1
|
Masta R, Kukupe E, Marcus R, Duke T. The identification of WHO emergency signs in children by nurses at triage in an emergency department. Paediatr Int Child Health 2024; 44:8-12. [PMID: 38482930 DOI: 10.1080/20469047.2024.2328903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/01/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The World Health Organization recommends the use of a three-tier triage system to recognise a sick child in low- and middle-income countries. The three tiers are based on standardised emergency and priority signs. No studies have evaluated the prevalence or reliable detection of these emergency signs. AIMS To determine the prevalence of WHO emergency signs and the underlying causes, and to determine whether nurses could reliably detect these signs in children presenting to the emergency department at Port Moresby General Hospital in Papua New Guinea. METHODS A prospective study measured inter-rater agreement between nurses at triage and a blinded second assessor trained in paediatrics. RESULTS The prevalence of emergency signs was 16.7%: 32 of 192 children had these signs at presentation; 18 (9.4%) had severe respiratory distress; 10 (5.2%) had severe dehydration; and 3 (1.6%) had convulsions. There was an acceptable inter-rater agreement between nurses and doctors (Cohen's Kappa score >0.4) for some signs: subcostal recession, intercostal recession, nasal flaring, lethargy, weak volume pulses, convulsions, sunken eyes and a poor conscious state. Obstructed breathing, cyanosis, tracheal tug and cold hands and feet were less commonly detected and had poor inter-rater agreement (Kappa score <0.4). CONCLUSIONS Effective screening at triage can enable prompt emergency treatment by nurses and can help focus doctors' attention on children who require it most. There is a need for additional training in the identification of some emergency signs. ABBREVIATIONS CED: children's emergency department; ETAT: emergency triage assessment and treatment; HCC: Hospital Care for Children; PMGH: Port Moresby General Hospital; PNG: Papua New Guinea; WHO: World Health Organization.
Collapse
Affiliation(s)
- Rachel Masta
- Children's Emergency Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Everlyn Kukupe
- Children's Emergency Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Rupert Marcus
- Children's Emergency Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Trevor Duke
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| |
Collapse
|
2
|
Britton KJ, Pomat W, Sapura J, Kave J, Nivio B, Ford R, Kirarock W, Moore HC, Kirkham LA, Richmond PC, Chan J, Lehmann D, Russell FM, Blyth CC. Clinical predictors of hypoxic pneumonia in children from the Eastern Highlands Province, Papua New Guinea: secondary analysis of two prospective observational studies. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:101052. [PMID: 38699291 PMCID: PMC11064719 DOI: 10.1016/j.lanwpc.2024.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/15/2024] [Accepted: 03/13/2024] [Indexed: 05/05/2024]
Abstract
Background Pneumonia is the leading cause of death in young children globally and is prevalent in the Papua New Guinea highlands. We investigated clinical predictors of hypoxic pneumonia to inform local treatment guidelines in this resource-limited setting. Methods Between 2013 and 2020, two consecutive prospective observational studies were undertaken enrolling children 0-4 years presenting with pneumonia to health-care facilities in Goroka Town, Eastern Highlands Province. Logistic regression models were developed to identify clinical predictors of hypoxic pneumonia (oxygen saturation <90% on presentation). Model performance was compared against established criteria to identify severe pneumonia. Findings There were 2067 cases of pneumonia; hypoxaemia was detected in 36.1%. The strongest independent predictors of hypoxic pneumonia were central cyanosis on examination (adjusted odds ratio [aOR] 5.14; 95% CI 3.47-7.60), reduced breath sounds (aOR 2.92; 95% CI 2.30-3.71), and nasal flaring or grunting (aOR 2.34; 95% CI 1.62-3.38). While the model developed to predict hypoxic pneumonia outperformed established pneumonia severity criteria, it was not sensitive enough to be clinically useful at this time. Interpretation Given signs and symptoms are unable to accurately detect hypoxia, all health care facilities should be equipped with pulse oximeters. However, for the health care worker without access to pulse oximetry, consideration of central cyanosis, reduced breath sounds, nasal flaring or grunting, age-specific tachycardia, wheezing, parent-reported drowsiness, or bronchial breathing as suggestive of hypoxaemic pneumonia, and thus severe disease, may prove useful in guiding management, hospital referral and use of oxygen therapy. Funding Funded by Pfizer Global and the Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Kathryn J. Britton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia
| | - William Pomat
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Joycelyn Sapura
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - John Kave
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Birunu Nivio
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Rebecca Ford
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Wendy Kirarock
- Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea
| | - Hannah C. Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- Centre for Child Health Research, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Peter C. Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Jocelyn Chan
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Fiona M. Russell
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Centre for International Child Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C. Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
- School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia
| |
Collapse
|
3
|
Muacevic A, Adler JR, Lala GE, Yar SR, Zaman MB, Afridi BK. Clinical Findings and Radiological Evaluation of WHO-Defined Severe Pneumonia Among Hospitalized Children. Cureus 2023; 15:e33804. [PMID: 36819341 PMCID: PMC9928894 DOI: 10.7759/cureus.33804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The leading infectious cause of death in children worldwide is pneumonia. Pneumonia claimed the lives of 740,180 kids under the age of five in 2019, accounting for 14% of all fatalities and 22% of deaths in kids between the ages of 1 and 5. Children and families worldwide are affected by pneumonia, but South Asia and Africa have the highest fatality rates. OBJECTIVE This study aims to determine the clinical risk factors and radiological assessment of the World Health Organization (WHO)-defined severe pneumonia in Pakistani hospitalized children. MATERIAL AND METHODS This cross-sectional study was carried out in the pediatric department of the Hayatabad Medical Complex between January 2021 and December 2021. The study included kids who had a fever, cough, and fast or difficulty breathing between the ages of 2 and 60 months. All of the included clinical pneumonia cases were acquired in the community. RESULTS A total of 360 clinically confirmed patients with pneumonia who presented with fever, cough, and fast or difficulty breathing were enrolled. Age ranged between 2 and 60 months, with a mean age of ±31 months. There were 168 (46.7%) males and 192 (53.3%) females. About 232 (64.4%) had radiological pneumonia, while the rest of the pneumonia cases 128 (35.5%) were without a radiological diagnosis. The most common presenting complaint was noisy breathing 119 (33%), followed by refusal of feeds 81 (22.5%), lethargy 69 (19.2%), seizure 40 (11.1%), nasal drainage 29 (8%), and abdominal pain 22 (6.1%). CONCLUSION The most specific clinical finding of radiographic pneumonia was bronchial breathing, while tachypnea was the most sensitive sign.
Collapse
|
4
|
Satoh C, Toizumi M, Nguyen HAT, Hara M, Bui MX, Iwasaki C, Takegata M, Kitamura N, Suzuki M, Hashizume M, Dang DA, Kumai Y, Yoshida LM, Kaneko KI. Prevalence and characteristics of children with otitis media with effusion in Vietnam. Vaccine 2021; 39:2613-2619. [PMID: 33858717 DOI: 10.1016/j.vaccine.2021.03.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE Otitis media with effusion (OME) commonly occurs and persists in young children. It can cause hearing impairment and damage to the tympanic membrane without treatment. We aimed to determine the prevalence and association of Streptococcus pneumoniae in the nasopharynx of healthy children before the introduction of a pneumococcal conjugate vaccine. METHODS In October 2016, nasopharyngeal swabs collection and otoscope examinations by an otolaryngologist were conducted in children aged less than 24 months in Nha Trang, Vietnam. OME was diagnosed as the presence of middle ear fluid using a digital otoscope equipped with a pneumatic otoscope. Quantitative PCR targeting pneumococci-specific lytA (the major autolysis gene) and bacterial culture were performed to detect S. pneumoniae. The point prevalence of OME in the study area was estimated. The association between OME and S. pneumoniae in the nasopharynx was evaluated using a multivariable logistic regression model. RESULTS Among the 274 children who underwent bilateral ear examinations and nasopharyngeal swab collections, 47 had OME (17.2%, 95% confidence interval [CI] 12.9-22.1%) and 96 were colonized with S. pneumoniae (35.0%, 29.4-41.0%). OME and nasopharyngeal S. pneumoniae carriage were positively associated in children aged less than 12 months (adjusted odds ratio [aOR] 3.83, 1.40-10.51). Day-care attendance and living in a rural area were independently associated with OME (aOR 5.87, 2.31-14.91, and aOR 3.77, 1.58-8.99, respectively). CONCLUSIONS The nasopharyngeal pneumococcal carriage was associated with OME among children aged <12 months. A further study after introducing a pneumococcal conjugate vaccine (PCV) is required to better understand the effect of PCV and S. pneumoniae carriage on OME in young children.
Collapse
Affiliation(s)
- Chisei Satoh
- Department of Otolaryngology, Nagasaki University Hospital, Nagasaki, Japan
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Hien Anh Thi Nguyen
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Minoru Hara
- Department of Otolaryngology, Kamio Memorial Hospital, Tokyo, Japan
| | | | - Chihiro Iwasaki
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Noriko Kitamura
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Motoi Suzuki
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Masahiro Hashizume
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan; Department of Global Health Policy, The University of Tokyo, Tokyo, Japan
| | - Duc Anh Dang
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Yoshihiko Kumai
- Department of Otolaryngology, Nagasaki University Hospital, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
| | - Ken-Ichi Kaneko
- Department of Otolaryngology, Nagasaki University Hospital, Nagasaki, Japan
| |
Collapse
|
5
|
Mohamed YH, Toizumi M, Uematsu M, Nguyen HAT, Le LT, Takegata M, Iwasaki C, Kitamura N, Nation ML, Dunne EM, Hinds J, Do HT, Vien MQ, Satzke C, Flasche S, Mulholland K, Dang DA, Kitaoka T, Yoshida LM. Prevalence of Streptococcus pneumoniae in conjunctival flora and association with nasopharyngeal carriage among children in a Vietnamese community. Sci Rep 2021; 11:337. [PMID: 33431887 PMCID: PMC7801475 DOI: 10.1038/s41598-020-79175-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
Conjunctival pneumococcal serotypes among members of a community have not been investigated well. We determined the prevalence and association of Streptococcus pneumoniae in the nasopharynx and conjunctiva among children in a community before pneumococcal conjugate vaccine introduction. In October 2016, conjunctival and nasopharyngeal swabs were collected from children (< 24 months old) and nasopharyngeal swabs from mothers in Nha Trang, Vietnam. Quantitative lytA PCR and DNA microarray were performed to detect and serotype S. pneumoniae. The association between S. pneumoniae in the nasopharynx and conjunctiva was evaluated using multivariable logistic regression model. Among 698 children, 62 (8.9%, 95% CI 6.9-11.2%) were positive for S. pneumoniae in the conjunctiva. Non-encapsulated S. pneumoniae were most commonly identified, followed by serotypes 6A, 6B, and 14. Nasopharyngeal and conjunctival detection were positively associated (aOR 47.30, 95% CI 24.07-92.97). Low birth-weight, day-care attendance, and recent eye symptoms were independently associated with S. pneumoniae detection in the conjunctiva (aOR 11.14, 95% CI 3.76-32.98, aOR 2.19, 95% CI 1.45-3.31, and aOR 3.59, 95% CI 2.21-5.84, respectively). Serotypes and genotypes in the conjunctiva and nasopharynx matched in 87% of the children. Three mothers' nasopharyngeal pneumococcal samples had matched serotype and genotype with their child's in the conjunctiva and nasopharynx. S. pneumoniae presence in nasopharynx and conjunctiva were strongly associated. The high concordance of serotypes suggests nasopharyngeal carriage may be a source of transmission to the conjunctiva.
Collapse
Affiliation(s)
- Yasser Helmy Mohamed
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Masafumi Uematsu
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Lien Thuy Le
- Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | - Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Chihiro Iwasaki
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Noriko Kitamura
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Monica L Nation
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's, University of London, London, UK
- London Bioscience Innovation Centre, BUGS Bioscience, London, UK
| | - Hung Thai Do
- Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | | | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Duc-Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| |
Collapse
|
6
|
Shrestha S, Chaudhary N, Shrestha S, Pathak S, Sharma A, Shrestha L, Kurmi OP. Clinical predictors of radiological pneumonia: A cross-sectional study from a tertiary hospital in Nepal. PLoS One 2020; 15:e0235598. [PMID: 32702037 PMCID: PMC7377451 DOI: 10.1371/journal.pone.0235598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 06/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background Despite readily availability of vaccines against both Hemophilus influenzae and Pneumococcus, pneumonia remains the most common cause of morbidity and mortality in children under the age of five years in Nepal. With growing antibiotic resistance and a general move towards more rational antibiotic use, early identification of clinical signs for the prediction of radiological pneumonia would help practitioners to start the treatment of patients. The main aim of this study was to reassess the clinical predictors of pneumonia in Nepal. Methods This cross-sectional study was conducted between June 2015 and November 2015 at Tribhuvan University Teaching Hospital, a tertiary hospital in Kathmandu, Nepal. Children aged 3–60 months with a clinical diagnosis of pneumonia by a physician were enrolled in the study. Radiological pneumonia was identified and categorized as per World Health Organization guidelines by an experienced radiologist blinded to patient characteristics. We calculated sensitivity and specificity of clinical signs and symptoms for radiological pneumonia. Results Out of 1021 children with fever, 160 cases were clinically diagnosed as pneumonia and were enrolled for this study. Among the enrolled patients, 61% had radiological pneumonia. Tachypnea had the highest sensitivity of 99%, while bronchial breathing had the highest specificity of 100%. During univariate analysis, grunting, wheezing, nasal discharge, decreased breath sounds, noisy breathing and hypoxemia were associated with radiological pneumonia. Only hypoxemia remained an independent predictor when adjusted for all the factors. Conclusion Tachypnea was the most sensitive sign, whereas bronchial breathing was most specific sign for radiological pneumonia.
Collapse
Affiliation(s)
- Sandeep Shrestha
- Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Nagendra Chaudhary
- Department of Pediatrics, Universal College of Medical Sciences, Bhairahawa, Nepal
- * E-mail:
| | - Saneep Shrestha
- Department of Community Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Santosh Pathak
- Department of Pediatrics, Chitwan Medical College, Bharatpur, Nepal
| | - Arun Sharma
- Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Laxman Shrestha
- Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
| | - Om P. Kurmi
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
7
|
Marini TJ, Castaneda B, Baran T, O'Connor TP, Garra B, Tamayo L, Zambrano M, Carlotto C, Trujillo L, Kaproth-Joslin KA. Lung Ultrasound Volume Sweep Imaging for Pneumonia Detection in Rural Areas: Piloting Training in Rural Peru. J Clin Imaging Sci 2019; 9:35. [PMID: 31538033 PMCID: PMC6737249 DOI: 10.25259/jcis_29_2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 05/21/2019] [Indexed: 01/19/2023] Open
Abstract
Objective: Pneumonia is the leading cause of pediatric mortality worldwide among children 0–5 years old. Lung ultrasound can be used to diagnose pneumonia in rural areas as it is a portable and relatively economic imaging modality with ~95% sensitivity and specificity for pneumonia in children. Lack of trained sonographers is the current limiting factor to its deployment in rural areas. In this study, we piloted training of a volume sweep imaging (VSI) ultrasound protocol for pneumonia detection in Peru with rural health workers. VSI may be taught to individuals with limited medical/ultrasound experience as it requires minimal anatomical knowledge and technical skill. In VSI, the target organ is imaged with a series of sweeps and arcs of the ultrasound probe in relation to external body landmarks. Methods: Rural health workers in Peru were trained on a VSI ultrasound protocol for pneumonia detection. Subjects were given a brief didactic session followed by hands-on practice with the protocol. Each attempt was timed and mistakes were recorded. Participants performed the protocol until they demonstrated two mistake-free attempts. Results: It took participants a median number of three attempts (range 1–6) to perform the VSI protocol correctly. Time to mastery took 51.4 ± 17.7 min. There were no significant differences among doctors, nurses, and technicians in total training time (P = 0.43) or number of attempts to success (P = 0.72). Trainee age was not found to be significantly correlated with training time (P = 0.50) or number of attempts to success (P = 0.40). Conclusion: Rural health workers learned a VSI protocol for pneumonia detection with relative ease in a short amount of time. Future studies should investigate the clinical efficacy of this VSI protocol for pneumonia detection. Key Message: A volume sweep imaging (VSI) protocol for pneumonia detection can be taught with minimal difficulty to rural health workers without prior ultrasound experience. No difference was found in training performance related to education level or age. VSI involves no significant knowledge of anatomy or technical skill.
Collapse
Affiliation(s)
- Thomas J Marini
- Departments of Imaging Sciences, University of Rochester, Rochester, New York, United States
| | - Benjamin Castaneda
- Department of Engineering, Pontifical Catholic University of Peru, Lima, Peru
| | - Timothy Baran
- Departments of Imaging Sciences, University of Rochester, Rochester, New York, United States
| | - Timothy P O'Connor
- Departments of Emergency Medicine, University of Rochester, Rochester, New York, United States
| | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, United States
| | - Lorena Tamayo
- Medical Innovation and Technology, San Isidrio, Peru
| | - Maria Zambrano
- Touro College of Osteopathic Medicine, Middletown, New York, United States
| | | | | | | |
Collapse
|
8
|
Jahan Y, Rahman A. A case report on management of severe childhood pneumonia in low resource settings. Respir Med Case Rep 2018; 25:192-195. [PMID: 30211000 PMCID: PMC6129689 DOI: 10.1016/j.rmcr.2018.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/18/2022] Open
Abstract
Pneumonia is a major cause of child mortality among children under five years, worldwide. Pneumonia infection may be caused by bacteria, viruses, or fungi in single or in both lungs. According to recent criteria developed by World Health Organization (WHO) in September (2013), pneumonia can be classified into severe pneumonia, pneumonia and no pneumonia. Most of the deaths occur from severe pneumonia and management of severe childhood pneumonia requires early identification, prompt referral and the availability of intensive quality of care. This case study aimed to represent the actual scenario of severe childhood pneumonia case management at community clinic. Considering that circumstances, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) developed an innovative day care management approach as safe, effective and less expensive alternative to hospital management of severe childhood pneumonia. A twenty-seven months old boy came to the Health & Family Welfare Centre (HFWC) with severe breathing difficulty, cough, history of fever. The management described below was continued daily until there was clinical improvement; no fever, no fast breathing, no lower chest wall indrawing, no danger signs, no rales on auscultation and no hypoxemia. Considering the WHO case management protocol for severe pneumonia, day care management approach on community clinic recommends that diagnosis of severe pneumonia should be based primarily on visible clinical parameters. On that basis, severe childhood pneumonia can be successfully managed at community clinics including for children with hypoxemia who is required prolong (4–6 hours) oxygen therapy.
Collapse
Affiliation(s)
- Yasmin Jahan
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
- Corresponding author.
| | - Atiqur Rahman
- School of Health, University of New England, Australia
| |
Collapse
|
9
|
Higdon MM, Hammitt LL, Deloria Knoll M, Baggett HC, Brooks WA, Howie SRC, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, Scott JAG, Thea DM, Driscoll AJ, Karron RA, Park DE, Prosperi C, Zeger SL, O'Brien KL, Feikin DR. Should Controls With Respiratory Symptoms Be Excluded From Case-Control Studies of Pneumonia Etiology? Reflections From the PERCH Study. Clin Infect Dis 2018; 64:S205-S212. [PMID: 28575354 PMCID: PMC5447853 DOI: 10.1093/cid/cix076] [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] [Indexed: 11/22/2022] Open
Abstract
Many pneumonia etiology case-control studies exclude controls with respiratory illness from enrollment or analyses. Herein we argue that selecting controls regardless of respiratory symptoms provides the least biased estimates of pneumonia etiology. We review 3 reasons investigators may choose to exclude controls with respiratory symptoms in light of epidemiologic principles of control selection and present data from the Pneumonia Etiology Research for Child Health (PERCH) study where relevant to assess their validity. We conclude that exclusion of controls with respiratory symptoms will result in biased estimates of etiology. Randomly selected community controls, with or without respiratory symptoms, as long as they do not meet the criteria for case-defining pneumonia, are most representative of the general population from which cases arose and the least subject to selection bias.
Collapse
Affiliation(s)
- Melissa M Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Henry C Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - W Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephen R C Howie
- Medical Research Council Unit, Basse, The Gambia.,Department of Paediatrics, University of Auckland, and.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Karen L Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore
| | - Orin S Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David R Murdoch
- Department of Pathology, University of Otago, and.,Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Donald M Thea
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts
| | - Amanda J Driscoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ruth A Karron
- Department of International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel E Park
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, District of Columbia
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and
| | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Daniel R Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | |
Collapse
|
10
|
Jahan Y, Rahman SA, Chowdhury AS, Moshiur Rahman M. Management of severe childhood pneumonia by day care approach in developing countries. Health Promot Perspect 2018; 8:88-91. [PMID: 29423367 PMCID: PMC5797313 DOI: 10.15171/hpp.2018.11] [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: 10/11/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Pneumonia is a major cause of child mortality among children under 5 years, worldwide. Pneumonia infection may be caused by bacteria, viruses, or fungi in single or in both lungs. According to recent criteria developed by the World Health Organization(WHO) in September (2013), pneumonia can be classified into severe pneumonia, pneumonia and no pneumonia. Most of the deaths occur from severe pneumonia. Methods: Disease management of severe childhood pneumonia requires early identification,prompt referral and the availability of intensive quality care. Under 5 years old children with severe pneumonia should receive day care, with antibiotic treatment, feeding, and supportive care with similar 24-hour hospital treatment. Results: Considering that difficulties, International Centre for Diarrheal Disease Research,Bangladesh (ICDDR, B) initiated Day Care Approach (DCA) model, as an innovative, safe,effective and less expensive alternative to hospital management of severe childhood pneumonia.A 24 months old girl came to the health care center with severe breathing difficulty, cough,history of fever and head nodding. The management described below was continued daily until there was clinical improvement; no fever, no fast breathing, no lower chest wall in drawing, no danger signs, no rales on auscultation, and no hypoxemia. Conclusion: Considering the WHO case management protocol for severe pneumonia, DCA recommends that diagnosis of severe pneumonia should be based primarily on visible clinical parameters. On that basis, severe childhood pneumonia can be successfully managed at daycare clinics including for children with hypoxemia who is required prolong (4-6 hours) oxygen therapy.
Collapse
Affiliation(s)
- Yasmin Jahan
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| | | | | | - Md Moshiur Rahman
- Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan
| |
Collapse
|
11
|
Malla L, Perera-Salazar R, McFadden E, English M. Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: a retrospective observational study. BMJ Open 2017; 7:e019478. [PMID: 29146662 PMCID: PMC5695483 DOI: 10.1136/bmjopen-2017-019478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/20/2017] [Accepted: 10/23/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Kenyan guidelines for antibiotic treatment of pneumonia recommended treatment of pneumonia characterised by indrawing with injectable penicillin alone in inpatient settings until early 2016. At this point, they were revised becoming consistent with WHO guidance after results of a Kenyan trial provided further evidence of equivalence of oral amoxicillin and injectable penicillin. This change also made possible use of oral amoxicillin for outpatient treatment in this patient group. However, given non-trivial mortality in Kenyan children with indrawing pneumonia, it remained possible they would benefit from a broader spectrum antibiotic regimen. Therefore, we compared the effectiveness of injectable penicillin monotherapy with a regimen combining penicillin with gentamicin. SETTING We used a large routine observational dataset that captures data on all admissions to 13 Kenyan county hospitals. PARTICIPANTS AND MEASURES The analyses included children aged 2-59 months. Selection of study population was based on inclusion criteria typical of a prospective trial, primary analysis (experiment 1, n=4002), but we also explored more pragmatic inclusion criteria (experiment 2, n=6420) as part of a secondary analysis. To overcome the challenges associated with the non-random allocation of treatments and missing data, we used propensity score (PS) methods and multiple imputation to minimise bias. Further, we estimated mortality risk ratios using log binomial regression and conducted sensitivity analyses using an instrumental variable and PS trimming. RESULTS The estimated risk of dying, in experiment 1, in those receiving penicillin plus gentamicin was 1.46 (0.85 to 2.43) compared with the penicillin monotherapy group. In experiment 2, the estimated risk was 1.04(0.76 to 1.40). CONCLUSION There is no statistical difference in the treatment of indrawing pneumonia with either penicillin or penicillin plus gentamicin. By extension, it is unlikely that treatment with penicillin plus gentamicin would offer an advantage to treatment with oral amoxicillin.
Collapse
Affiliation(s)
- Lucas Malla
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rafael Perera-Salazar
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Emily McFadden
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Health Services Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| |
Collapse
|
12
|
Malla L, Perera-Salazar R, McFadden E, English M. Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: protocol for an observational study. BMJ Open 2017; 7:e016784. [PMID: 28928185 PMCID: PMC5623534 DOI: 10.1136/bmjopen-2017-016784] [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: 03/13/2017] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION WHO treatment guidelines are widely recommended for guiding treatment for millions of children with pneumonia every year across multiple low-income and middle-income countries. Guidelines are based on synthesis of available evidence that provides moderate certainty in evidence of effects for forms of pneumonia that can result in hospitalisation. However, trials have included fewer children from Africa than other settings, and it is suggested that African children with pneumonia have higher mortality. Thus, despite improving access to recommended treatments and deployment with high coverage of childhood vaccines, pneumonia remains one of the top causes of mortality for children in Kenya. Establishing whether there are benefits of alternative treatment regimens to help reduce mortality would require pragmatic clinical trials. However, these remain relatively expensive and time consuming. This protocol describes an approach to using secondary analysis of a new, large observational dataset as a potentially cheaper and quicker way to examine the comparative effectiveness of penicillin versus penicillin plus gentamicin in treatment of indrawing pneumonia. Addressing this question is important, as although it is now recommended that this form of pneumonia is treated with oral medication as an outpatient, it remains associated with non-trivial mortality that may be higher outside trial populations. METHODS AND ANALYSIS We will use a large observational dataset that captures data on all admissions to 13 Kenyan county hospitals. These data represent the findings of clinicians in practice and, because the system was developed for large observational research, pose challenges of non-random treatment allocation and missing data. To overcome these challenges, this analysis will use a rigorous approach to study design, propensity score methods and multiple imputation to minimise bias. ETHICS AND DISSEMINATION The primary data are held by hospitals participating in the Kenyan Clinical Information Network project with de-identifed data shared with the Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme for agreed analyses. The use of data for the analysis described received ethical clearance from the KEMRI scientific and ethical review committee. The findings of this analysis will be published.
Collapse
Affiliation(s)
- Lucas Malla
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rafael Perera-Salazar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily McFadden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Kenya Medical Research Institute-Wellcome Trust, Nairobi, Kenya
| |
Collapse
|
13
|
Gray A, Chhor L, Sanyalack S, Lim R, Lai J, Vilivong K, Morpeth M, Soukaloun D, Russell F. Some sustained improvements in pneumonia case management four and five years following implementation of paediatric hospital guidelines in Lao PDR. Sci Rep 2017; 7:10679. [PMID: 28878405 PMCID: PMC5587579 DOI: 10.1038/s41598-017-10880-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/15/2017] [Indexed: 11/23/2022] Open
Abstract
In 2010, WHO paediatric hospital guidelines were implemented in Lao PDR, along with training workshops and feedback audits, achieving significant improvements in pneumonia case management when assessed one-year post-intervention. The sustainability of these improvements is hereby assessed, four and five years post-intervention. Medical records of children aged 1-59 months, diagnosed with pneumonia in 2010, 2011, 2014 and 2015 from a central Lao hospital were reviewed. Information relating to clinical steps in pneumonia case management was extracted and a scoring system applied based on the documentation of each clinical step, producing a pneumonia assessment score for each case. Comparisons of clinical steps and mean assessment score across study years were performed using Pearson's chi-squared and t-tests, respectively. Of 231 pneumonia cases, the mean assessment scores in 2010, 2011, 2014 and 2015 were 57%, 96%, 69% and 69% respectively, showing a significant reduction from the immediate post-intervention period (2011) to 2015 (p < 0.01). Mean assessment score in 2014/2015 was significantly higher than in 2010 (p < 0.01). The high standards of pneumonia case management in 2011 were not observed in 2014/2015 in the absence of ongoing intervention but overall quality of care remained higher than pre-intervention levels, suggesting some degree of sustainability in the long-term.
Collapse
Affiliation(s)
- Amy Gray
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia.
- The Royal Children's Hospital, Parkville, Victoria, Australia.
| | - Louis Chhor
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Ruth Lim
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Jana Lai
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Melinda Morpeth
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Douangdao Soukaloun
- Mahosot Hospital, Vientiane, Lao PDR
- University of Health Sciences, Vientiane, Lao PDR
| | - Fiona Russell
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
- Pneumococcal Group, Murdoch Childrens Research Institute, The Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
14
|
English M, Irimu G, Nyamai R, Were F, Garner P, Opiyo N. Developing guidelines in low-income and middle-income countries: lessons from Kenya. Arch Dis Child 2017; 102:846-851. [PMID: 28584069 PMCID: PMC5564491 DOI: 10.1136/archdischild-2017-312629] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/22/2017] [Accepted: 04/16/2017] [Indexed: 11/11/2022]
Abstract
There are few examples of sustained nationally organised, evidence-informed clinical guidelines development processes in Sub-Saharan Africa. We describe the evolution of efforts from 2005 to 2015 to support evidence-informed decision making to guide admission hospital care practices in Kenya. The approach to conduct reviews, present evidence, and structure and promote transparency of consensus-based procedures for making recommendations improved over four distinct rounds of policy making. Efforts to engage important voices extended from government and academia initially to include multiple professional associations, regulators and practitioners. More than 100 people have been engaged in the decision-making process; an increasing number outside the research team has contributed to the conduct of systematic reviews, and 31 clinical policy recommendations has been developed. Recommendations were incorporated into clinical guideline booklets that have been widely disseminated with a popular knowledge and skills training course. Both helped translate evidence into practice. We contend that these efforts have helped improve the use of evidence to inform policy. The systematic reviews, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approaches and evidence to decision-making process are well understood by clinicians, and the process has helped create a broad community engaged in evidence translation together with a social or professional norm to use evidence in paediatric care in Kenya. Specific sustained efforts should be made to support capacity and evidence-based decision making in other African settings and clinical disciplines.
Collapse
Affiliation(s)
- Mike English
- Health Serviecs Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Rachel Nyamai
- Maternal, Newborn, Adolescent and Child Health Unit, Ministry of Health, Nairobi, Kenya
| | - Fred Were
- Kenya Paediatric Association, Nairobi, Kenya
| | - Paul Garner
- Centre for Evidence Synthesis for Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Newton Opiyo
- Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| |
Collapse
|
15
|
Bénet T, Picot VS, Awasthi S, Pandey N, Bavdekar A, Kawade A, Robinson A, Rakoto-Andrianarivelo M, Sylla M, Diallo S, Russomando G, Basualdo W, Komurian-Pradel F, Endtz H, Vanhems P, Paranhos-Baccalà G, For The Gabriel Network. Severity of Pneumonia in Under 5-Year-Old Children from Developing Countries: A Multicenter, Prospective, Observational Study. Am J Trop Med Hyg 2017; 97:68-76. [PMID: 28719310 PMCID: PMC5508893 DOI: 10.4269/ajtmh.16-0733] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Pneumonia is the leading cause of death in children. The objectives were to evaluate the microbiological agents linked with hypoxemia in hospitalized children with pneumonia from developing countries, to identify predictors of hypoxemia, and to characterize factors associated with in-hospital mortality. A multicenter, observational study was conducted in five hospitals, from India (Lucknow, Vadu), Madagascar (Antananarivo), Mali (Bamako), and Paraguay (San Lorenzo). Children aged 2-60 months with radiologically confirmed pneumonia were enrolled prospectively. Respiratory and whole blood specimens were collected, identifying viruses and bacteria by real-time multiplex polymerase chain reaction (PCR). Microbiological agents linked with hypoxemia at admission (oxygen saturation < 90%) were analyzed by multivariate logistic regression, and factors associated with 14-day in-hospital mortality were assessed by bivariate Cox regression. Overall, 405 pneumonia cases (3,338 hospitalization days) were analyzed; 13 patients died within 14 days of hospitalization. Hypoxemia prevalence was 17.3%. Detection of human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) in respiratory samples was independently associated with increased risk of hypoxemia (adjusted odds ratio [aOR] = 2.4, 95% confidence interval [95% CI] = 1.0-5.8 and aOR = 2.5, 95% CI = 1.1-5.3, respectively). Lower chest indrawing and cyanosis were predictive of hypoxemia (positive likelihood ratios = 2.3 and 2.4, respectively). Predictors of death were Streptococcus pneumoniae detection by blood PCR (crude hazard ratio [cHR] = 4.6, 95% CI = 1.5-14.0), procalcitonin ≥ 50 ng/mL (cHR = 22.4, 95% CI = 7.3-68.5) and hypoxemia (cHR = 4.8, 95% CI = 1.6-14.4). These findings were consistent on bivariate analysis. hMPV and RSV in respiratory samples were linked with hypoxemia, and S. pneumoniae in blood was associated with increased risk of death among hospitalized children with pneumonia in developing countries.
Collapse
Affiliation(s)
- Thomas Bénet
- Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Valentina Sanchez Picot
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | | | - Nitin Pandey
- Chhatrapati Shahu Ji Maharaj University, Lucknow, India
| | | | | | | | | | | | | | | | - Wilma Basualdo
- Hospital Pediátrico "Niños de Acosta Ñu," San Lorenzo, Paraguay
| | - Florence Komurian-Pradel
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Hubert Endtz
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Philippe Vanhems
- Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Gláucia Paranhos-Baccalà
- Laboratoire des Pathogènes Emergents, Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | | |
Collapse
|
16
|
Bénet T, Sánchez Picot V, Messaoudi M, Chou M, Eap T, Wang J, Shen K, Pape JW, Rouzier V, Awasthi S, Pandey N, Bavdekar A, Sanghavi S, Robinson A, Rakoto-Andrianarivelo M, Sylla M, Diallo S, Nymadawa P, Naranbat N, Russomando G, Basualdo W, Komurian-Pradel F, Endtz H, Vanhems P, Paranhos-Baccalà G. Microorganisms Associated With Pneumonia in Children <5 Years of Age in Developing and Emerging Countries: The GABRIEL Pneumonia Multicenter, Prospective, Case-Control Study. Clin Infect Dis 2017; 65:604-612. [PMID: 28605562 PMCID: PMC7108107 DOI: 10.1093/cid/cix378] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/02/2017] [Indexed: 12/14/2022] Open
Abstract
Background Pneumonia, the leading infectious cause of child mortality globally, mainly afflicts developing countries. This prospective observational study aimed to assess the microorganisms associated with pneumonia in children aged <5 years in developing and emerging countries. Methods A multicenter, case-control study by the GABRIEL (Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries) network was conducted between 2010 and 2014 in Cambodia, China, Haiti, India (2 sites), Madagascar, Mali, Mongolia, and Paraguay. Cases were hospitalized children with radiologically confirmed pneumonia; controls were children from the same setting without any features suggestive of pneumonia. Nasopharyngeal swabs were collected from all subjects; 19 viruses and 5 bacteria were identified by reverse-transcription polymerase chain reaction. Associations between microorganisms and pneumonia were quantified by calculating the adjusted population attributable fraction (aPAF) after multivariate logistic regression analysis adjusted for sex, age, time period, other pathogens, and site. Results Overall, 888 cases and 870 controls were analyzed; ≥1 microorganism was detected in respiratory samples in 93.0% of cases and 74.4% of controls (P < .001). Streptococcus pneumoniae, Mycoplasma pneumoniae, human metapneumovirus, rhinovirus, respiratory syncytial virus (RSV), parainfluenza virus 1, 3, and 4, and influenza virus A and B were independently associated with pneumonia; aPAF was 42.2% (95% confidence interval [CI], 35.5%-48.2%) for S. pneumoniae, 18.2% (95% CI, 17.4%-19.0%) for RSV, and 11.2% (95% CI, 7.5%-14.7%) for rhinovirus. Conclusions Streptococcus pneumoniae, RSV, and rhinovirus may be the major microorganisms associated with pneumonia infections in children <5 years of age from developing and emerging countries. Increasing S. pneumoniae vaccination coverage may substantially reduce the burden of pneumonia among children in developing countries.
Collapse
Affiliation(s)
- Thomas Bénet
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS de Lyon, UCBL1
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, France
| | - Valentina Sánchez Picot
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS de Lyon, UCBL1
| | - Mélina Messaoudi
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS de Lyon, UCBL1
| | | | - Tekchheng Eap
- Department of Pneumology, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens and Dr Christophe Mérieux Laboratory, Fondation Mérieux, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | - Kunling Shen
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Capital Medical University, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, China
| | - Jean-William Pape
- Centres GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Centres GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes), Port-au-Prince, Haiti
| | | | - Nitin Pandey
- Chatrapati Shahu Ji Maharaj Medical University, Lucknow
| | | | | | | | | | | | | | | | | | | | - Wilma Basualdo
- Hospital Pediátrico Niños de Acosta Ñu, San Lorenzo, Paraguay
| | - Florence Komurian-Pradel
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS de Lyon, UCBL1
| | - Hubert Endtz
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS de Lyon, UCBL1
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Philippe Vanhems
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS de Lyon, UCBL1
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, France
| | - Gláucia Paranhos-Baccalà
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS UMR 5308, ENS de Lyon, UCBL1
| |
Collapse
|
17
|
Cisneros-Velarde P, Correa M, Mayta H, Anticona C, Pajuelo M, Oberhelman R, Checkley W, Gilman RH, Figueroa D, Zimic M, Lavarello R, Castaneda B. Automatic pneumonia detection based on ultrasound video analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4117-4120. [PMID: 28269188 DOI: 10.1109/embc.2016.7591632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pneumonia is a disease which causes high mortality in children under five years old, particularly in developing countries. This paper proposes a novel application of ultrasound video analysis for the detection of pneumonia. This application is based on the processing of small video chunks, in which an image processing algorithm analyzes each frame to get some overall video statistics. Then, based on these quantities, the likeness of presence of pneumonia in the video is determined. The algorithm exploits different geometrical properties of typical anatomical and pathological features that commonly appear in lung sonography and which are already clinically typified in the literature. Our technique has been tested on different transverse thoracic scanning protocols and probe's maneuvers, thus, under a variety of clinical and usage protocols. Then, it can be targeted towards screening applications. We present encouraging results (AUC measure between 0.7851 and 0.9177) based on the analysis of 346 videos with an average duration of eight seconds. The analyzed videos were taken from children who were between three and five years old. Finally, our algorithm can be used directly as a classifier, but we detail how its performance may be enhanced if used as a first stage of a larger pipeline of other complementary pneumonia detection processes.
Collapse
|
18
|
Gathara D, Malla L, Ayieko P, Karuri S, Nyamai R, Irimu G, van Hensbroek MB, Allen E, English M. Variation in and risk factors for paediatric inpatient all-cause mortality in a low income setting: data from an emerging clinical information network. BMC Pediatr 2017; 17:99. [PMID: 28381208 PMCID: PMC5382487 DOI: 10.1186/s12887-017-0850-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital mortality data can inform planning for health interventions and may help optimize resource allocation if they are reliable and appropriately interpreted. However such data are often not available in low income countries including Kenya. METHODS Data from the Clinical Information Network covering 12 county hospitals' paediatric admissions aged 2-59 months for the periods September 2013 to March 2015 were used to describe mortality across differing contexts and to explore whether simple clinical characteristics used to classify severity of illness in common treatment guidelines are consistently associated with inpatient mortality. Regression models accounting for hospital identity and malaria prevalence (low or high) were used. Multiple imputation for missing data was based on a missing at random assumption with sensitivity analyses based on pattern mixture missing not at random assumptions. RESULTS The overall cluster adjusted crude mortality rate across hospitals was 6 · 2% with an almost 5 fold variation across sites (95% CI 4 · 9 to 7 · 8; range 2 · 1% - 11 · 0%). Hospital identity was significantly associated with mortality. Clinical features included in guidelines for common diseases to assess severity of illness were consistently associated with mortality in multivariable analyses (AROC =0 · 86). CONCLUSION All-cause mortality is highly variable across hospitals and associated with clinical risk factors identified in disease specific guidelines. A panel of these clinical features may provide a basic common data framework as part of improved health information systems to support evaluations of quality and outcomes of care at scale and inform health system strengthening efforts.
Collapse
Affiliation(s)
- David Gathara
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
| | - Lucas Malla
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN UK
| | - Philip Ayieko
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
| | - Stella Karuri
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
| | - Rachel Nyamai
- Division of Maternal, Newborn, Child and Adolescent Health, Ministry of Health, Nairobi, Kenya
| | - Grace Irimu
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, 19676-00202 Kenya
| | - Michael Boele van Hensbroek
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, 22700 1100 DE The Netherlands
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Mike English
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN UK
| |
Collapse
|
19
|
Hoffmann J, Machado D, Terrier O, Pouzol S, Messaoudi M, Basualdo W, Espínola EE, Guillen RM, Rosa-Calatrava M, Picot V, Bénet T, Endtz H, Russomando G, Paranhos-Baccalà G. Viral and bacterial co-infection in severe pneumonia triggers innate immune responses and specifically enhances IP-10: a translational study. Sci Rep 2016; 6:38532. [PMID: 27922126 PMCID: PMC5138590 DOI: 10.1038/srep38532] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/10/2016] [Indexed: 12/23/2022] Open
Abstract
Mixed viral and bacterial infections are widely described in community-acquired pneumonia; however, the clinical implications of co-infection on the associated immunopathology remain poorly studied. In this study, microRNA, mRNA and cytokine/chemokine secretion profiling were investigated for human monocyte-derived macrophages infected in-vitro with Influenza virus A/H1N1 and/or Streptococcus pneumoniae. We observed that the in-vitro co-infection synergistically increased interferon-γ-induced protein-10 (CXCL10, IP-10) expression compared to the singly-infected cells conditions. We demonstrated that endogenous miRNA-200a-3p, whose expression was synergistically induced following co-infection, indirectly regulates CXCL10 expression by targeting suppressor of cytokine signaling-6 (SOCS-6), a well-known regulator of the JAK-STAT signaling pathway. Additionally, in a subsequent clinical pilot study, immunomodulators levels were evaluated in samples from 74 children (≤5 years-old) hospitalized with viral and/or bacterial community-acquired pneumonia. Clinically, among the 74 cases of pneumonia, patients with identified mixed-detection had significantly higher (3.6-fold) serum IP-10 levels than those with a single detection (P = 0.03), and were significantly associated with severe pneumonia (P < 0.01). This study demonstrates that viral and bacterial co-infection modulates the JAK-STAT signaling pathway and leads to exacerbated IP-10 expression, which could play a major role in the pathogenesis of pneumonia.
Collapse
Affiliation(s)
- Jonathan Hoffmann
- Laboratoire des Pathogènes Émergents, Fondation Mérieux - CIRI - Inserm U1111, Lyon, France
| | - Daniela Machado
- Laboratoire des Pathogènes Émergents, Fondation Mérieux - CIRI - Inserm U1111, Lyon, France
| | - Olivier Terrier
- Virologie et Pathologie Humaine VirPath, CIRI - UCBL1 - Inserm U1111 - CNRS UMR 5308 - ENS de Lyon, Lyon, France
| | - Stephane Pouzol
- Laboratoire des Pathogènes Émergents, Fondation Mérieux - CIRI - Inserm U1111, Lyon, France
| | - Mélina Messaoudi
- Laboratoire des Pathogènes Émergents, Fondation Mérieux - CIRI - Inserm U1111, Lyon, France
| | - Wilma Basualdo
- Hospital General Pediátrico Niños de Acosta Ñu, Ministerio de Salud Pública y Bienestar Social, Paraguay
| | - Emilio E Espínola
- Departamento de Biología Molecular y Biotecnologia, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | - Rosa M. Guillen
- Departamento de Biología Molecular y Biotecnologia, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | - Manuel Rosa-Calatrava
- Virologie et Pathologie Humaine VirPath, CIRI - UCBL1 - Inserm U1111 - CNRS UMR 5308 - ENS de Lyon, Lyon, France
| | - Valentina Picot
- Laboratoire des Pathogènes Émergents, Fondation Mérieux - CIRI - Inserm U1111, Lyon, France
| | - Thomas Bénet
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hubert Endtz
- Laboratoire des Pathogènes Émergents, Fondation Mérieux - CIRI - Inserm U1111, Lyon, France
| | - Graciela Russomando
- Departamento de Biología Molecular y Biotecnologia, Instituto de Investigaciones en Ciencias de la Salud, Universidad Nacional de Asunción, Paraguay
| | | |
Collapse
|
20
|
Predictive Accuracy of Chest Radiographs in Diagnosing Tachypneic Children. Indian J Pediatr 2016; 83:930-6. [PMID: 26935199 DOI: 10.1007/s12098-016-2057-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To test the predictive accuracy and reporting reproducibility of digital chest radiographs under low-resource conditions. METHODS One hundred thirty four tachypneic children who presented to two Indian hospitals were enrolled. Based on review of 16 variables recorded in the Emergency Room (ER) by a senior pediatrician, children were given one of the four clinical diagnoses: pneumonia, wheezy disease, mixed and non-respiratory. Every child also had a digital CXR. It was interpreted by ER physician, pediatrician and two independent radiologists. All used the same standardized interpretation system (one or more of: normal, minor patches, major patches, hyperinflation, lobar change, pleural effusion). RESULTS The 10 % of CXRs showing pleural effusions reliably predicted pneumonia and disease severity. For all other CXR findings, the correlation between CXR interpretation and clinical diagnosis was moderate to poor. Apart from pleural effusions, inter-observer agreements between interpretations made by ER physician, pediatrician and radiologist were also poor (kappa <0.4). CONCLUSIONS With the exception of pleural effusions, CXR findings, interpreted by a radiologist, had moderate to poor power to predict respiratory diagnosis or disease severity defined by a pediatrician. Value of CXRs was further reduced by poor inter-observer agreement. When investigating tachypneic children under low-resource conditions, CXRs should be used with a clear understanding of their limitations.
Collapse
|
21
|
Mbonye MK, Burnett SM, Naikoba S, Ronald A, Colebunders R, Van Geertruyden JP, Weaver MR. Effectiveness of educational outreach in infectious diseases management: a cluster randomized trial in Uganda. BMC Public Health 2016; 15:714. [PMID: 27488692 PMCID: PMC4972969 DOI: 10.1186/s12889-016-3375-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 07/26/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Integrated Infectious Diseases Capacity Building Evaluation (IDCAP) teams designed and implemented two health worker in-service training approaches: 1) an off-site classroom-based integrated management of infectious diseases (IMID) course with distance learning aspects, and 2) on-site support (OSS), an educational outreach intervention. We tested the effects of OSS on workload and 12 facility performance indicators for emergency triage assessment and treatment, HIV testing, and malaria and pneumonia case management among outpatients by two subgroups: 1) mid-level practitioners (MLP) who attended IMID training (IMID-MLP) and 2) health workers who did not (No-IMID). METHODS Thirty-six health facilities participated in the IDCAP trial, with 18 randomly assigned to Arm A and 18 to Arm B. Two MLP in both arms received IMID. All providers at Arm A facilities received nine monthly OSS visits from April to December 2010 while Arm B did not. From November 2009 to December 2010, 777,667 outpatient visits occurred. We analyzed 669,580 (86.1 %) outpatient visits, where provider cadre was reported. Treatment was provided by 64 IMID-MLP and 1,515 No-IMID providers. The effect of OSS was measured by the difference in pre/post changes across arms after controlling for covariates (adjusted ratio of relative risks = a RRR). RESULTS The effect of OSS on patients-per-provider-per-day (workload) among IMID-MLP (aRRR = 1.21; p = 0.48) and No-IMID (aRRR = 0.90; p = 0.44) was not statistically significant. Among IMID-MLP, OSS was effective for three indicators: malaria cases receiving an appropriate antimalarial (aRRR = 1.26, 99 % CI = 1.02-1.56), patients with negative malaria test result prescribed an antimalarial (aRRR = 0.49, 99 % CI = 0.26-0.92), and patients with acid-fast bacilli smear negative result receiving empiric treatment for acute respiratory infection (aRRR = 2.04, 99 % CI = 1.06-3.94). Among No-IMID, OSS was effective for two indicators: emergency and priority patients admitted, detained or referred (aRRR = 2.12, 99 % CI = 1.05-4.28) and emergency patients receiving at least one appropriate treatment (aRRR = 1.98, 99 % CI = 1.21-3.24). CONCLUSION Effects of OSS on workload were not statistically significant. Significant OSS effects on facility performance across subgroups were heterogeneous. OSS supported MLP who diagnosed and treated patients to apply IMID knowledge. For other providers, OSS supported team work to manage emergency patients. This evidence on OSS effectiveness could inform interventions to improve health workers' capacity to deliver better quality infectious diseases care.
Collapse
Affiliation(s)
- Martin Kayitale Mbonye
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sarah M. Burnett
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Accordia Global Health Foundation, Washington, DC USA
- PATH, Washington, DC USA
| | - Sarah Naikoba
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Save the Children, Kampala, Uganda
| | - Allan Ronald
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba Canada
| | - Robert Colebunders
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Marcia R. Weaver
- Department of Global Health, University of Washington, International Training and Education Center for Health (I-TECH), Seattle, WA USA
- Department of Global Health, University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA USA
| |
Collapse
|
22
|
Bassat Q, Lanaspa M, Machevo S, O'Callaghan-Gordo C, Madrid L, Nhampossa T, Acácio S, Roca A, Alonso PL. Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models. Trop Med Int Health 2016; 21:1147-56. [DOI: 10.1111/tmi.12738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Quique Bassat
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| | - Miguel Lanaspa
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| | - Sónia Machevo
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| | - Cristina O'Callaghan-Gordo
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
- Centre for Research in Environmental Epidemiology; Barcelona Spain
| | - Lola Madrid
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| | - Tacilta Nhampossa
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
- National Institute of Health; Ministry of Health; Maputo Mozambique
| | - Sozinho Acácio
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
- National Institute of Health; Ministry of Health; Maputo Mozambique
| | - Anna Roca
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
- Medical Research Council Unit; Banjul The Gambia
| | - Pedro L. Alonso
- ISGlobal; Barcelona Centre of International Health Research; Universitat de Barcelona; Barcelona Spain
- Centro de Investigação em Saúde de Manhiça; Maputo Mozambique
| |
Collapse
|
23
|
Usonis V, Ivaskevicius R, Diez-Domingo J, Esposito S, Falup-Pecurariu OG, Finn A, Rodrigues F, Spoulou V, Syrogiannopoulos GA, Greenberg D. Comparison between diagnosis and treatment of community-acquired pneumonia in children in various medical centres across Europe with the United States, United Kingdom and the World Health Organization guidelines. Pneumonia (Nathan) 2016; 8:5. [PMID: 28702285 PMCID: PMC5469201 DOI: 10.1186/s41479-016-0005-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/30/2015] [Indexed: 11/27/2022] Open
Abstract
Background The aim of this study was to review the current status and usage of guidelines in the diagnosis and treatment of community-acquired pneumonia (CAP) in European countries and to compare to established guidelines in the United States (US), United Kingdom (UK), and the World Health Organization (WHO). Methods A questionnaire was developed and distributed by the Community-Acquired Pneumonia Paediatric Research Initiative (CAP-PRI) working group and distributed to medical centres across Europe. Results Out of 19 European centres, 6 (31.6 %) used WHO guidelines (3 in combination with other guidelines), 5 (26.3 %) used national guidelines, and 5 (26.3 %) used local guidelines. Chest radiograph and complete blood count were the most common diagnostic examinations, while evaluation of clinical symptoms and laboratory tests varied significantly. Tachypnoea and chest recession were considered criteria for diagnosis in all three guidelines. In US and UK guidelines blood cultures, atypical bacterial and viral detection tests were recommended. In European centres in outpatient settings, amoxicillin was used in 16 (84 %) centers, clarithromycin in 9 (37 %) centers and azithromycin in 7 (47 %) centers, whereas in hospital settings antibiotic treatment varied widely. Amoxicillin is recommended as the first drug of choice for outpatient treatment in all guidelines. Conclusions Although local variations in clinical criteria, laboratory tests, and antibiotic resistance rates may necessitate some differences in standard empirical antibiotic regimens, there is considerable scope for standardisation across European centres for the diagnosis and treatment of CAP. Electronic supplementary material The online version of this article (doi:10.1186/s41479-016-0005-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Vytautas Usonis
- Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania
| | | | | | - Susanna Esposito
- Department of Maternal and Paediatric Sciences, Università degli Studi di Milano Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Adam Finn
- Bristol Children's Vaccine Centre, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Fernanda Rodrigues
- Infectious Diseases Unit & Emergency Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vana Spoulou
- First Department of Paediatrics, Agia Sophia Children's Hospital, Athens, Greece
| | - George A Syrogiannopoulos
- Department of Paediatrics, General University Hospital of Larissa, Larissa, Greece.,School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - David Greenberg
- The Paediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health-Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | |
Collapse
|
24
|
Etiology and Factors Associated with Pneumonia in Children under 5 Years of Age in Mali: A Prospective Case-Control Study. PLoS One 2015; 10:e0145447. [PMID: 26696249 PMCID: PMC4687909 DOI: 10.1371/journal.pone.0145447] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/03/2015] [Indexed: 11/28/2022] Open
Abstract
Background There are very limited data on children with pneumonia in Mali. The objective was to assess the etiology and factors associated with community-acquired pneumonia in hospitalized children <5 years of age in Mali. Methods A prospective hospital-based case-control study was implemented in the Pediatric department of Gabriel Touré University Hospital at Bamako, Mali, between July 2011-December 2012. Cases were children with radiologically-confirmed pneumonia; Controls were hospitalized children without respiratory features, matched for age and period. Respiratory specimens, were collected to identify 19 viruses and 5 bacteria. Whole blood was collected from cases only. Factors associated with pneumonia were assessed by multivariate logistic regression. Results Overall, 118 cases and 98 controls were analyzed; 44.1% were female, median age was 11 months. Among pneumonia cases, 30.5% were hypoxemic at admission, mortality was 4.2%. Pneumonia cases differed from the controls regarding clinical signs and symptoms but not in terms of past medical history. Multivariate analysis of nasal swab findings disclosed that S. pneumoniae (adjusted odds ratio [aOR] = 3.4, 95% confidence interval [95% CI]: 1.6–7.0), human metapneumovirus (aOR = 17.2, 95% CI: 2.0–151.4), respiratory syncytial virus [RSV] (aOR = 7.4, 95% CI: 2.3–23.3), and influenza A virus (aOR = 10.7, 95% CI: 1.0–112.2) were associated with pneumonia, independently of patient age, gender, period, and other pathogens. Distribution of S. pneumoniae and RSV differed by season with higher rates of S. pneumoniae in January-June and of RSV in July-September. Pneumococcal serotypes 1 and 5 were more frequent in pneumonia cases than in the controls (P = 0.009, and P = 0.04, respectively). Conclusions In this non-PCV population from Mali, pneumonia in children was mainly attributed to S. pneumoniae, RSV, human metapneumovirus, and influenza A virus. Increased pneumococcal conjugate vaccine coverage in children could significantly reduce the burden of pneumonia in sub-Saharan African countries.
Collapse
|
25
|
Agreement Between the World Health Organization Algorithm and Lung Consolidation Identified Using Point-of-Care Ultrasound for the Diagnosis of Childhood Pneumonia by General Practitioners. Lung 2015; 193:531-8. [PMID: 25921013 DOI: 10.1007/s00408-015-9730-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/15/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE The World Health Organization (WHO) case management algorithm for acute lower respiratory infections has moderate sensitivity and poor specificity for the diagnosis of pneumonia. We sought to determine the feasibility of using point-of-care ultrasound in resource-limited settings to identify pneumonia by general health practitioners and to determine agreement between the WHO algorithm and lung consolidations identified by point-of-care ultrasound. METHODS An expert radiologist taught two general practitioners how to perform point-of-care ultrasound over a seven-day period. We then conducted a prospective study of children aged 2 months to 3 years in Peru and Nepal with and without respiratory symptoms, which were evaluated by point-of-care ultrasound to identify lung consolidation. RESULTS We enrolled 378 children: 127 were controls without respiratory symptoms, 82 had respiratory symptoms without clinical pneumonia, and 169 had clinical pneumonia by WHO criteria. Point-of-care ultrasound was performed in the community (n = 180), in outpatient offices (n = 95), in hospital wards (n = 19), and in Emergency Departments (n = 84). Average time to perform point-of-care ultrasound was 6.4 ± 2.2 min. Inter-observer agreement for point-of-care ultrasound interpretation between general practitioners was high (κ = 0.79, 95 % CI 0.73-0.81). The diagnosis of pneumonia using the WHO algorithm yielded a sensitivity of 69.6 % (95 % CI 55.7-80.8 %), specificity of 59.6 % (95 % CI 54.0-65.0 %), and positive and negative likelihood ratios of 1.73 (95 % CI 1.39-2.15) and 0.51 (95 % CI 0.30-0.76) when lung consolidation on point-of-care ultrasound was used as the reference. CONCLUSIONS The WHO algorithm disagreed with point-of-care ultrasound findings in more than one-third of children and had an overall low performance when compared with point-of-care ultrasound to identify lung consolidation. A paired approach with point-of-care ultrasound may improve case management in resource-limited settings.
Collapse
|
26
|
Rambaud-Althaus C, Althaus F, Genton B, D'Acremont V. Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2015; 15:439-50. [PMID: 25769269 DOI: 10.1016/s1473-3099(15)70017-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pneumonia is the biggest cause of deaths in young children in developing countries, but early diagnosis and intervention can effectively reduce mortality. We aimed to assess the diagnostic value of clinical signs and symptoms to identify radiological pneumonia in children younger than 5 years and to review the accuracy of WHO criteria for diagnosis of clinical pneumonia. METHODS We searched Medline (PubMed), Embase (Ovid), the Cochrane Database of Systematic Reviews, and reference lists of relevant studies, without date restrictions, to identify articles assessing clinical predictors of radiological pneumonia in children. Selection was based on: design (diagnostic accuracy studies), target disease (pneumonia), participants (children aged <5 years), setting (ambulatory or hospital care), index test (clinical features), and reference standard (chest radiography). Quality assessment was based on the 2011 Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. For each index test, we calculated sensitivity and specificity and, when the tests were assessed in four or more studies, calculated pooled estimates with use of bivariate model and hierarchical summary receiver operation characteristics plots for meta-analysis. FINDINGS We included 18 articles in our analysis. WHO-approved signs age-related fast breathing (six studies; pooled sensitivity 0·62, 95% CI 0·26-0·89; specificity 0·59, 0·29-0·84) and lower chest wall indrawing (four studies; 0·48, 0·16-0·82; 0·72, 0·47-0·89) showed poor diagnostic performance in the meta-analysis. Features with the highest pooled positive likelihood ratios were respiratory rate higher than 50 breaths per min (1·90, 1·45-2·48), grunting (1·78, 1·10-2·88), chest indrawing (1·76, 0·86-3·58), and nasal flaring (1·75, 1·20-2·56). Features with the lowest pooled negative likelihood ratio were cough (0·30, 0·09-0·96), history of fever (0·53, 0·41-0·69), and respiratory rate higher than 40 breaths per min (0·43, 0·23-0·83). INTERPRETATION Not one clinical feature was sufficient to diagnose pneumonia definitively. Combination of clinical features in a decision tree might improve diagnostic performance, but the addition of new point-of-care tests for diagnosis of bacterial pneumonia would help to attain an acceptable level of accuracy. FUNDING Swiss National Science Foundation.
Collapse
Affiliation(s)
- Clotilde Rambaud-Althaus
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Fabrice Althaus
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Blaise Genton
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland; Infectious Disease Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland; Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
27
|
Sonego M, Pellegrin MC, Becker G, Lazzerini M. Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies. PLoS One 2015; 10:e0116380. [PMID: 25635911 PMCID: PMC4312071 DOI: 10.1371/journal.pone.0116380] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 12/06/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries. DESIGN Systematic review and meta-analysis. STUDY SELECTION Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries. DATA SOURCES Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014. RISK OF BIAS ASSESSMENT Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. RESULTS Out of 10,655 papers retrieved, 77 studies from 39 countries (198,359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37‒13.92); age below two months (5.22, 1.70‒16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67‒8.61), chronic underlying diseases (4.76, 3.27‒6.93); HIV/AIDS (4.68, 3.72‒5.90); and severe malnutrition (OR 4.27, 3.47‒5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03‒3.31); low maternal education (1.43, 1.13‒1.82); low socio-economic status (1.62, 1.32‒2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11‒4.31). Immunisation (0.46, 0.36‒0.58) and good antenatal practices (0.50, 0.31‒0.81) were associated with decreased odds of death. CONCLUSIONS Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.
Collapse
Affiliation(s)
- Michela Sonego
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery, and Health Science, University of Trieste, Trieste, Italy
| | - Maria Chiara Pellegrin
- Department of Medicine, Surgery, and Health Science, University of Trieste, Trieste, Italy
| | - Genevieve Becker
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- * E-mail:
| |
Collapse
|
28
|
Picot VS, Bénet T, Messaoudi M, Telles JN, Chou M, Eap T, Wang J, Shen K, Pape JW, Rouzier V, Awasthi S, Pandey N, Bavdekar A, Sanghvi S, Robinson A, Contamin B, Hoffmann J, Sylla M, Diallo S, Nymadawa P, Dash-Yandag B, Russomando G, Basualdo W, Siqueira MM, Barreto P, Komurian-Pradel F, Vernet G, Endtz H, Vanhems P, Paranhos-Baccalà G. Multicenter case-control study protocol of pneumonia etiology in children: Global Approach to Biological Research, Infectious diseases and Epidemics in Low-income countries (GABRIEL network). BMC Infect Dis 2014; 14:635. [PMID: 25927410 PMCID: PMC4272811 DOI: 10.1186/s12879-014-0635-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/17/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Data on the etiologies of pneumonia among children are inadequate, especially in developing countries. The principal objective is to undertake a multicenter incident case-control study of <5-year-old children hospitalized with pneumonia in developing and emerging countries, aiming to identify the causative agents involved in pneumonia while assessing individual and microbial factors associated with the risk of severe pneumonia. METHODS/DESIGN A multicenter case-control study, based on the GABRIEL network, is ongoing. Ten study sites are located in 9 countries over 3 continents: Brazil, Cambodia, China, Haiti, India, Madagascar, Mali, Mongolia, and Paraguay. At least 1,000 incident cases and 1,000 controls will be enrolled and matched for age and date. Cases are hospitalized children <5 years with radiologically confirmed pneumonia, and the controls are children without any features suggestive of pneumonia. Respiratory specimens are collected from all enrolled subjects to identify 19 viruses and 5 bacteria. Whole blood from pneumonia cases is being tested for 3 major bacteria. S. pneumoniae-positive specimens are serotyped. Urine samples from cases only are tested for detection of antimicrobial activity. The association between procalcitonin, C-reactive protein and pathogens is being evaluated. A discovery platform will enable pathogen identification in undiagnosed samples. DISCUSSION This multicenter study will provide descriptive results for better understanding of pathogens responsible for pneumonia among children in developing countries. The identification of determinants related to microorganisms associated with pneumonia and its severity should facilitate treatment and prevention.
Collapse
Affiliation(s)
- Valentina Sanchez Picot
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Thomas Bénet
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
- Epidemiology and Public Health Unit, University of Lyon 1, Lyon, France.
| | - Melina Messaoudi
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Jean-Noël Telles
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Monidarin Chou
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia.
| | - Tekchheng Eap
- Department of Pneumology, National Pediatric Hospital, Phnom Penh, Cambodia.
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens and Dr. Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College), Beijing, China.
| | - Kunling Shen
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Jean-William Pape
- GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) Centers, Port au Prince, Haiti.
| | - Vanessa Rouzier
- GHESKIO (Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes) Centers, Port au Prince, Haiti.
| | | | - Nitin Pandey
- Chatrapati Shahuji Maharaj University, Lucknow, India.
| | | | | | | | - Bénédicte Contamin
- Fondation Mérieux, Centre d'Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar.
| | - Jonathan Hoffmann
- Fondation Mérieux, Centre d'Infectiologie Charles Mérieux (CICM), Antananarivo, Madagascar.
| | | | | | | | | | | | - Wilma Basualdo
- Hospital Pediátrico "Niños de Acosta Ñu", San Lorenzo, Paraguay.
| | - Marilda M Siqueira
- Respiratory virus Laboratory, Oswaldo Cruz Foundation, Hospital Bonsucesso, Rio de Janeiro, Brazil.
| | - Patricia Barreto
- Respiratory virus Laboratory, Oswaldo Cruz Foundation, Hospital Bonsucesso, Rio de Janeiro, Brazil.
| | - Florence Komurian-Pradel
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Guy Vernet
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Hubert Endtz
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| | - Philippe Vanhems
- Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
- Epidemiology and Public Health Unit, University of Lyon 1, Lyon, France.
| | - Gláucia Paranhos-Baccalà
- Emerging Pathogens Laboratory - Fondation Mérieux, Centre International de Recherche en Infectiologie (CIRI) Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 21, Avenue Tony Garnier, Lyon, 69007, France.
| |
Collapse
|
29
|
Räsänen J, Gavriely N. Childhood Pneumonia Screener: a concept. Pneumonia (Nathan) 2014; 5:52-58. [PMID: 31641574 PMCID: PMC5922325 DOI: 10.15172/pneu.2014.5/515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/01/2014] [Indexed: 12/02/2022] Open
Abstract
Childhood pneumonia continues to be the number one cause of death in children under five years of age in developing countries. In addition to mortality, pneumonia constitutes an enormous economic and social burden because late diagnosis is associated with high cost of treatment and often leads to chronic health problems. There are several bottlenecks in developing countries in the case flow of a child with lung infection: 1) recognising the symptoms as a reason to seek care, 2) getting the patient to a first-tier health facility, 3) scarcity of trained healthcare personnel who can diagnose the condition and its severity, 4) access to a second-tier facility in severe cases. These factors are commonly present in rural areas but even in more urban settings, access to a physician is often delayed. The Childhood Pneumonia Screener project aims at bridging the diagnostic gap using emerging technology. Mobile “smart” phone communication with several inexpensive dedicated sensors is proposed as a rapid data-collection and transmission unit that is connected to a central location where trained personnel assisted by sophisticated signal processing algorithms, evaluate the data and determine if the child is likely to have pneumonia and what the level and urgency of care should be.
Collapse
Affiliation(s)
- Jukka Räsänen
- 17Department of Anesthesiology, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL 33612 USA
| | | |
Collapse
|
30
|
Gowraiah V, Awasthi S, Kapoor R, Sahana D, Venkatesh P, Gangadhar B, Awasthi A, Verma A, Pai N, Seear M. Can we distinguish pneumonia from wheezy diseases in tachypnoeic children under low-resource conditions? A prospective observational study in four Indian hospitals. Arch Dis Child 2014; 99:899-906. [PMID: 24925892 DOI: 10.1136/archdischild-2013-305740] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acute respiratory infections are the commonest cause of mortality and morbidity in children worldwide. A quarter of all deaths occur in India alone. In order to reduce this disease burden, there is a need for better diagnostic criteria, particularly ones allowing early detection of high-risk children. METHODS We enrolled 516 under 5 year olds, in four Indian hospitals, who met WHO age-dependent tachypnoea criteria for pneumonia at presentation. Patients underwent a protocolised examination assessing 29 items, including history, examination, O2 saturation, plus scores for chest X-ray, auscultation and conscious level. Treatment was determined by the emergency room (ER) physician. All children were reviewed at day 4 by a paediatrician and placed into four diagnostic categories: pneumonia, wheezy disease, mixed and non-respiratory. RESULTS The majority had wheezy diseases (42.8%). The remainder had pneumonia (35.9%), mixed disease (18.6%) and non-respiratory (2.7%). Best diagnostic predictors for wheezy disease were (auscultation/previous similar episodes) and for pneumonia (auscultation/CXR score). Mortality was 1.6%. Best disease severity predictors were conscious level, weight/age z score and respiratory/pulse rates. INTERPRETATION Current tachypnoea-based algorithms significantly overdiagnose pneumonia in children and underdiagnose wheezy diseases. Diagnostic accuracy can be improved by various combinations of clinical variables, but the best single diagnostic predictor is auscultation. Simple criteria can also be defined that reliably detect which tachypnoeic children are at high risk of death or deterioration. Management plans based on these protocols could reduce unnecessary antibiotic use, improve the management of wheezy diseases and reduce mortality by earlier identification of high-risk children.
Collapse
Affiliation(s)
- Vishwanath Gowraiah
- Divisions of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
| | - Shally Awasthi
- Department of Paediatrics, King George Medical University, Lucknow, India
| | - Rashmi Kapoor
- Department of Pediatrics, Regency Hospital, Kanpur, India
| | - Devdas Sahana
- Department of Paediatrics, Vanivilas Hospital, Bangalore Medical College & Research Centre, Bangalore, India
| | - Pushpalatha Venkatesh
- Department of Paediatrics, Bowring and Lady Curzon Hospital, Bangalore Medical College & Research Centre, Bangalore, India
| | - Belvadi Gangadhar
- Department of Paediatrics, Vanivilas Hospital, Bangalore Medical College & Research Centre, Bangalore, India
| | | | - Anilkumar Verma
- Department of Paediatrics, King George Medical University, Lucknow, India
| | - Nanditha Pai
- Department of Paediatrics, Vanivilas Hospital, Bangalore Medical College & Research Centre, Bangalore, India
| | - Michael Seear
- Divisions of Respiratory Medicine, BC's Children's Hospital, Vancouver, Canada
| |
Collapse
|
31
|
Weaver MR, Burnett SM, Crozier I, Kinoti SN, Kirunda I, Mbonye MK, Naikoba S, Ronald A, Rubashembusya T, Zawedde S, Willis KS. Improving facility performance in infectious disease care in Uganda: a mixed design study with pre/post and cluster randomized trial components. PLoS One 2014; 9:e103017. [PMID: 25133799 PMCID: PMC4136733 DOI: 10.1371/journal.pone.0103017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/12/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The effects of two interventions, Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS), were tested on 23 facility performance indicators for emergency triage assessment and treatment (ETAT), malaria, pneumonia, tuberculosis, and HIV. METHODS The trial was implemented in 36 primary care facilities in Uganda. From April 2010, two mid-level practitioners per facility participated in IMID training. Eighteen of 36 facilities were randomly assigned to Arm A, and received OSS in 2010 (nine monthly two-day sessions); 18 facilities assigned to Arm B did not receive OSS in 2010. Data were collected from Nov 2009 to Dec 2010 using a revised Ministry of Health outpatient medical form and nine registers. We analyzed the effect of IMID training alone by measuring changes before and during IMID training in Arm B, the combined effect of IMID training and OSS by measuring changes in Arm A, and the incremental effect of OSS by comparing changes across Arms A and B. RESULTS IMID training was associated with statistically significant improvement in three indicators: outpatients triaged (adjusted relative risks (aRR) = 1.29, 99%CI = 1.01,1.64), emergency and priority patients admitted, detained, or referred (aRR = 1.59, 99%CI = 1.04,2.44), and pneumonia suspects assessed (aRR = 2.31, 99%CI = 1.50,3.55). IMID training and OSS combined was associated with improvements in six indicators: three ETAT indicators (outpatients triaged (aRR = 2.03, 99%CI = 1.13,3.64), emergency and priority patients admitted, detained or referred (aRR = 3.03, 99%CI = 1.40,6.56), and emergency patients receiving at least one appropriate treatment (aRR = 1.77, 99%CI = 1.10,2.84)); two malaria indicators (malaria cases receiving appropriate antimalarial (aRR = 1.50, 99%CI = 1.04,2.17), and patients with negative malaria test results prescribed antimalarial (aRR = 0.67, 99%CI = 0.46,0.97)); and enrollment in HIV care (aRR = 1.58, 99%CI = 1.32,1.89). OSS was associated with incremental improvement in emergency patients receiving at least one appropriate treatment (adjusted ratio of RR = 1.84,99%CI = 1.09,3.12). CONCLUSION The trial showed that the OSS intervention significantly improved performance in one of 23 facility indicators.
Collapse
Affiliation(s)
- Marcia R. Weaver
- Departments of Global Health and Health Services, University of Washington, Seattle Washington, United States of America
| | - Sarah M. Burnett
- Accordia Global Health Foundation, Washington, District of Columbia, United States of America, and Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Ian Crozier
- Accordia Global Health Foundation, Washington, District of Columbia, United States of America
| | - Stephen N. Kinoti
- Center for Human Services, University Research Co. LLC, Bethesda, Maryland, United States of America, and Fio Corporation, Toronto, Ontario, Canada
| | | | - Martin K. Mbonye
- Infectious Diseases Institute, Makerere University, Kampala, Uganda and Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Sarah Naikoba
- Infectious Diseases Institute, Makerere University, Kampala, Uganda and Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Allan Ronald
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Timothy Rubashembusya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda and Institute of Development Policy and Management, University of Manchester, Manchester, England
| | - Stella Zawedde
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Kelly S. Willis
- Accordia Global Health Foundation, Washington, District of Columbia, United States of America
| |
Collapse
|
32
|
Agweyu A, Kibore M, Digolo L, Kosgei C, Maina V, Mugane S, Muma S, Wachira J, Waiyego M, Maleche-Obimbo E. Prevalence and correlates of treatment failure among Kenyan children hospitalised with severe community-acquired pneumonia: a prospective study of the clinical effectiveness of WHO pneumonia case management guidelines. Trop Med Int Health 2014; 19:1310-20. [PMID: 25130866 PMCID: PMC4241029 DOI: 10.1111/tmi.12368] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective To determine the extent and pattern of treatment failure (TF) among children hospitalised with community-acquired pneumonia at a large tertiary hospital in Kenya. Methods We followed up children aged 2–59 months with WHO-defined severe pneumonia (SP) and very severe pneumonia (VSP) for up to 5 days for TF using two definitions: (i) documentation of pre-defined clinical signs resulting in change of treatment (ii) primary clinician's decision to change treatment with or without documentation of the same pre-defined clinical signs. Results We enrolled 385 children. The risk of TF varied between 1.8% (95% CI 0.4–5.1) and 12.4% (95% CI 7.9–18.4) for SP and 21.4% (95% CI 15.9–27) and 39.3% (95% CI 32.5–46.4) for VSP depending on the definition applied. Higher rates were associated with early changes in therapy by clinician in the absence of an obvious clinical rationale. Non-adherence to treatment guidelines was observed for 70/169 (41.4%) and 67/201 (33.3%) of children with SP and VSP, respectively. Among children with SP, adherence to treatment guidelines was associated with the presence of wheeze on initial assessment (P = 0.02), while clinician non-adherence to guideline-recommended treatments for VSP tended to occur in children with altered consciousness (P < 0.001). Using propensity score matching to account for imbalance in the distribution of baseline clinical characteristics among children with VSP revealed no difference in TF between those treated with the guideline-recommended regimen vs. more costly broad-spectrum alternatives [risk difference 0.37 (95% CI −0.84 to 0.51)]. Conclusion Before revising current pneumonia case management guidelines, standardised definitions of TF and appropriate studies of treatment effectiveness of alternative regimens are required. Objectif Déterminer l'ampleur et les caractéristiques de l’échec du traitement (ET) chez les enfants hospitalisés avec une pneumonie acquise dans la communauté dans un grand hôpital tertiaire du Kenya. Méthodes Nous avons suivi des enfants âgés de 2 à 59 mois avec une pneumonie sévère (PS) et une pneumonie très sévère (PTS) telles que définies par l’OMS, sur un maximum de cinq jours pour l’ET, en utilisant deux définitions: (a) documentation des signes cliniques prédéfinis ayant entraîné un changement du traitement, (b) décision primaire du clinicien de changer de traitement avec ou sans documentation des mêmes signes cliniques prédéfinis. Résultats Nous avons recruté 385 enfants. Le risque d’ET variait de 1,8% (IC95%: 0,4 à 5,1) à 12,4% (IC95%: 7,9 à 18,4) pour la PS et de 21,4% (IC95%: 15,9 à 27) à 39,3% (IC95%: 32,5 à 46,4) pour la PTS selon la définition appliquée. Des taux plus élevés étaient associés à des changements précoces du traitement par le clinicien en l'absence d'une justification clinique évidente. Le non-respect des directives de traitement a été observé pour 70/169 (41,4%) et 67/201 (33,3%) enfants avec une PS et une PTS respectivement. Chez les enfants avec une PS, le respect des directives de traitement était associé avec la présence d'une respiration sifflante au cours l’évaluation initiale (P = 0,02) tandis que le non respect par les cliniciens des traitements recommandés pour la PTS tendait à se produire chez les enfants avec une altération de la conscience (P <0,001). L'utilisation du score de propension correspondant pour tenir compte du déséquilibre dans la répartition des caractéristiques cliniques de base chez les enfants avec une PTS n'a révélé aucune différence dans l’ET entre ceux traités avec le régime recommandé par les directives et ceux traités par des alternatives plus coûteuses à large spectre (différence de risque: 0,37 (IC95%: -0,84 à 0,51). Conclusion Avant la révision des directives actuelles de prise en charge des cas de pneumonie, des définitions standard d’ET et des études appropriées de l'efficacité des traitements alternatifs sont nécessaires. Objetivo Determinar la extensión y el patrón del fallo en el tratamiento (FT) en niños hospitalizados con una neumonía adquirida en la comunidad, ingresados en un gran hospital terciario de Kenia. Métodos Hemos seguido a niños con edades entre los 2-59 meses con una neumonía severa (NS) y neumonía muy severa (NMS) según definición de la OMS de hasta cinco días para FT utilizando dos definiciones: (a) documentación de signos clínicos pre-definidos que resultaron en un cambio de tratamiento (b) decisión del clínico principal de cambiar el tratamiento con o sin documentación de los mismos signos clínicos pre-definidos. Resultados Incluimos a 385 niños. El riesgo de FT varió entre un 1.8% (IC 95% 0.4 a 5.1) y 12.4% (IC 95% 7.9 a 18.4) para NS y 21.4% (IC 95% 15.9 a 27) y 39.3% (IC 95% 32.5 a 46.4) para NMS dependiendo de la definición que se aplicase. Unas mayores tasas estaban asociadas con cambios tempranos en la terapia por el clínico y en ausencia de un razonamiento clínico obvio. Se observaba una no adherencia a las guías de tratamiento en 70/169 (41.4%) y 67/201 (33.3%) de los niños con NS y NMS respectivamente. Entre los niños con SP, la adherencia a las guías de tratamiento estaba asociada con la presencia de sibilancias en la evaluación inicial (P=0.02) mientras que la no adherencia del clínico a los tratamientos recomendados por las guías para NMS tendían a ocurrir en niños con un estado alterado de consciencia (P<0.001). Utilizando el pareamiento por puntaje de propensión para equilibrar los grupos en la distribución de las características clínicas de base de los niños con NMS, se observó que no existían diferencias en FT entre aquellos tratados con el régimen recomendado por las guías versus alternativas más costosas de amplio espectro (diferencias de riesgo 0.37 (IC 95% -0.84 a 0.51). Conclusión Antes de revisar las actuales guías de manejo de casos de neumonía, se requieren definiciones estandarizadas de FT y estudios apropiados de la efectividad del tratamiento de regímenes alternativos.
Collapse
Affiliation(s)
- Ambrose Agweyu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Orimadegun A, Ogunbosi B, Orimadegun B. Hypoxemia predicts death from severe falciparum malaria among children under 5 years of age in Nigeria: the need for pulse oximetry in case management. Afr Health Sci 2014; 14:397-407. [PMID: 25320590 DOI: 10.4314/ahs.v14i2.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Oxygen saturation is a good marker for disease severity in emergency care. However, studies have not considered its use in identifying individuals infected with Plasmodium falciparum at risk of deaths. OBJECTIVE To investigate the prevalence and predictive value of hypoxaemia for deaths in under-5s with severe falciparum malaria infection. METHODS Oxygen saturation was prospectively measured alongside other indicators of disease severity in 369 under-5s admitted to a tertiary hospital in Nigeria. Participants were children in whom falciparum malaria parasitaemia was confirmed with blood film microscopy in the presence of any of the World Health Organization-defined life-threatening features for malaria. RESULTS Overall mortality rate was 8.1%. Of the 16 indicators of the disease severity assessed, hypoxaemia (OR=7.54; 95% CI=2.80, 20.29), co-morbidity with pneumonia (OR=19.27; 95% CI=2.87, 29.59), metabolic acidosis (OR=6.21; 95% CI=2.21, 17.47) and hypoglycaemia (OR=19.71; 95% CI=2.61, 25.47) were independent predictors of death. Cerebral malaria, male gender, wasting, hypokalaemia, hyponatriaemia, azotaemia and renal impairment were significantly associated with death in univariate analysis but not logistic regression model. CONCLUSIONS Hypoxaemia predicts deaths in Nigerian children with severe malaria, irrespective of other features. Efforts should always be made to measure oxygen saturation as part of the treatments for severe malaria in children.
Collapse
Affiliation(s)
- Adebola Orimadegun
- Institute of Child Health College of Medicine, University of Ibadan, Nigeria
| | - Babatunde Ogunbosi
- Department of Paediatrics, College of Medicine, University of Ibadan, Nigeria
| | - Bose Orimadegun
- Department of Chemical Pathology, College of Medicine, University of Ibadan, Nigeria
| |
Collapse
|
34
|
Ginsburg AS, Gerth-Guyette E, Mollis B, Gardner M, Chham S. Oxygen and pulse oximetry in childhood pneumonia: surveys of clinicians and student clinicians in Cambodia. Trop Med Int Health 2014; 19:537-44. [PMID: 24628874 DOI: 10.1111/tmi.12291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To better understand the availability of oxygen and pulse oximetry, barriers to use, clinician perceptions and practices regarding their role in the management of childhood pneumonia, and the formal education and training regarding these technologies received by student clinicians in Cambodia. METHODS In the clinician survey, we surveyed 81 clinicians practising at all national paediatric, provincial and district referral hospitals throughout Cambodia. Respondents were primarily physicians whose scope of practice included paediatrics, and most reported the presence of oxygen (93% (95% confidence interval (CI) [87, 98])) but less availability of pulse oximetry (51% (95% CI [39, 61])). RESULTS Common barriers to use included a lack of policies and guidelines, as well as a lack of training. In the student clinician survey, 332 graduating medical and nursing students were surveyed, and most reported learning about oxygen (96% (95% CI [94, 98])) and pulse oximetry (72% (95% CI [67, 77])) during their training. CONCLUSIONS Data from both surveys indicate that despite their utility, oxygen and pulse oximetry may be underused in Cambodia. The reported barriers and perceptions of the tools indicate a clear role for improved training for clinicians and students on the use of oxygen and pulse oximetry, the value of oxygen and pulse oximetry for managing childhood pneumonia, and the need for improved policies and guidelines governing their use.
Collapse
|
35
|
Review of guidelines for evidence-based management for childhood community-acquired pneumonia in under-5 years from developed and developing countries. Pediatr Infect Dis J 2013; 32:1281-2. [PMID: 24141800 DOI: 10.1097/inf.0b013e3182a4dcfa] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Determinants of oxygen therapy in childhood pneumonia in a resource-constrained region. ISRN PEDIATRICS 2013; 2013:435976. [PMID: 23819060 PMCID: PMC3684098 DOI: 10.1155/2013/435976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 05/13/2013] [Indexed: 11/21/2022]
Abstract
Childhood pneumonia is a leading cause of morbidity and mortality among underfives particularly in the resource-constraint part of the world. A high proportion of these deaths are due to lack of oxygen, thereby making oxygen administration a life-saving adjunctive when indicated. However, many primary health centres that manage most of the cases often lack the adequate manpower and facilities to decide which patient should be on oxygen therapy. Therefore, this study aimed to determine factors that predict hypoxaemia at presentation in children with severe pneumonia.
Four hundred and twenty children aged from 2 to 59 months (40% infants) with severe pneumonia admitted to a health centre in rural Gambia were assessed at presentation. Eighty-one of them (19.30%) had hypoxaemia (oxygen saturation < 90%). Children aged 2–11 months, with grunting respiration, cyanosis, and head nodding, and those with cardiomegaly on chest radiograph were at higher risk of hypoxaemia (P < 0.05). Grunting respiration (OR = 5.210, 95% CI 2.287–7.482) and cyanosis (OR = 83.200, 95% CI 5.248–355.111) were independent predictors of hypoxaemia in childhood pneumonia. We conclude that children that grunt and are centrally cyanosed should be preferentially commenced on oxygen therapy even when there is no facility to confirm hypoxaemia.
Collapse
|
37
|
Fox MP, Thea DM, Sadruddin S, Bari A, Bonawitz R, Hazir T, Bin Nisar Y, Qazi SA. Low rates of treatment failure in children aged 2-59 months treated for severe pneumonia: a multisite pooled analysis. Clin Infect Dis 2012; 56:978-87. [PMID: 23264361 DOI: 10.1093/cid/cis1201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Despite advances in childhood pneumonia management, it remains a major killer of children worldwide. We sought to estimate global treatment failure rates in children aged 2-59 months with World Health Organization-defined severe pneumonia. METHODS We pooled data from 4 severe pneumonia studies conducted during 1999-2009 using similar methodologies. We defined treatment failure by day 6 as death, danger signs (inability to drink, convulsions, abnormally sleepy), fever (≥38°C) and lower chest indrawing (LCI; days 2-3), LCI (day 6), or antibiotic change. RESULTS Among 6398 cases of severe pneumonia from 10 countries, 564 (cluster adjusted: 8.5%; 95% confidence interval [CI], 5.9%-11.5%) failed treatment by day 6. The most common reasons for clinical failure were persistence of fever and LCI or LCI or fever alone (75% of failures). Seventeen (0.3%) children died. Danger signs were uncommon (<1%). Infants 6-11 months and 2-5 months were 2- and 3.5-fold more likely, respectively, to fail treatment (adjusted OR [AOR], 1.8 [95% CI, 1.4-2.3] and AOR, 3.5 [95% CI, 2.8-4.3]) as children aged 12-59 months. Failure was increased 7-fold (AOR, 7.2 [95% CI, 5.0-10.5]) when comparing infants 2-5 months with very fast breathing to children 12-59 months with normal breathing. CONCLUSIONS Our findings demonstrate that severe pneumonia case management with antibiotics at health facilities or in the community is associated with few serious morbidities or deaths across diverse geographic settings and support moves to shift management of severe pneumonia with oral antibiotics to outpatients in the community.
Collapse
Affiliation(s)
- Matthew P Fox
- Center for Global Health and Development, Boston University, Boston, MA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Ginsburg AS, Van Cleve WC, Thompson MIW, English M. Oxygen and pulse oximetry in childhood pneumonia: a survey of healthcare providers in resource-limited settings. J Trop Pediatr 2012; 58:389-93. [PMID: 22170511 DOI: 10.1093/tropej/fmr103] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Globally, pneumonia is the leading cause of death in children <5 years of age. Hypoxemia, a frequent complication of pneumonia, is a risk factor for death. To better understand the availability of oxygen and pulse oximetry, barriers to use and provider perceptions and practices regarding their role in childhood pneumonia, we conducted a survey using a convenience sampling strategy targeting clinicians working in resource-limited countries. Most respondents were physicians from public district and provincial hospitals with access to oxygen and pulse oximetry; however, reported therapeutic use for childhood pneumonia was low. Common barriers included insufficient supply, competition for use, lack of policies, guidelines and training and perceived high cost. Despite the frequency of hypoxemia, the inaccuracy of clinical predictors, the poor outcome hypoxemia portends and the effectiveness of pulse oximetry and oxygen in childhood pneumonia, our data indicate that these tools may be underused in resource-limited settings.
Collapse
|
39
|
Webb C, Ngama M, Ngatia A, Shebbe M, Morpeth S, Mwarumba S, Bett A, Nokes DJ, Seale AC, Kazungu S, Munywoki P, Hammitt LL, Scott JAG, Berkley JA. Treatment failure among Kenyan children with severe pneumonia--a cohort study. Pediatr Infect Dis J 2012; 31:e152-7. [PMID: 22692700 PMCID: PMC3691501 DOI: 10.1097/inf.0b013e3182638012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pneumonia is the leading cause of childhood mortality worldwide. The World Health Organization recommends presumptive treatment based on clinical syndromes. Recent studies raise concerns over the frequency of treatment failure in Africa. METHODS We applied a definition of treatment failure to data prospectively collected from children who were 2-59 months of age with severe, or very severe, pneumonia admitted to Kilifi District Hospital, Kenya, from May 2007 through May 2008 and treated using World Health Organization guidelines. The primary outcome was treatment failure at 48 hours. RESULTS Of 568 children, median age 11 months, 165 (29%) had very severe pneumonia, 30 (5.3%) a positive HIV test and 62 (11%) severe malnutrition. One hundred eleven (20%; 95% confidence interval: 17-23%) children failed treatment at 48 hours and 34 (6.0%) died; 22 (65%) deaths occurred before 48 hours. Of 353 children with severe pneumonia, without HIV or severe malnutrition, 42 (12%) failed to respond at 48 hours, 15 (4.3%) failed at 5 days and 1 child (0.3%) died. Among 215 children with either severe pneumonia complicated by HIV or severe malnutrition, or very severe pneumonia, 69 (32%) failed to treatment at 48 hours, 47 (22%) failed at 5 days and 33 (16%) died. Treatment failure at 48 hours was associated with shock, bacteremia, very severe pneumonia, oxygen saturation in hemoglobin <95%, severe malnutrition, HIV and age <1 year in multivariable models. CONCLUSIONS In this setting, few children with uncomplicated severe pneumonia fail treatment or die under current guidelines. Deaths mainly occurred early and may be reduced by improving prevention, prehospital care and treatment of sepsis.
Collapse
Affiliation(s)
- Clare Webb
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Mwanajuma Ngama
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Anthony Ngatia
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Mohammed Shebbe
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Susan Morpeth
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Salim Mwarumba
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Ann Bett
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - D. James Nokes
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
,Department of Biological Sciences, University of Warwick, Coventry, UK.
| | - Anna C. Seale
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Sidi Kazungu
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Patrick Munywoki
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - Laura L. Hammitt
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
| | - J. Anthony G. Scott
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - James A. Berkley
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Medicine Research - Coast, PO Box 230, Kilifi, 80108, Kenya.
,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
40
|
Abstract
Pediatric respiratory illnesses are a huge burden to emergency departments worldwide. This article reviews the latest evidence in the epidemiology, assessment, management, and disposition of children presenting to the emergency department with asthma, croup, bronchiolitis, and pneumonia.
Collapse
Affiliation(s)
- Joseph Choi
- McGill University FRCP Emergency Medicine Residency Program, Royal Victoria Hospital, 687 Pine Avenue West, Room A4.62, Montreal, Quebec, Canada H3A 1A1.
| | | |
Collapse
|
41
|
Evaluation of the World Health Organization criteria for chest radiographs for pneumonia diagnosis in children. Eur J Pediatr 2012; 171:369-74. [PMID: 21870077 DOI: 10.1007/s00431-011-1543-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED Our objective was to compare the inter-observer level of agreement in diagnosing pneumonia using the World Health Organization (WHO) guidelines for the interpretation of radiographs. We conducted a prospective study in a pediatric emergency room. Fifteen observers (13 pediatricians, 2 radiologists) interpreted 200 pediatric (<5 years old) chest radiographs using the WHO guidelines. Observers were blinded to the clinical presentation. RESULTS were analyzed for kappa values. Individual readings were compared to two "gold standard" teams: (1) radiologist and pediatrician and (2) two radiologists. RESULTS Alveolar pneumonia, non-alveolar pneumonia, and no pneumonia were found (by radiologists) in 12.8%, 2.7%, and 78.6% of readings, respectively. The mean kappa values for alveolar pneumonia, non-alveolar pneumonia, and no pneumonia of observers versus the team consisting of a radiologist and a pediatrician were 0.73, 0.23, and 0.61, respectively. For non-alveolar pneumonia, the mean kappa value was higher for the gold standard consisting of a radiologist and a pediatrician when compared to the two-radiologist team. Pediatricians overdiagnosed "non-alveolar pneumonia" compared with radiologists. In contrast, for the alveolar pneumonia and no-pneumonia diagnoses, no significant differences were found. CONCLUSIONS The WHO guidelines for interpretation of chest radiographs result in high level of agreement between readers for the definition of "alveolar pneumonia" and "no pneumonia" but poor agreement for non-alveolar pneumonia. The disagreement with regard to the latter was associated with overdiagnosis by pediatricians, which may lead to overtreatment. We believe that radiographic non-alveolar pneumonia should not be an endpoint for clinical trials and research, nor should it be implemented in clinical setting.
Collapse
|
42
|
Welling RD, Azene EM, Kalia V, Pongpirul K, Starikovsky A, Sydnor R, Lungren MP, Johnson B, Kimble C, Wiktorek S, Drum T, Short B, Cooper J, Khouri NF, Mayo-Smith WW, Mahesh M, Goldberg BB, Garra BS, Destigter KK, Lewin JS, Mollura DJ. White Paper Report of the 2010 RAD-AID Conference on International Radiology for Developing Countries: identifying sustainable strategies for imaging services in the developing world. J Am Coll Radiol 2012; 8:556-62. [PMID: 21807349 DOI: 10.1016/j.jacr.2011.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 01/27/2011] [Indexed: 11/18/2022]
Abstract
The 2010 RAD-AID Conference on International Radiology for Developing Countries was a multidisciplinary meeting to discuss data, experiences, and models pertaining to radiology in the developing world, where widespread shortages of imaging services reduce health care quality. The theme of this year's conference was sustainability, with a focus on establishing and maintaining imaging services in resource-limited regions. Conference presenters and participants identified 4 important components of sustainability: (1) sustainable financing models for radiology development, (2) integration of radiology and public health, (3) sustainable clinical models and technology solutions for resource-limited regions, and (4) education and training of both developing and developed world health care personnel.
Collapse
Affiliation(s)
- Rodney D Welling
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Agweyu A, Opiyo N, English M. Experience developing national evidence-based clinical guidelines for childhood pneumonia in a low-income setting--making the GRADE? BMC Pediatr 2012; 12:1. [PMID: 22208358 PMCID: PMC3268095 DOI: 10.1186/1471-2431-12-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 01/01/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The development of evidence-based clinical practice guidelines has gained wide acceptance in high-income countries and reputable international organizations. Whereas this approach may be a desirable standard, challenges remain in low-income settings with limited capacity and resources for evidence synthesis and guideline development. We present our experience using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach for the recent revision of the Kenyan pediatric clinical guidelines focusing on antibiotic treatment of pneumonia. METHODS A team of health professionals, many with minimal prior experience conducting systematic reviews, carried out evidence synthesis for structured clinical questions. Summaries were compiled and distributed to a panel of clinicians, academicians and policy-makers to generate recommendations based on best available research evidence and locally-relevant contextual factors. RESULTS We reviewed six eligible articles on non-severe and 13 on severe/very severe pneumonia. Moderate quality evidence suggesting similar clinical outcomes comparing amoxicillin and cotrimoxazole for non-severe pneumonia received a strong recommendation against adopting amoxicillin. The panel voted strongly against amoxicillin for severe pneumonia over benzyl penicillin despite moderate quality evidence suggesting clinical equivalence between the two and additional factors favoring amoxicillin. Very low quality evidence suggesting ceftriaxone was as effective as the standard benzyl penicillin plus gentamicin for very severe pneumonia received a strong recommendation supporting the standard treatment. CONCLUSIONS Although this exercise may have fallen short of the rigorous requirements recommended by the developers of GRADE, it was arguably an improvement on previous attempts at guideline development in low-income countries and offers valuable lessons for future similar exercises where resources and locally-generated evidence are scarce.
Collapse
Affiliation(s)
- Ambrose Agweyu
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Newton Opiyo
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics, University of Oxford, Oxford, UK
| |
Collapse
|
44
|
Lungren MP, Horvath JJ, Welling RD, Azene EM, Starikovsky A, Bashir MR, Mollura DJ, Maxfield C. Global health training in radiology residency programs. Acad Radiol 2011; 18:782-91. [PMID: 21458308 DOI: 10.1016/j.acra.2011.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/17/2011] [Accepted: 01/24/2011] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To measure perceptions of radiology residents regarding the imaging needs of the developing world and the potential role of an organized global health imaging curriculum during residency training. MATERIALS AND METHODS An electronic survey was created and then distributed to residents in accredited US radiology residency. RESULTS Two hundred ninety-four residents responded to the survey. A majority (61%) planned to pursue future international medical aid work, even though a similar proportion (59%) believed that they would be ill-prepared with their current training to pursue this career goal. The vast majority (91%) of respondents stated that their residency program offers no opportunities to participate in global health imaging experiences. Most surveyed residents felt that an organized global health imaging curriculum would improve understanding of basic disease processes (87%) and cost-conscious care (82%), prepare residents for lifelong involvement in global health (80%), and increase interpretative skills in basic radiology modalities (73%). If such a curriculum were available, most (62%) of surveyed residents stated that they would be likely or very likely to participate. Many (58%) believed the availability of such a program would have influenced their choice of residency program; a similar proportion of residents (75%) believed that the availability of a global health imaging curriculum would increase recruitment to the field of radiology. CONCLUSION Many radiology residents are motivated to acquire global health imaging experience, with most survey respondents planning to participate in global health initiatives. These data demonstrate an imbalance between the level of resident interest and the availability of global health imaging opportunities, and support the need for discussion on how to implement global health imaging training within radiology residency programs.
Collapse
|
45
|
Addo-Yobo E, Anh DD, El-Sayed HF, Fox LM, Fox MP, MacLeod W, Saha S, Tuan TA, Thea DM, Qazi S. Outpatient treatment of children with severe pneumonia with oral amoxicillin in four countries: the MASS study. Trop Med Int Health 2011; 16:995-1006. [PMID: 21545381 DOI: 10.1111/j.1365-3156.2011.02787.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A recent randomized clinical trial demonstrated home-based treatment of WHO-defined severe pneumonia with oral amoxicillin was equivalent to hospital-based therapy and parenteral antibiotics. We aimed to determine whether this finding is generalizable across four countries. METHODS Multicentre observational study in Bangladesh, Egypt, Ghana and Vietnam between November 2005 and May 2008. Children aged 3-59 months with WHO-defined severe pneumonia were enrolled at participating health centres and managed at home with oral amoxicillin (80-90 mg/kg per day) for 5 days. Children were followed up at home on days 1, 2, 3 and 6 and at a facility on day 14 to look for cumulative treatment failure through day 6 and relapse between days 6 and 14. RESULTS Of 6582 children screened, 873 were included, of whom 823 had an outcome ascertained. There was substantial variation in presenting characteristics by site. Bangladesh and Ghana had fever (97%) as a more common symptom than Egypt (74%) and Vietnam (66%), while in Vietnam, audible wheeze was more common (49%) than at other sites (range 2-16%). Treatment failure by day 6 was 9.2% (95% CI: 7.3-11.2%) across all sites, varying from 6.4% (95% CI: 3.1-9.8%) in Ghana to 13.2% (95% CI: 8.4-18.0%) in Vietnam; 2.7% (95% CI: 1.5-3.9%) of the 733 children well on day 6 relapsed by day 14. The most common causes of treatment failure were persistence of lower chest wall indrawing (LCI) at day 6 (3.8%; 95% CI: 2.6-5.2%), abnormally sleepy or difficult to wake (1.3%; 95% CI: 0.7-2.3%) and central cyanosis (1.3%; 95% CI: 0.7-2.3%). All children survived and only one adverse drug reaction occurred. Treatment failure was more frequent in young infants and those presenting with rapid respiratory rates. CONCLUSIONS Clinical treatment failure and adverse event rates among children with severe pneumonia treated at home with oral amoxicillin did not substantially differ across geographic areas. Thus, home-based therapy of severe pneumonia can be applied to a wide variety of settings.
Collapse
Affiliation(s)
- Emmanuel Addo-Yobo
- Komfo Anokye Teaching Hospital, University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Childhood pneumonias are an important cause of morbidity and mortality and annually contribute to over 2 million deaths among children under five years of age. To combat this, a standardized case management protocol developed by the World Health Organization has been adopted by the National programs in most high burden, resource constrained settings. This can detect patients with pneumonia early on and with ease at community level and also identify those who are at risk of dying due to a severe form of the disease if not referred or appropriately treated. However, as most deaths due to pneumonia occur in health facilities, it is equally important to standardise treatment at a facility level with pulse oximetry, regular monitoring for complications and the judicious use of antibiotics. The challenge is to identify other respiratory illnesses which mimic pneumonia resulting in under treatment with bronchodilators and over usage of antibiotics. This becomes particularly important in developing countries which have the dual burden of both the infectious and non-infectious illnesses. The strategy also needs refinement for diagnosing and treating pneumonia in severely under nourished and / or HIV co-infected children who are both at higher risk of disease as well as death due to it.
Collapse
Affiliation(s)
- Varinder Singh
- Department of Paediatrics, Lady Hardinge Medical College and assoc Kalawati Saran Children's Hospital, Bangla Sahib Marg, N Delhi 110001, India.
| | | |
Collapse
|
47
|
Simbalista R, Araújo M, Nascimento-Carvalho CM. Outcome of children hospitalized with community-acquired pneumonia treated with aqueous penicillin G. Clinics (Sao Paulo) 2011; 66:95-100. [PMID: 21437443 PMCID: PMC3044566 DOI: 10.1590/s1807-59322011000100017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 10/14/2010] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the evolution and outcome of children hospitalized with community-acquired pneumonia receiving penicillin. METHODS A search was carried out for all hospitalized community-acquired pneumonia cases in a 37-month period. Inclusion criteria comprised age >2 months, intravenous penicillin G use at 200,000 IU/kg/day for >48 h and chest x-ray results. Confounders leading to exclusion included underlying debilitating or chronic pulmonary illnesses, nosocomial pneumonia or transference to another hospital. Pneumonia was confirmed if a pulmonary infiltrate or pleural effusion was described by an independent radiologist blind to the clinical information. Data on admission and evolution were entered on a standardized form. RESULTS Of 154 studied cases, 123 (80%) and 40 (26%) had pulmonary infiltrate or pleural effusion, respectively. Penicilli was substituted by other antibiotics in 28 (18%) patients, in whom the sole significant decrease was in the frequency of tachypnea from the first to the second day of treatment (86% vs. 50%, p = 0.008). Among patients treated exclusively with penicillin G, fever (46% vs. 26%, p = 0.002), tachypnea (74% vs. 59%, p = 0.003), chest indrawing (29% vs. 13%, p<0.001) and nasal flaring (10% vs. 1.6%, p = 0.001) frequencies significantly decreased from admission to the first day of treatment. Patients treated with other antimicrobial agents stayed longer in the hospital than those treated solely with penicillin G (16 ± 6 vs. 8 ± 4 days, p<0.001, mean difference (95% confidence interval) 8 (6-10)). None of the studied patients died. CONCLUSION Penicillin G successfully treated 82% (126/154) of the study group and improvement was marked on the first day of treatment.
Collapse
|
48
|
Pneumonia in Children in Developing Countries. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2011; 697:59-75. [DOI: 10.1007/978-1-4419-7185-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
49
|
White Paper Report of the RAD-AID Conference on International Radiology for Developing Countries: Identifying Challenges, Opportunities, and Strategies for Imaging Services in the Developing World. J Am Coll Radiol 2010; 7:495-500. [PMID: 20630383 DOI: 10.1016/j.jacr.2010.01.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 01/27/2010] [Indexed: 11/22/2022]
|
50
|
Validation and development of a clinical prediction rule in clinically suspected community-acquired pneumonia. Pediatr Emerg Care 2010; 26:399-405. [PMID: 20502390 DOI: 10.1097/pec.0b013e3181e05779] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a mathematical model to predict the probability of having community-acquired pneumonia and to evaluate an already developed prediction rule that has not been validated in a clinical scenario. METHODS Children who presented with fever and had presumptive clinical diagnosis of pneumonia were evaluated in 4 institutions of different complexity during 1 year. The variables assessed were sex, age, respiratory rate, days with fever, maximum body temperature, presence of tachypnea, cough, chest pain, intercostal retraction, nasal flaring, abdominal pain, vomiting, grunting, rales, decreased breath sounds, wheezing, fatigue, loss of appetite, loss of sleep, and season of the year. The chest radiographs were photographed and then interpreted by 2 pediatric radiologists. RESULTS A total of 257 children were evaluated: 179 (69%) had clinical and radiological diagnosis of community-acquired pneumonia, and 78 (30%) had no radiological confirmation. A total of 96 photographs were recorded, and in 64 of the cases, there was agreement in the diagnosis between the evaluating pediatrician and the radiologists (kappa index = 0.68).With the calculated probabilities, it was possible to build a receiving operating characteristic curve and, based on the estimated coefficients we calculated, a value associated to the probability of having pneumonia. CONCLUSIONS We developed a model including 5 variables of high level of sensitivity for the diagnosis of pneumonia. To use it, it would be useful to apply the appropriate software. In addition, we validated a clinical prediction rule of 4 variables that proved to have 93.8% sensitivity to diagnose pneumonia in children with a fever and localized rales, or decreased breath sounds, or tachypnea, or any combination of these 4 variables.
Collapse
|