-01828-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background Worldwide cardiovascular disease is the major cause of disability and premature death. This is due to the ascending trend of consuming an unhealthy diet and obesity which increases the risk of hypertension and type 2 diabetes mellitus. Thus this study aimed to determine the pooled prevalence of the cardiovascular disease in Ethiopia.
Methods Medline, Scopus, and Google Scholar search engines were accessed using medical subject heading (MeSH) terms for studies based in Ethiopia, from 2000 to 2018. However, studies done among a specific group of the population were excluded from the study. Data were extracted by one reviewer and then checked independently by a second reviewer. Studies were qualitatively synthesis in terms of design, quality, study population, outcomes, and result. Sub-group analysis and sensitivity tests were conducted to identify potential influences on the prevalence estimates. Quantitative results were pooled in a statistical meta-analysis using STATA version 14 software. Result Nine eligible cross-sectional studies were included in the analysis. The prevalence ranges from 1 to 20%. The pooled prevalence of cardiovascular disease (CVD) was 5% (95% CI: 3–8%). The prevalence was higher in the population who visits hospitals, 8% (95% CI: 4–12%) compared to the general population, 2% (95% CI: 1–5%). There was no significant difference in the overall prevalence of CVD between males and females. Conclusion The prevalence of cardiovascular disease was high. A higher prevalence of CVD was found among patients who visited health institutions than the general population and no observed significant sex difference in the prevalence
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Affiliation(s)
- Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Rahma Ali
- Department of Population and Family Health, Faculty of Public, Jimma University, Jimma, Ethiopia
| | - Afework Tadele
- Department of Population and Family Health, Faculty of Public, Jimma University, Jimma, Ethiopia
| | - Shegaye Shumet
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Getawa S, Getaneh Z, Melku M. Hematological Abnormalities and Associated Factors Among Undernourished Under-Five Children Attending University of Gondar Specialized Referral Hospital, Northwest Ethiopia. J Blood Med 2020; 11:465-478. [PMID: 33376434 PMCID: PMC7755328 DOI: 10.2147/jbm.s284572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The hematopoietic system is one of the systems which can be affected by malnutrition, leading to impaired production of all blood cell lines. Undernourished children with hematological abnormalities like anemia are at higher risk of mortality. Therefore, this study aimed at determining the magnitude and associated factors of hematological abnormalities among undernourished under-five children attending at the University of Gondar Specialized Referral Hospital, Northwest Ethiopia. Methods and Materials An institution-based cross-sectional study was conducted on a total of 251 undernourished under-five children at University of Gondar Specialized Referral Hospital from January to May 2020. A convenient sampling technique was employed to select study participants. Data were collected using a pretested structured questionnaire. Blood samples were collected for complete blood count which were determined by Sysmex KX-21N analyzer. Stool sample was processed via direct wet mount. Thin and thick blood films were examined to assess malaria parasite. The data were entered to EpiData version 4.6.0.0 and analyzed using SPSS version 23 software. Bi-variable and multi-variable binary logistic regression model were fitted to identify factors associated with hematological abnormalities. A p-value <0.05 in the multivariable analysis was considered as statistically significant. Results The overall magnitude of anemia, leukocytosis, thrombocytosis, thrombocytopenia, and leukopenia was 53.4%, 26.7%, 23.9%, 8%, and 2.8%, respectively. Being male, age 6-23 months, high birth order, intestinal parasite infection, edema, not eating vegetables and fruits, and paternal occupation were found to be associated with anemia. Only the age of a child was associated with leukocytosis in undernourished children. Conclusion The current study demonstrated the predominant existence of anemia, leukocytosis, and thrombocytosis among undernourished under-five children. Therefore, early diagnosis, monitoring and setting intervention strategies for anemia especially among children under two years old are required to prevent further complication.
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Affiliation(s)
- Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Zegeye Getaneh
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Science, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Zar HJ, Dawa J, Fischer GB, Castro-Rodriguez JA. Challenges of COVID-19 in children in low- and middle-income countries. Paediatr Respir Rev 2020; 35:70-74. [PMID: 32654854 PMCID: PMC7316049 DOI: 10.1016/j.prrv.2020.06.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 12/31/2022]
Abstract
As the coronavirus pandemic extends to low and middle income countries (LMICs), there are growing concerns about the risk of coronavirus disease (COVID-19) in populations with high prevalence of comorbidities, the impact on health and economies more broadly and the capacity of existing health systems to manage the additional burden of COVID-19. The direct effects of COVID are less of a concern in children, who seem to be largely asymptomatic or to develop mild illness as occurs in high income countries; however children in LMICs constitute a high proportion of the population and may have a high prevalence of risk factors for severe lower respiratory infection such as HIV or malnutrition. Further diversion of resources from child health to address the pandemic among adults may further impact on care for children. Poor living conditions in LMICs including lack of sanitation, running water and overcrowding may facilitate transmission of SARS-CoV-2. The indirect effects of the pandemic on child health are of considerable concern, including increasing poverty levels, disrupted schooling, lack of access to school feeding schemes, reduced access to health facilities and interruptions in vaccination and other child health programs. Further challenges in LMICs include the inability to implement effective public health measures such as social distancing, hand hygiene, timely identification of infected people with self-isolation and universal use of masks. Lack of adequate personal protective equipment, especially N95 masks is a key concern for health care worker protection. While continued schooling is crucial for children in LMICs, provision of safe environments is especially challenging in overcrowded resource constrained schools. The current crisis is a harsh reminder of the global inequity in health in LMICs. The pandemic highlights key challenges to the provision of health in LMICs, but also provides opportunities to strengthen child health broadly in such settings.
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Affiliation(s)
- Heather J. Zar
- Department of Paediatrics and Child Health, SA MRC Unit on Child and Adolescent Health, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa,Corresponding author
| | - Jeanette Dawa
- College of Health Sciences, University of Nairobi, Nairobi, Kenya,Washington State University – Global Health Program, Nairobi, Kenya
| | - Gilberto Bueno Fischer
- Universidade Federal de Ciências da Saúde de Porto Alegre School of Medicine, Porto Alegre, Brazil,Pneumology Department Hospital da Criança Santo Antonio Porto Alegre, Porto Alegre, Brazil
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, Division of Pediatrics, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Bitew ZW, Alebel A, Worku T, Alemu A. Recovery rate and its predictors among children with severe acute malnutrition in Addis Ababa, Ethiopia: A retrospective cohort study. PLoS One 2020; 15:e0235259. [PMID: 32701985 PMCID: PMC7377431 DOI: 10.1371/journal.pone.0235259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Malnutrition is a public health problem in under-five children in several parts of the world even after decades of the implementation of management protocols. An estimated 17 million children under the age of five years are living with severe acute malnutrition and the majorities are found in Asia and Africa, including Ethiopia. OBJECTIVE The main objective of this study was to determine the recovery rate and its predictors among under-five children who were admitted to St. Paul's Hospital Millennium Medical College from 2012 to 2019. METHODS An institution based retrospective cohort study was employed at St. Paul's Hospital Millennium Medical College from May 20, 2019 to June 28, 2019. Data were collected by reviewing children's' medical records using a structured checklist. A total of 534 charts were selected using a simple random sampling method and 515 of them were used for the final analysis. Ep-info version 7 software was used for data entry and STATA Version 15 for analysis. The Kaplan Meier failure estimate with Log-rank test was used to determine the survival estimates. Bi-variable and multivariable Cox proportional hazards regression model were fitted to identify predictors of mortality. Finally, variables with p-values less than 0.05 in the multivariable Cox regression were considered as independent predictors. The proportional hazards assumption was checked using the Schoenfeld residuals test and the final model fitness was checked using the Cox-Snail residual test. RESULT In this study, a total of 515 subjects were followed for 8672 child-days and 79% of the subjects recovered from SAM with the median time of 17 days. The incidence density rate of recovery was 46 per 1000 child-days. Tuberculosis (AHR(Adjusted Hazard Ratio) 0.44 & 95% CI: 0.32, 0.62), pale conjunctiva (AHR,0.67 & 95% CI: 0.52, 0.88), IV fluid infusion (AHR, 0.71 & 95 CI: 0.51, 0.98), feeding F100 (AHR, 1.63 & 95% CI:1.04,2.54), Vitamin A supplementation (AHR, 1.3 & 95% CI:1.07, 1.59) and bottle feeding (AHR, 0.79 & 95CI%: 0.64-0.98) were the independent predictors of time to recovery from SAM. CONCLUSION In conclusion, the recovery rate was relatively higher than the Sphere standard and the national SAM management protocol. Co-morbidities and the treatments given were the main determinants of recovery of children. Co-morbidities must be managed as early as possible and the treatments given during the SAM management process need to be given with precaution.
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Affiliation(s)
- Zebenay Workneh Bitew
- Department of Pediatric Nursing, School of Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- * E-mail:
| | - Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Teshager Worku
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ayinalem Alemu
- Department of Medical Microbiology, Ethipian Public Health Institute, Addis Ababa, Ethiopia
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The morbidity burden from emergency conditions in Jimma city, Southwest Ethiopia. Int Emerg Nurs 2020; 55:100874. [PMID: 32475801 DOI: 10.1016/j.ienj.2020.100874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/21/2020] [Accepted: 04/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sub-Saharan Africa shares a disproportionately large ratio of the global acute disease burden, however epidemiological data specific to the burden of emergency conditions are lacking. This study aimed to determine the morbidity burden of emergency conditions in Jimma city, Southwest Ethiopia. METHODS A cross-sectional study was conducted using emergency case registries of three years from 2014 to 2017, at Jimma Medical Center and Shenen Gibe Hospital. 39,537 emergency visits were included in the study. The data were exported to SPSS V.23.0 for statistical analysis, descriptive analysis was used to summarize demographic characteristics, causes of visit, and morbidity rates. Findings were integrated with population-based health demographic reports quantifying the morbidity burden. Outcome measures were overall number of emergency visits and morbidity rates for the population groups. RESULTS From a total of 39,537 visits, those between 15 and 29 years of age accounted for 42.1% (n = 16615), and 50.6% (n = 20004) were females. Communicable, Maternal, Neonatal and Nutritional (CMNNs) conditions accounted for 57.2%(n = 22597), followed by injuries (22.9%, n = 9055). Top five conditions were non-specific trauma (2.3%, n = 4861), complicated labor (8.4%, n = 3320), lower respiratory infections (8.1%, n = 3213), acute febrile illness (6.6%, n = 2600), and neonatal infections (3.7%, n = 1444). CONCLUSION The burden of acute conditions presented to public hospitals in Jimma city is high. Traumatic injuries, obstetric emergencies, lower respiratory infections, and neonatal emergencies were the most frequent causes of acute visits. An appropriate emergency care system that addresses this high burden of acute emergencies should be established in the study area.
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Lai J, Nguyen C, Tabwaia B, Nikuata A, Baueri N, Timeon E, Diaaldeen M, Iuta T, Ozturk MH, Moore A, Hall A, Nyambat B, Davis S, Rahman A, Erasmus W, Fox K, Russell F. Temporal decline in diarrhea episodes and mortality in Kiribati children two years following rotavirus vaccine introduction, despite high malnutrition rates: a retrospective review. BMC Infect Dis 2020; 20:207. [PMID: 32164562 PMCID: PMC7069014 DOI: 10.1186/s12879-020-4874-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 02/11/2020] [Indexed: 11/24/2022] Open
Abstract
Background Kiribati introduced rotavirus vaccine in 2015. To estimate the impact of rotavirus vaccine on acute gastroenteritis (AGE) and severe acute malnutrition (SAM) among children under 5 in Kiribati, a retrospective review of inpatient and outpatient AGE and hospitalized SAM was undertaken. Methods Inpatient data for admissions and hospital deaths due to AGE, SAM and all-causes were collected for children under 5 from all hospitals on the main island, Tarawa, from January 2010–December 2013 (pre-rotavirus vaccine) and January 2016–September 2017 (post-rotavirus vaccine). National outpatient diarrhea data were collected from January 2010 to August 2017 for under 5. An interrupted time-series analysis was undertaken to estimate the effect of rotavirus vaccine on the rates of inpatient and outpatient AGE, inpatient SAM; and inpatient case fatality rates for AGE and SAM, were calculated pre- and post-rotavirus vaccine introduction. Results The incidence rate of AGE admissions from Tarawa and national AGE outpatient presentations significantly declined by 37 and 44%, respectively, 2 years following rotavirus vaccine introduction. There was a significant decline in the percentage of AGE contributing to all-cause under 5 admissions (12·8% vs. 7·2%, p < 0·001) and all-cause under-five mortality (15·9% vs. 5·7%, p = 0·006) pre- and post-rotavirus vaccine introduction. The estimated incidence rate of inpatient SAM decreased by 24% in under 5 s, 2 years following rotavirus vaccine introduction. Conclusions AGE morbidity and mortality and hospitalized SAM rates have declined following rotavirus vaccine introduction in Kiribati children.
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Affiliation(s)
- Jana Lai
- Murdoch Children's Research Institute, Melbourne, Australia. .,Australian National University, Canberra, Australia.
| | - Cattram Nguyen
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Beia Tabwaia
- Ministry of Health and Medical Services, Tarawa, Kiribati
| | | | | | - Eretii Timeon
- Ministry of Health and Medical Services, Tarawa, Kiribati
| | | | | | | | | | | | - Batmunkh Nyambat
- WHO Regional Office for the Western Pacific, Manila, Philippines
| | | | | | | | - Kimberley Fox
- WHO Regional Office for the Western Pacific, Manila, Philippines.,Center for Disease Control and Prevention, Atlanta, USA
| | - Fiona Russell
- Murdoch Children's Research Institute, Melbourne, Australia.,Centre for International Child Health, Dept. of Paediatrics, The University of Melbourne, Melbourne, Australia
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10
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Time to Recovery from Severe Acute Malnutrition and Its Predictors among Admitted Children Aged 6-59 Months at the Therapeutic Feeding Center of Pawi General Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study. Int J Pediatr 2020; 2020:8406597. [PMID: 32231706 PMCID: PMC7086446 DOI: 10.1155/2020/8406597] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/01/2020] [Accepted: 02/01/2020] [Indexed: 12/22/2022] Open
Abstract
Background Ethiopia is one of the countries in sub-Saharan Africa with the highest rates of severe acute malnutrition. Early recovery is a performance indicator for severe acute malnourished children for the therapeutic feeding. Despite the available interventions to tackle nutritional problems, there is scarce information on time to recovery and its determinants among children with SAM in Ethiopia. Objective The study is aimed at assessing time to recovery from severe acute malnutrition and its predictors among admitted children aged 6-59 months at the therapeutic feeding center of Pawi General Hospital, northwest Ethiopia, from January 2013 to December 2017. Methods An institution-based retrospective follow-up study was conducted among 398 children aged 6-59 months. The data were collected by using data extraction sheet. The data were cleaned and entered using EpiData version 4.2.0.0 and exported to Stata version 14 statistical software for further analysis. Kaplan-Meier survival curve was used to estimate median nutritional recovery time after initiation of inpatient treatment, and log-rank test was used to compare time to recovery between groups. The Cox proportional regression model was used to identify the predictors of recovery time. Adjusted hazard rate with its 95% CI was reported to show strength of relationship. Results The recovery rate was 5.3 per 100 person-day observations, and the median recovery time was 14 days (95% CI: 13-15). The lower chance of early recovery was found among children who were not fully vaccinated (AHR: 0.73 (95% CI: 0.56, 0.96)), while high chance of recovery was found among children who had no anemia (AHR: 1.66 (95% CI: 1.23, 2.23)), TB (AHR: 2.03 (95% CI: 1.11, 3.71)), and malaria infection (AHR: 1.54 (95% CI: 1.09, 2.17)) at admission. Conclusion and Recommendation. The overall nutritional recovery rate was below the accepted minimum standard. Children not fully vaccinated and children without malaria, anemia, and TB comorbidities at admission had a higher chance of recovering early from severe acute malnutrition. Hence, treating comorbidities is vital for prompt nutritional recovery.
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11
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Ebrahim AJ, Naik F, Teni FS. Costs incurred by caregivers of under-five inpatients with community-acquired pneumonia at a university hospital in south-western Ethiopia. S Afr J Infect Dis 2019; 34:109. [PMID: 34485450 PMCID: PMC8377825 DOI: 10.4102/sajid.v34i1.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/11/2019] [Indexed: 11/01/2022] Open
Abstract
Background Pneumonia is one of the commonest diseases among children in Ethiopia resulting in deaths and hospitalisations. The objective of the current study was to determine the cost incurred by caregivers of under-five children with community-acquired pneumonia admitted to the paediatric ward of Jimma University Specialized Hospital, south-western Ethiopia. Methods An institution-based cross-sectional study was conducted from 01 January to 28 February 2017, through interviews with caregivers. Data on costs incurred before hospital visit, direct medical and non-medical costs, and indirect costs incurred by caregivers of the children were collected. The collected data were analysed using Statistical Package for Social Sciences version 23. Results Among the 120 caregivers in the study, a median total cost of 304.5 Ethiopian birr (13.22 USD) was reported. This was mostly contributed by indirect costs associated with earnings lost by caregivers related to travel and stay at hospital with the children. Factors, including permanent residence, family size, hospital stay, wealth index, education and major occupation, were found to have statistically significant association with the level of cost incurred by caregivers. Conclusion This study identified that a significant level of cost is incurred by caregivers of the children in the hospital, a majority of which was contributed by the lost earnings because of the time spent at the hospital with the children.
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Affiliation(s)
- Awol J Ebrahim
- Department of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Feki Naik
- Department of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Fitsum S Teni
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Amare AT, Kebede ZT, Welch HD. Epidemiology of bacterial meningitis in children admitted to Gondar University Hospital in the post pneumococcal vaccine era. Pan Afr Med J 2019; 31:193. [PMID: 31086637 PMCID: PMC6488968 DOI: 10.11604/pamj.2018.31.193.10254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/12/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Community acquired bacterial meningitis (CABM) is responsible for high mortality and disabling sequelae. Introduction of pneumococcal conjugate vaccine (PCV-10) and haemophilus influenzeatype b (Hib) has changed the epidemiological and clinical features of patients presenting with CABM as it is shown in different literatures over the last decade. The aim of this study was to assess the clinical and epidemiologic features and outcomes of CABM after the introduction of PCV-10 in Gondar University Hospital (GUH). METHODS This is a retrospective study among children between 2 months and 14 years of age discharged from Gondar University Hospital. All patient records discharged with a diagnosis of meningitis at GUH were reviewed from September 2011 - September 2013. The data was collected using a structured questionnaire from the patient record charts and analysis was done using SPSS-20. RESULTS 80 cases (1.6%) of CABM out of 4996 admissions were identified. There were 60 (75%) cases of CABM using WHO criteria of cerebrospinal fluid leukocytosis (CSF) > 100cells/mm3, or 10-100cells/mm3 with either hypoglycorrhea or increased protein; and 20 (25%) with culture confirmation. S. Pneumoniae was the most frequent pathogen identified in 14 (70%) children. The most common age group were infants 2-12 month old (n = 32, 40%). Children with adverse outcomes had shown a higher frequency of being older children (p = 0.045), loss of consciousness (p = 0.046), seizure at admission (p < 0.01), and a positive CSF culture (p = 0.03). CONCLUSION Introduction of PCV-10 has shown a decreased admission rate, mortality, and neurologic sequelae due to CABM.
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Affiliation(s)
- Ashenafi Tazebew Amare
- Department of Paediatrics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Zemene Tigabu Kebede
- Department of Paediatrics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Wagnew F, Worku W, Dejenu G, Alebel A, Eshetie S. An overview of the case fatality of inpatient severe acute malnutrition in Ethiopia and its association with human immunodeficiency virus/tuberculosis comorbidity-a systematic review and meta-analysis. Int Health 2019; 10:405-411. [PMID: 29986102 DOI: 10.1093/inthealth/ihy043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Mortality of children with severe acute malnutrition (SAM) is a devastating problem in Ethiopia. This study estimated the pooled case fatality ratio of SAM among children <5 y of age and its association with comorbidity. Methods An electronic search was carried out using the database of MEDLINE/PubMed through the HINARI Programme, Google Scholar and Google for grey literature. A random effects model was used to estimate the pooled case fatality ratio of SAM and the hazard ratio (HR) of human immunodeficiency virus (HIV)/tuberculosis (TB) comorbidity using Stata/SE version 14. Results A total of 13 studies were included in the meta-analysis. The overall case fatality ratio of SAM among children <5 y of age in Ethiopia was 11.3% (95% confidence interval [CI] 8.8-13.7) with the I2 heterogeneity test (I2=89.5%). Furthermore, the HR of SAM children was 3.4 (95% CI 1.91-6.06) in HIV and 2.08 (95% CI 1.2-3.61) in TB comorbidity as compared with their counterparts without comorbidity. Conclusions In the aggregate, the pooled case fatality ratio was unacceptably high in Ethiopia. The case fatality ratio of SAM children is higher in HIV and TB comorbidity. Therefore, escalation of the existing nutritional strategies and early case detection of comorbidity are strongly recommended to mitigate the case fatality ratio of SAM.
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Affiliation(s)
- Fasil Wagnew
- Department of Nursing, College of Medicine and Health Sciences, DebreMarkos University, Debre Markos, Ethiopia
| | - Wubet Worku
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getiye Dejenu
- Department of Public Health College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Animut Alebel
- Department of Nursing, College of Medicine and Health Sciences, DebreMarkos University, Debre Markos, Ethiopia
| | - Setegn Eshetie
- College of Health Science, University of Gondar, Gondar, Ethiopia
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Doocy S, Ververs MT, Spiegel P, Beyrer C. The food security and nutrition crisis in Venezuela. Soc Sci Med 2019; 226:63-68. [PMID: 30849671 DOI: 10.1016/j.socscimed.2019.02.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
As Venezuela's economic and political crises continues to evolve, hyperinflation, declining food production and food shortages are contributing to the deterioration of the food and nutrition situation. While official data is largely unavailable, food security and nutrition data from a variety of sources suggest that nearly the entire population is food insecure and that prevalence of acute malnutrition among children is reaching crisis levels in vulnerable populations. In the most recent national survey, 80% of households were food insecure and most households receiving government food assistance reported only occasional receipt. Prevalence of acute malnutrition among children under five increased in vulnerable communities across many states, surpassing serious or critical thresholds in multiple states. Hospitals across the country are reporting increases in both the number and proportion of pediatric consultations and admissions with acute malnutrition, and malnutrition deaths are increasingly common. Declining food security, increases in prevalence of acute malnutrition among children in vulnerable communities, rising pediatric hospital admissions with acute malnutrition and clinician reports of child deaths due to acute malnutrition are indicative of a crisis. The response to the nutrition and food security crisis to date has been limited. There is an urgent need to begin taking steps to address widespread food insecurity and to support treatment for children with acute malnutrition.
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Affiliation(s)
- Shannon Doocy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Guesh G, Degu G, Abay M, Beyene B, Brhane E, Brhane K. Survival status and predictors of mortality among children with severe acute malnutrition admitted to general hospitals of Tigray, North Ethiopia: a retrospective cohort study. BMC Res Notes 2018; 11:832. [PMID: 30477540 PMCID: PMC6257969 DOI: 10.1186/s13104-018-3937-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Despite the presence standard protocol for management of severe acute malnutrition case-fatality rates in African hospitals remain unacceptably high. The case in Ethiopia is not different from others. Therefore, this study was aimed to assess survival status and predictors of mortality among children with severe acute malnutrition admitted to stabilization centers of general hospitals in Tigray region, northern Ethiopia. A 24 months retrospective longitudinal study was conducted among 569 randomly selected medical records of children admitted to stabilizing centers. Both bi-variable and multivariable Cox regression analysis was conducted to identify predictors of mortality. Association was summarized using AHR, and statistical significances were declared at 95% CI and P-value < 0.05. Results During follow up, 456 [82%] of children had got cured, 37 [6.65%] were absconded and 21 [3.8%] were died. The overall mean survival time was 41.93 [95% CI 40.17–43.68] days. Impaired conscious level [AHR = 6.69, 95% CI 2.43–19.93], development of comorbidity after admission [AHR 12.71, 95% CI 2.79–57.94] and being urban in residence [AHR = 2.73, 95% CI 1.12–6.64] were predictors of mortality. Therefore, interventions to reduce further mortality should focus in children having impaired consciousness level and who developed comorbidity after admission. Electronic supplementary material The online version of this article (10.1186/s13104-018-3937-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Getu Degu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Mebrahtu Abay
- School of Public Health, College of Health Science, Aksum University, P.O. Box: 298, Aksum, Ethiopia
| | - Berhe Beyene
- School of Public Health, College of Health Science, Aksum University, P.O. Box: 298, Aksum, Ethiopia
| | - Ermyas Brhane
- School of Public Health, College of Health Science, Aksum University, P.O. Box: 298, Aksum, Ethiopia.
| | - Kalayu Brhane
- Department Public Health, College of Health Science, Debre Berhan University, P.O. Box: 445, Debre Berhan, Ethiopia
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Jofiro G, Jemal K, Beza L, Bacha Heye T. Prevalence and associated factors of pediatric emergency mortality at Tikur Anbessa specialized tertiary hospital: a 5 year retrospective case review study. BMC Pediatr 2018; 18:316. [PMID: 30285667 PMCID: PMC6167843 DOI: 10.1186/s12887-018-1287-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 09/17/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Childhood mortality remains high in resource-limited third world countries. Most childhood deaths in hospital often occur within the first 24 h of admission. Many of these deaths are from preventable causes. This study aims to describe the patterns of mortality in children presenting to the pediatric emergency department. METHODS This was a five-year chart review of deaths in pediatric patients aged 7 days to 13 years presenting to the Tikur Anbessa Specialized Tertiary Hospital (TASTH) from January 2012 to December 2016. Data were collected using a pretested, structured checklist, and analyzed using the SPSS Version 20. Multivariate analysis by logistic regression was carried out to estimate any measures of association between variables of interest and the primary outcome of death. RESULTS The proportion of pediatric emergency department (PED) deaths was 4.1% (499 patients) out of 12,240 PED presentations. This translates to a mortality rate of 8.2 deaths per 1000 patients per year. The three top causes of deaths were pneumonia, congestive heart failure (CHF) and sepsis. Thirty two percent of the deaths occurred within 24 h of presentation with 6.5% of the deaths being neonates and the most common co-morbid illness was malnutrition (41.1%). Multivariate analysis revealed that shortness of breath [AOR=2.45, 95% CI (1.22-4.91)], late onset of signs and symptoms [AOR=3.22, 95% CI (1.34-7.73)], fever [AOR=3.17, 95% CI (1.28-7.86)], and diarrhea [AOR=3.36, 95% CI (1.69-6.67)] had significant association with early mortality. CONCLUSION The incidence of pediatric emergency mortality was high in our study. A delay in presentation of more than 48 hours, diarrheal diseases and shortness of breath were significantly associated with early pediatric mortality. Early identification and intervention are required to reduce pediatric emergency mortality.
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Affiliation(s)
- Gemechu Jofiro
- Addis Ababa Regional Health Bureau Department of Emergency, Box 245, Addis Ababa, PO Ethiopia
| | - Kemal Jemal
- Department of Nursing, Salale University College of Health Sciences, Fitche, Ethiopia
| | - Lemlem Beza
- Department of Emergency Medicine, Addis Ababa University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
| | - Tigist Bacha Heye
- Department of Pediatric and Child Health, Division of Emergency Medicine and Critical Care, Addis Ababa University College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
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Wagnew F, Tesgera D, Mekonnen M, Abajobir AA. Predictors of mortality among under-five children with severe acute malnutrition, Northwest Ethiopia: an institution based retrospective cohort study. Arch Public Health 2018; 76:64. [PMID: 30275951 PMCID: PMC6158814 DOI: 10.1186/s13690-018-0309-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 08/28/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, approximately 19 million children under 5 years are suffering from Severe Acute Malnutrition (SAM). It is a major cause of morbidity and mortality in low-income countries including Ethiopia. However, little is known regarding predictors of mortality among these children in Ethiopia. The current study aimed to assess the potential predictors of mortality among under-five children with SAM admitted to a stabilization center. METHOD A retrospective cohort study was conducted in 527 under-five children who were admitted for SAM at the University of Gondar comprehensive specialized hospital from 2014 to 2016. Data were collected from a randomly selected chart after getting ethical clearance. Data were cleaned, coded and entered to Epi-info (version 7) and analyzed using STATA (version14). The outcome was computed by using tables and graphs. A multivariable cox proportional hazards model was fitted to identify predictors of mortality. RESULT Overall, the median follow-up period was 10 days with interquartile range (Q1, Q3: 8, 17). At the end of the follow-up, the mortality rate was 66(12.52%). Anemia (AHR(Adjusted Hazard Ratio): 2.3, 95% CI: 1.2, 4.5), Shock (AHR: 7.9, 95% CI: 3.7, 16.7), no intake of antibiotics (AHR: 2.3 95% CI: 1.2, 4.4), IV-Fluid (AHR: 3.2, 95% CI: 1.7, 5.8), no intake of F75 (AHR: 6.6,95% CI: 2.9, 14.7) and no intake of F100 (AHR: 3, 95% CI: 1.6, 5.4) were independent predictors of mortality. CONCLUSION The survival status of under-five children with SAM was lower than the national standard protocol. Altered general conditions such as shock, anemia, not adhering to medical and nutritional therapies were identified as predictors of mortality among SAM children. Health education on early medical seeking behavior and adherence on the routine regimens may improve this gap in child survival.
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Affiliation(s)
- Fasil Wagnew
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Daftary RK, Murray BL, Reynolds TA. Development of a simple, practice-based tool to assess quality of paediatric emergency care delivery in resource-limited settings: identifying critical actions via a Delphi study. BMJ Open 2018; 8:e021123. [PMID: 30093514 PMCID: PMC6089303 DOI: 10.1136/bmjopen-2017-021123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Provision of timely, high-quality care for the initial management of critically ill children in African hospitals remains a challenge. Monitoring the completion of critical actions during resuscitations can inform efforts to reduce variability and improve outcomes. We sought to develop a practice-based tool based on contextually relevant actions identified via a Delphi process. Our goal was to develop a tool that could identify gaps in care, facilitate identification of training and standardised assessment to support quality improvement efforts. DESIGN Six sentinel conditions were selected based on disease epidemiology and mortality at rural and urban African emergency departments. Potential critical actions were identified through focused literature review. These actions were evaluated within a three-round modified Delphi process. A set of logistical filters was applied to the candidate list to derive a practice-based tool. SETTING AND PARTICIPANTS Attendees at an international emergency medicine conference comprised an expert panel of 25 participants, with 84% working primarily in African settings. Consensus rounds allowing novel responses were conducted via online and in-person surveys. RESULTS The expert panel generated 199 actions that apply to six conditions in emergently ill children. Application of appropriateness criteria refined this to 92 candidate actions across the following seven categories: core skills, active seizure, altered mental status, diarrhoeal illness, febrile illness, respiratory distress and polytrauma. From these, we identified 28 actions for inclusion in a practice-based tool contextually relevant to the initial management of critically ill children in Africa. CONCLUSIONS A group consensus process identified critical actions for severely ill children with select sentinel conditions in emergency paediatric care in an African setting. Absence of these actions during resuscitation might reflect modifiable gaps in quality of care. The resulting practice-based tool is context relevant and can serve as a foundation for training and quality improvement efforts in African hospitals and emergency departments.
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Affiliation(s)
- Rajesh Kirit Daftary
- Department of Emergency Medicine, University of California, San Francisco, California, USA
| | - Brittany Lee Murray
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Teri Ann Reynolds
- Department of Emergency Medicine, University of California, San Francisco, California, USA
- Emergency and Trauma Care Program, World Health Organization, Geneva, Switzerland
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Girum T, Kote M, Tariku B, Bekele H. Survival status and predictors of mortality among severely acute malnourished children <5 years of age admitted to stabilization centers in Gedeo Zone: a retrospective cohort study. Ther Clin Risk Manag 2017; 13:101-110. [PMID: 28176953 PMCID: PMC5271381 DOI: 10.2147/tcrm.s119826] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite the existence of standard protocol, many stabilization centers (SCs) continue to experience high mortality of children receiving treatment for severe acute malnutrition. Assessing treatment outcomes and identifying predictors may help to overcome this problem. Therefore, a 30-month retrospective cohort study was conducted among 545 randomly selected medical records of children <5 years of age admitted to SCs in Gedeo Zone. Data was entered by Epi Info version 7 and analyzed by STATA version 11. Cox proportional hazards model was built by forward stepwise procedure and compared by the likelihood ratio test and Harrell's concordance, and fitness was checked by Cox-Snell residual plot. During follow-up, 51 (9.3%) children had died, and 414 (76%) and 26 (4.8%) children had recovered and defaulted (missed follow-up for 2 consecutive days), respectively. The survival rates at the end of the first, second and third weeks were 95.3%, 90% and 85%, respectively, and the overall mean survival time was 79.6 days. Age <24 months (adjusted hazard ratio [AHR] =2.841, 95% confidence interval [CI] =1.101-7.329), altered pulse rate (AHR =3.926, 95% CI =1.579-9.763), altered temperature (AHR =7.173, 95% CI =3.05-16.867), shock (AHR =3.805, 95% CI =1.829-7.919), anemia (AHR =2.618, 95% CI =1.148-5.97), nasogastric tube feeding (AHR =3.181, 95% CI =1.18-8.575), hypoglycemia (AHR =2.74, 95% CI =1.279-5.87) and treatment at hospital stabilization center (AHR =4.772, 95% CI =1.638-13.9) were independent predictors of mortality. The treatment outcomes and incidence of death were in the acceptable ranges of national and international standards. Intervention to further reduce deaths has to focus on young children with comorbidities and altered general conditions.
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Affiliation(s)
- Tadele Girum
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite
| | - Mesfin Kote
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch
| | - Befikadu Tariku
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch
| | - Henok Bekele
- Department of Planning, Adare Hospital, Southern Region Health Bureau, Hawassa, Ethiopia
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Demographic and mortality analysis of hospitalized children at a referral hospital in Addis Ababa, Ethiopia. BMC Pediatr 2016; 16:168. [PMID: 27765020 PMCID: PMC5073447 DOI: 10.1186/s12887-016-0709-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/13/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Global childhood mortality rates remain high. Millennium Development Goal 4 focused efforts on reducing rates by two-thirds between 1990 and 2015. In Ethiopia, child mortality rates dropped 71 % from 1990 to 2015, however it is estimated that 184,000 Ethiopian children die each year. There is limited information about pediatric hospital admissions in Ethiopia. Our aims were to examine the temporal relationship of mortality to admission, describe the demographics, and identify cause mortality of children admitted to the Zewditu Memorial Hospital (ZMH). METHODS A four-year retrospective review of pediatric admissions was conducted at the pediatric emergency room and pediatric hospital ward at ZMH in Addis Ababa, Ethiopia. Admission entries from 2011-2014 of children age 29 days-14 years were reviewed. Age, gender, admission date, disease classification, discharge status and date were obtained. Patient gender was compared using Chi-square analysis. A descriptive analysis was used for age and cause mortality. RESULTS A total of 6866 patient entries were reviewed. The proportion of admissions younger than age 5 was 0.747 (95 % CI 0.736-0.757). Overall mortality was 0.042 (95 % CI, 0.037-0.047). The proportion of recorded deaths occurring within 2 days of admission was 0.437 (95 % CI 0.380-0.494). The proportion of male admissions was significantly higher than female admissions in all age groups (male 0.575, p < 0.0001, 95 % CI 0.562-0.586). The main causes of mortality were pneumonia (0.253, 95 % CI, 0.203-0.303), severe acute malnutrition (0.222, 95 % CI 0.174-0.27), HIV/AIDS-related complications (0.056, 95 % CI 0.029-0.083), spina bifida (0.049, 95 % CI 0.024-0.074), and hydrocephalus (0.045, 95 % CI 0.021-0.069). CONCLUSIONS Our study revealed a lower mortality rate than previously reported in Ethiopia. Despite this, 44 % of pediatric hospital mortality occurred early during hospitalization, higher than reported at other Ethiopian hospitals. This adds further evidence that systematic efforts should be dedicated to improve pediatric emergency care. Admissions included 58 % male patients, similar to other reports in Ethiopia implying that this may be a nation-wide phenomenon. The observed disparity may be due to societal factors regarding care-seeking behaviors or male predilection for respiratory illness warranting further investigation. Cause mortality patterns were similar to reports in analogous settings.
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Bekele A, Janakiraman B. Physical therapy guideline for children with malnutrition in low income countries: clinical commentary. J Exerc Rehabil 2016; 12:266-75. [PMID: 27656622 PMCID: PMC5031388 DOI: 10.12965/jer.1632674.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 07/14/2016] [Indexed: 11/22/2022] Open
Abstract
Physical therapy intervention along with nutritional rehabilitation has recently become an inevitable combo after recent evidences suggesting a strong interaction between malnutrition and neuro-muscular disabilities which contribute to a significant burden in global settings. Recent studies confirm that appropriate physical assessment of neuro-musculo skeletal system, developmental assessment or cognitive tools along with nutritional assessments followed by exercise rehabilitation will yield positive results in children with malnutrition. There is an obvious need to make available a simple physical therapy exercise guidelines with simple measure and exercise to be used in resource limited settings of developing countries. The purpose of this clinical commentary is to summarize simple assessment tools to evaluate activity impairment, participation restriction, gross motor activity and simple physical therapy intervention program for children with disability secondary to malnutrition.
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Affiliation(s)
- Abey Bekele
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Balamurugan Janakiraman
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Nosek CA, Buck WC, Caviness AC, Foust A, Nyondo Y, Bottomani M, Kazembe PN. Hospital admissions from a pediatric HIV care and treatment program in Malawi. BMC Pediatr 2016; 16:22. [PMID: 26830336 PMCID: PMC4736238 DOI: 10.1186/s12887-016-0556-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background The scale up of pediatric antiretroviral treatment programs across Sub-Saharan Africa over the last decade has brought increasing numbers of children into HIV care. This patient population requiring life-long care presents new challenges in the outpatient and inpatient settings. We sought to describe hospitalizations from a large pediatric HIV treatment facility to better understand the scope of the situation and identify areas for improved care delivery. Methods We conducted a retrospective case series of all HIV-infected and exposed patients <18 years enrolled at Baylor College of Medicine Children’s Foundation Malawi, from October 2004-October 2010. Patients admitted to the hospital on or after the day of enrollment were included. Data were extracted from electronic clinic records. Analysis was done at the patient and admission level, as some patients had multiple admissions. Results Of 5062 patients enrolled in care, 877 (17.3 %) had 1137 admissions at median age 24 months (IQR: 12–62). 191 (21.8 %) patients had multiple admissions. A high proportion of admissions occurred in patients under two years (49.4 %), those within one month of clinic enrollment (32.9 %), those with severe immune suppression (44.0 %), and those not on ART (48.5 %). The frequency of primary admission diagnoses varied across these same variables, with malnutrition, pneumonia, and malaria being the most common. Conclusions Illness requiring hospitalization is common in HIV-infected and exposed children and these results reinforce the need for a comprehensive care package with special attention to nutrition. Strengthened programs for malaria prevention and expanded access to pneumococcal vaccine are also needed. The high burden of admissions in children under 24 months and those newly enrolled in care suggests a need for continued improvement of early infant diagnosis and provider-initiated testing programs to link patients to care before they are symptomatic. Similarly, the high proportion of admissions in those not yet started on ART emphasizes the importance of rapid initiation of ART for eligible pediatric patients.
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Affiliation(s)
- Carl A Nosek
- Baylor Children's Foundation Malawi, Lilongwe, Malawi. .,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
| | - W Chris Buck
- Baylor Children's Foundation Malawi, Lilongwe, Malawi.,Department of Pediatrics, University of California Los Angeles, Maputo, Mozambique
| | - Alison C Caviness
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Abbie Foust
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Yewo Nyondo
- Baylor Children's Foundation Malawi, Lilongwe, Malawi
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Mpimbaza A, Sears D, Sserwanga A, Kigozi R, Rubahika D, Nadler A, Yeka A, Dorsey G. Admission Risk Score to Predict Inpatient Pediatric Mortality at Four Public Hospitals in Uganda. PLoS One 2015. [PMID: 26218274 PMCID: PMC4517901 DOI: 10.1371/journal.pone.0133950] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Mortality rates among hospitalized children in many government hospitals in sub-Saharan Africa are high. Pediatric emergency services in these hospitals are often sub-optimal. Timely recognition of critically ill children on arrival is key to improving service delivery. We present a simple risk score to predict inpatient mortality among hospitalized children. Between April 2010 and June 2011, the Uganda Malaria Surveillance Project (UMSP), in collaboration with the National Malaria Control Program (NMCP), set up an enhanced sentinel site malaria surveillance program for children hospitalized at four public hospitals in different districts: Tororo, Apac, Jinja and Mubende. Clinical data collected through March 2013, representing 50249 admissions were used to develop a mortality risk score (derivation data set). One year of data collected subsequently from the same hospitals, representing 20406 admissions, were used to prospectively validate the performance of the risk score (validation data set). Using a backward selection approach, 13 out of 25 clinical parameters recognizable on initial presentation, were selected for inclusion in a final logistic regression prediction model. The presence of individual parameters was awarded a score of either 1 or 2 based on regression coefficients. For each individual patient, a composite risk score was generated. The risk score was further categorized into three categories; low, medium, and high. Patient characteristics were comparable in both data sets. Measures of performance for the risk score included the receiver operating characteristics curves and the area under the curve (AUC), both demonstrating good and comparable ability to predict deathusing both the derivation (AUC =0.76) and validation dataset (AUC =0.74). Using the derivation and validation datasets, the mortality rates in each risk category were as follows: low risk (0.8% vs. 0.7%), moderate risk (3.5% vs. 3.2%), and high risk (16.5% vs. 12.6%), respectively. Our analysis resulted in development of a risk score that ably predicted mortality risk among hospitalized children. While validation studies are needed, this approach could be used to improve existing triage systems.
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Affiliation(s)
- Arthur Mpimbaza
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
- * E-mail:
| | - David Sears
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, United States of America
| | | | - Ruth Kigozi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Denis Rubahika
- National Malaria Control Program, Ministry of Health Uganda, Kampala, Uganda
| | - Adam Nadler
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, United States of America
| | - Adoke Yeka
- Infectious Diseases Research Collaboration, Kampala, Uganda
- School of Public Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, United States of America
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Saaka M, Osman SM, Amponsem A, Ziem JB, Abdul-Mumin A, Akanbong P, Yirkyio E, Yakubu E, Ervin S. Treatment Outcome of Severe Acute Malnutrition Cases at the Tamale Teaching Hospital. J Nutr Metab 2015; 2015:641784. [PMID: 26064678 PMCID: PMC4433717 DOI: 10.1155/2015/641784] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 11/22/2022] Open
Abstract
Objective. This study investigated the treatment outcomes and determinant factors likely to be associated with recovery rate. Methods. A retrospective chart review (RCR) was performed on 348 patients who were enrolled in the outpatient care (OPC) during the study period. Results. Of the 348 cases, 33.6% recovered (having MUAC ≥125 mm), 49.1% defaulted, and 11.5% transferred to other OPC units to continue with treatment. There were 187 (53.7%) males and 161 (46.3%) females with severe malnutrition. The average weight gain rate was 28 g/kg/day. Controlling for other factors, patients who completed the treatment plan had 3.2 times higher probability of recovery from severe acute malnutrition (SAM) as compared to patients who defaulted (adjusted odds ratio (AOR) = 3.2, 95% CI = 1.9, 5.3, and p < 0.001). The children aged 24-59 months had 5.8 times higher probability of recovery from SAM as compared to children aged 6-11 months (AOR = 5.8, 95% CI = 2.5, 10.6, and p < 0.001). Conclusions. Cure rate was low and the default rate was quite high. Children who were diagnosed as having marasmus on admission stayed longer before recovery than their kwashiorkor counterparts. Younger children were of greater risk of nonrecovery.
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Affiliation(s)
- Mahama Saaka
- School of Medicine and Health Sciences, University for Development Studies, P.O. Box 1883, Tamale, Ghana
| | | | - Anthony Amponsem
- School of Medicine and Health Sciences, University for Development Studies, P.O. Box 1883, Tamale, Ghana
- Tamale Teaching Hospital, P.O. Box 16, Tamale, Ghana
| | - Juventus B. Ziem
- School of Medicine and Health Sciences, University for Development Studies, P.O. Box 1883, Tamale, Ghana
- Tamale Teaching Hospital, P.O. Box 16, Tamale, Ghana
| | - Alhassan Abdul-Mumin
- School of Medicine and Health Sciences, University for Development Studies, P.O. Box 1883, Tamale, Ghana
- Tamale Teaching Hospital, P.O. Box 16, Tamale, Ghana
| | - Prosper Akanbong
- School of Medicine and Health Sciences, University for Development Studies, P.O. Box 1883, Tamale, Ghana
- Tamale Teaching Hospital, P.O. Box 16, Tamale, Ghana
| | | | - Eliasu Yakubu
- Tamale Teaching Hospital, P.O. Box 16, Tamale, Ghana
| | - Sean Ervin
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
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Gordon DM, Shehibo A, Tazebew A, Huddart MR, Kadir A, Allen N, Draper H, Kokeb M. Implementation of an in-patient pediatric mortality reduction intervention, Gondar University Hospital, Ethiopia. Public Health Action 2014; 4:265-70. [PMID: 26400707 DOI: 10.5588/pha.14.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Gondar University Hospital (GUH) is a resource-limited tertiary care hospital in northern Ethiopia. OBJECTIVE To evaluate the aggregate effect of care standardization, institutional guidelines, and simulation-based training on pediatric mortality at a resource-limited hospital. DESIGN Uncontrolled pre-post study. GUH in-patients aged from 30 days to 14 years were included in the program evaluation (baseline 11 September-18 November 2010; intervention 19 September-9 December 2011). Interns attached to the GUH pediatrics department from 6 September to 9 December 2011 were included in the training evaluation. Institution-specific management guidelines were prepared for choking, respiratory distress, dehydration, sepsis, congestive heart failure, coma, and seizure. Approval for the protocols was obtained from each pediatric faculty member. Interns received a 3.5 h simulation-based training in triage, procedural skills, and protocol usage. Primary outcome was overall deaths (%); secondary outcomes were deaths within 24 h of admission (%) and median pre/post-training emergency management test scores (%). RESULTS No difference in mortality (OR 0.72, 95%CI 0.40-1.29, P = 0.265) or first 24 h mortality (crude OR 0.97, 95%CI 0.37-2.55) was observed. Trainee examination scores improved from 33% to 74% (P < 0.001). CONCLUSION Combining care standardization, management protocols, and simulation-based training did not reduce mortality among pediatric in-patients. Focused, simulation-based training improved short-term test scores among interns.
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Affiliation(s)
- D M Gordon
- Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA
| | - A Shehibo
- Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia
| | - A Tazebew
- Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia
| | - M R Huddart
- Embrace, Yorkshire and Humber Infant and Childrens Transport Service, Sheffield, UK
| | - A Kadir
- Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA
| | - N Allen
- Yale University Global Health Leadership Institute, Eugene, Oregon, USA
| | - H Draper
- Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA
| | - M Kokeb
- Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia
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Dicko F, Desmonde S, Koumakpai S, Dior-Mbodj H, Kouéta F, Baeta N, Koné N, Akakpo J, Signate Sy H, Ye D, Renner L, Lewden C, Leroy V. Reasons for hospitalization in HIV-infected children in West Africa. J Int AIDS Soc 2014; 17:18818. [PMID: 24763078 PMCID: PMC3999943 DOI: 10.7448/ias.17.1.18818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 02/17/2014] [Accepted: 03/12/2014] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Current knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration). METHODS We performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions. RESULTS From April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1-8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7-23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%). CONCLUSIONS Overall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.
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Affiliation(s)
- Fatoumata Dicko
- Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali
| | - Sophie Desmonde
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France;
| | - Sikiratou Koumakpai
- Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin
| | | | - Fla Kouéta
- Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso
| | | | - Niaboula Koné
- Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali
| | - Jocelyn Akakpo
- Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin
| | | | - Diarra Ye
- Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso
| | | | - Charlotte Lewden
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France
| | - Valériane Leroy
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France
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