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Bushra Q, Fatima S, Hameed A, Mukhtar S. Epidemiological trends of febrile infants presenting to the Paediatric Emergency department, in a tertiary care hospital, Karachi, Pakistan: a retrospective review. BMJ Open 2024; 14:e076611. [PMID: 39181554 PMCID: PMC11344527 DOI: 10.1136/bmjopen-2023-076611] [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: 06/12/2023] [Accepted: 08/06/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Understanding the epidemiological patterns of febrile infants can offer valuable insights for optimising management strategies and developing quality improvement initiatives, aiming to improve healthcare delivery in high-volume, low-resource emergency departments (EDs). OBJECTIVES To characterise the epidemiology of febrile infants presenting to the paediatric ED of a tertiary care hospital. METHODS A retrospective chart review of medical records was performed for febrile infants ≤1 year old, at paediatric ED, Indus Hospital and Health Network (IHHN), Karachi, Pakistan (1 January 2020-31 December 2020). RESULTS There were a total of 2311 patients in the study, with a male-to-female ratio of 1.4:1. The mean age of presentation was 4.9±2.7 months. Cough (n=1002, 43.2%) was the most frequent presenting symptom. The most common provisional ED diagnosis in ≤1 month of age was sepsis (n=98, 51%), bronchopneumonia (n=138, 28.6%) in 1.1-3 and 3.1-6 months (n=176, 36.45%); and upper respiratory tract illness (n=206, 47.4%) in 6.1-12 months of age. Age was significantly associated with provisional ED diagnosis and outcomes (p<0.001). Of 175 ED admissions (n=47, 26.8%), patients were discharged with a hospital diagnosis of bronchopneumonia and (n=27, 15.4) of sepsis. The infant mortality rate was 3/1000 live births. CONCLUSIONS This study is the first of its kind to explore the epidemiology of febrile infants in Pakistan, highlighting the burden and severity of respiratory illnesses and sepsis. It underscores the challenges of resource-limited settings, failing to meet the need for admission of febrile infants presenting to ED, IHHN. Moreover, it has highlighted the necessity to optimise the existing triage systems to effectively allocate resources and manage high patient volumes in low-resource EDs.
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Affiliation(s)
- Quratulain Bushra
- Paediatric Emergency, Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Sara Fatima
- Paediatric Emergency, Indus Hospital and Health Network, Karachi, Sindh, Pakistan
| | - Ammara Hameed
- Bahria University Medical and Dental College, Karachi, Sindh, Pakistan
| | - Sama Mukhtar
- Emergency Medicine, Indus Hospital & Health Network, Karachi, Sindh, Pakistan
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Ramzi NH, Hoong ATC, Johari NA, Nathan AM, Teh CSJ, Sulaiman NA, Ilias MI, Deris ZZ, Hazlan SNH, Nasir NSM, Bakar AA, Helmi MAM, Juhari WKW, Kamarudin N, Chong CW, Cleary DW, Clarke SC, Sulaiman LH. Multicentre case-control study of pneumococcal infections among children with pneumonia in Peninsular Malaysia (MY-Pneumo): a study protocol. BMC Public Health 2024; 24:2255. [PMID: 39164673 PMCID: PMC11334605 DOI: 10.1186/s12889-024-19789-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/13/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND S. pneumoniae (SPN) is the most common cause of pneumonia. The disease can be effectively prevented through immunisation. Since December 2020, the Malaysian Government has included the 10-valent pneumococcal conjugate vaccine (PCV10) for all infants born on or after 1 January 2020 as part of the National Immunisation Programme (NIP). However, the epidemiology of pneumonia remains poorly understood. To fill the knowledge gap, we established a multicentre surveillance study to understand the burden of pneumococcal pneumonia among young children in Peninsular Malaysia. METHODS MY-Pneumo is a multicentre prospective case-control study conducted in three sentinel sites located in three different states of Peninsular Malaysia - Kuala Lumpur, Pahang, and Kelantan. A cohort of at least 500 incident cases and 500 controls is enrolled beginning in October 2021 and matched for age. Cases are hospitalised children < 5 years with radiologically confirmed pneumonia, and the controls are children without any features suggestive of pneumonia. Clinical samples, including nasopharyngeal swabs (NPS) and urine, are collected according to the study protocol. Biological fluids such as blood, cerebrospinal fluid (CSF) and pleural fluid are obtained from invasive pneumonia disease (IPD) patients, if available. All children are tested for SPN using polymerase chain reaction (PCR) and pneumococcal urine antigen test (PUAT) using BinaxNow. DISCUSSION Surveillance data, including carriage rate, serotype variations and the phylogeny data structure of SPN among young children in Malaysia during PCV implementation, will be generated from this study. Trends and patterns of pneumococcal serotypes by different regions are important for targeted public health strategies. Our data will provide baseline information for estimating the impact of PCV10 implementation and will influence policymakers' decisions regarding the upgrade from PCV10 to a higher-valency conjugate vaccine in Malaysia. TRIAL REGISTRATION This project was registered at ClinicalTrials.gov (NCT04923035) on 2021, June 11. The study protocol was approved by the International Medical University Joint-Committee on Research & Ethics (4.15/JCM-216/2021) and the Institutional Review Board at sentinel sites (USM/JEPeM/21020190, IREC 2021-114, MREC ID No: 2021128-9769) and University of Southampton's Ethics and Research Governance (ERGo II 64844).
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Affiliation(s)
- Nurul Hanis Ramzi
- Institute for Research, Development and Innovation, IMU University (formerly known as International Medical University), Kuala Lumpur, 57000, Malaysia.
| | - Andrew Tan Chun Hoong
- Institute for Research, Development and Innovation, IMU University (formerly known as International Medical University), Kuala Lumpur, 57000, Malaysia
| | - Nur Alia Johari
- Institute for Research, Development and Innovation, IMU University (formerly known as International Medical University), Kuala Lumpur, 57000, Malaysia
| | - Anna Marie Nathan
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Norhayati Aida Sulaiman
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia
| | - Mohamad Ikram Ilias
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, 16150, Malaysia
| | - Zakuan Zainy Deris
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kota Bharu, 16150, Malaysia
| | - Siti Nur Haidar Hazlan
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kota Bharu, 16150, Malaysia
| | - Nur Syafiqah Mohamad Nasir
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kota Bharu, 16150, Malaysia
| | - Asrar Abu Bakar
- Department of Paediatric, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, 25200, Malaysia
| | - Muhd Alwi Muhd Helmi
- Department of Paediatric, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, 25200, Malaysia
| | - Wan Khairunnisa Wan Juhari
- Department of Paediatric, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, 25200, Malaysia
| | - Norhidayah Kamarudin
- Department of Pathology and Laboratory Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, 25200, Malaysia
| | - Chun Wie Chong
- Institute for Research, Development and Innovation, IMU University (formerly known as International Medical University), Kuala Lumpur, 57000, Malaysia
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, 47500, Malaysia
| | - David W Cleary
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Faculty of Medicine & Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Stuart C Clarke
- Institute for Research, Development and Innovation, IMU University (formerly known as International Medical University), Kuala Lumpur, 57000, Malaysia
- Faculty of Medicine & Institute for Life Sciences, University of Southampton, Southampton, UK
- Southampton Biomedical Research Centre, National Institute for Health and Care Research (NIHR), University Hospital Southampton Foundation NHS Trust, Southampton, UK
| | - Lokman Hakim Sulaiman
- Institute for Research, Development and Innovation, IMU University (formerly known as International Medical University), Kuala Lumpur, 57000, Malaysia
- Department of Community Medicine, School of Medicine, IMU University (formerly known as International Medical University), Kuala Lumpur, 57000, Malaysia
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Boltena MT, Wolde M, Hailu B, El-Khatib Z, Steck V, Woldegerima S, Siraneh Y, Morankar S. Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:12652. [PMID: 38825623 PMCID: PMC11144712 DOI: 10.1038/s41598-024-62651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
Excessive and improper use of antibiotics causes antimicrobial resistance which is a major threat to global health security. Hospitals in sub-Saharan Africa (SSA) has the highest prevalence of antibiotic use. This systematic review and meta-analysis aimed to determine the pooled point prevalence (PPP) of evidence-based antimicrobial use among hospitalized patients in SSA. Literature was retrieved from CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Meta-analysis was conducted using STATA version 17. Forest plots using the random-effect model were used to present the findings. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test. The protocol was registered in PROSPERO with code CRD42023404075. The review was conducted according to PRISMA guidelines. A total of 26, 272 study participants reported by twenty-eight studies published from 10 countries in SSA were included. The pooled point prevalence of antimicrobial use in SSA were 64%. The pooled estimate of hospital wards with the highest antibiotic use were intensive care unit (89%). The pooled prevalence of the most common clinical indication for antibiotic use were community acquired infection (41%). The pooled point prevalence of antimicrobial use among hospitalized patients were higher in SSA. Higher use of antibiotics was recorded in intensive care units. Community acquired infection were most common clinical case among hospitalized patients. Health systems in SSA must design innovative digital health interventions to optimize clinicians adhere to evidence-based prescribing guidelines and improve antimicrobial stewardship.
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Affiliation(s)
- Minyahil Tadesse Boltena
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Mirkuzie Wolde
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- University of Technology Sydney, Sydney, Australia
| | - Belachew Hailu
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Ziad El-Khatib
- Global Public Health Department, Karolinska Institute, Solna, Sweden
| | - Veronika Steck
- Department of Pharmacology and Therapeutics, Faculty of Life Sciences, McGill University, Montreal, Canada
| | - Selam Woldegerima
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yibeltal Siraneh
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sudhakar Morankar
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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M S, Vaithilingan S. Childhood Pneumonia in Low- and Middle-Income Countries: A Systematic Review of Prevalence, Risk Factors, and Healthcare-Seeking Behaviors. Cureus 2024; 16:e57636. [PMID: 38586234 PMCID: PMC10998654 DOI: 10.7759/cureus.57636] [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] [Received: 03/10/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024] Open
Abstract
Childhood pneumonia is a major contributor to illness and death in children under the age of five globally. Despite advancements in medical science, the burden of pediatric community-acquired pneumonia (CAP) remains high, particularly in low- and middle-income countries. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and healthcare-seeking behaviors associated with pediatric CAP to inform the development of targeted community-based interventions. An extensive search of various databases such as Medline, EMBASE, Web of Science, Cochrane, PubMed, PubMed Central, Helinet, SpringerLink, Google Scholar, and Biomed Central was performed, resulting in 65 potentially relevant studies. After a thorough evaluation process, 25 studies were selected for the final analysis. These selected studies offered valuable information on the epidemiology, risk factors, and healthcare-seeking behaviors associated with childhood pneumonia. The review revealed that environmental factors such as indoor air pollution, overcrowding, and exposure to tobacco smoke are significant risk factors for pediatric pneumonia. Additionally, socioeconomic factors, including poverty and a lack of access to clean water and sanitation, contribute to the vulnerability of children to this disease. Poor healthcare-seeking behaviors, driven by limited knowledge and awareness of pneumonia symptoms and treatment, further exacerbate the situation. The review also highlighted the critical role of vaccination, particularly against Haemophilus influenzae type b (Hib) and pneumococcus, in preventing pneumonia. However, gaps in vaccination coverage and challenges in accessing healthcare services remain barriers to effective pneumonia control. In light of these findings, the review recommends the implementation of community-based interventions that address the multifaceted determinants of pediatric pneumonia. These interventions should focus on improving environmental conditions, enhancing access to preventive measures such as vaccination, and promoting better healthcare-seeking behaviors through education and awareness campaigns. It is essential for healthcare providers, policymakers, and community members to collaborate in developing and implementing culturally appropriate and sustainable interventions. This cooperation aims to lessen the impact of pneumonia on children and their families.
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Affiliation(s)
- Selvi M
- Community Health Nursing Department, Vinayaka Mission's Research Foundation, Salem, IND
| | - Sasi Vaithilingan
- Community Health Nursing Department, Vinayaka Mission's College of Nursing, Puducherry, IND
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Diboue Betote PH, Del Florence Ndedi Moni E, Matchuenkam SRG, Beack SSB, Fifen R, Ouedraogo R, Agbor GA, Semde R, Nnanga N, Nyegue MA. Sex-dependent vulnerability for Wistar rats model following intranasal instillation with Klebsiella pneumoniae ATCC 43816 causing lobar pneumonia. Pneumonia (Nathan) 2024; 16:5. [PMID: 38523293 PMCID: PMC10962189 DOI: 10.1186/s41479-024-00126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae has become one of the major threats to public health as it causes nosocomial and community-acquired infections like lobar pneumonia. This infection causes acute inflammation in the lung, characterized by the recruitment of polymorphonuclear cells, generating free radicals, and decreasing the endogenous antioxidant balance system. Many experimental studies have focused on the induction, progression and resolution of infection up to its peak, but these documented processes remain highly random and their sex dependence un-elicited. These fluctuations of physiopathological parameters would impact disease progression depending on the animal's model and bacterial strain used. The present study investigated the sex-dependent vulnerability of Wistar rats to K. pneumoniae ATCC 43816 lobar pneumonia induced by the intranasal instillation method. METHODS Experimental pneumonia was induced by K. pneumoniae ATCC 43816 in male and female Wistar rats following intranasal instillation. The physiopathogenesis of the disease was studied by bacteriological and histopathological exams, histomorphometric analysis of the blood and/or lung tissue, and body weight loss in infected animals. In addition, the overall severity of lesions was determined by the total score obtained by averaging the individual scores from the same group of animals. RESULTS The K. pneumoniae ATCC 43816 strain showed inoculation dose-, incubation time of the disease- and sex-dependent- differences in its ability to induce lobar pneumonia. Evaluation of different parameters showed that the disease peaked on day 15 post-inoculation, with more pathogenic effects on female rats. This observed sex-dependence difference in Wistar rats was mainly highlighted by the determined lethal dose 50 (LD50), bacterial load count in whole blood and lung tissues, body weight loss, inflammatory granulomas forming and diffuse alveolar damages. The pathogenicity was confirmed by scoring the severity of pathologic lesions of lung tissues. CONCLUSIONS The results obtained highlighted the gender-dependency in the physiopathogenesis processes of K. pneumoniae ATCC 43816 induced-lobar pneumonia, in Wistar rats. Female Wistar rats' susceptibility is useful in studying pathology and in preclinical trial investigations of new treatments for infectious pneumonia.
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Affiliation(s)
- Patrick Hervé Diboue Betote
- Laboratory of Drug Development, Centre for Training, Research and Expertise in Drug Sciences, Doctoral School of Sciences and Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.
- Laboratory of Pharmacology and Drugs Discovery, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon.
- Department of Microbiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon.
- Department of Galenical Pharmacy and Pharmaceutical Law, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
| | | | - Sonia Raïssa Gayap Matchuenkam
- Laboratory of Pharmacology and Drugs Discovery, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Sandrine Suzanne Bayengue Beack
- Laboratory of Pharmacology and Drugs Discovery, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
- Department of Food Sciences and Technology, Faculty of Agriculture and Veterinary Medicine, University of Buea, Buea, Cameroon
| | - Rodrigue Fifen
- Department of Animal Biology and Physiology, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Raogo Ouedraogo
- Laboratory of Drug Development, Centre for Training, Research and Expertise in Drug Sciences, Doctoral School of Sciences and Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Gabriel A Agbor
- Laboratory of Pharmacology and Drugs Discovery, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Rasmané Semde
- Laboratory of Drug Development, Centre for Training, Research and Expertise in Drug Sciences, Doctoral School of Sciences and Health, University Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Nga Nnanga
- Department of Galenical Pharmacy and Pharmaceutical Law, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Laboratory of Pharmaceutical Technology, Centre for Research On Medicinal Plants and Traditional Medicine, Institute of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
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Alemu T, Ayele B, Sorato MM. Determinants of under-five pneumonia in randomly selected health facilities at Aleta Wondo Woreda, Sidama Region Ethiopia: Case-control study. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13725. [PMID: 38098208 PMCID: PMC10775889 DOI: 10.1111/crj.13725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/26/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Under-five mortality reduction due to pneumonia is not Signiant, particularly in developing countries. Pneumonia contributed to 27.5% to 31.3% of health facility visits by children 2 to 59 months in Aleta Wondo Woreda. Previous studies have shown inconclusive evidence on determinants of pneumonia in children. METHODS An institution-based unmatched case-control study was conducted to assess determinants of pneumonia among under-five children at Aleta Wondo Woreda, Sidama Region. RESULT One-hundred forty-five cases and 290 controls of children aged 2 to 59 months participated in the study. The mean ± (SD) age of the children was 18.81 months (2.1 ± 11.43) and 28.26 months (2.1 ± 16.007) for cases and controls, respectively. Only 56% (n = 145) of cases open house windows daily, whereas most 68.6% (n = 290) of controls house windows open daily. Ninety five (62.8%) of cases and 68.6% of controls were exclusively breastfed for 6 months. Household income ≥1500 Ethiopian birr (AOR = 0.45, 95% CI, 0.017-0.120, p < 0.000), child location outside of cooking house during cooking (AOR = 0.101, 95% CI, 0.43-0.238, p < 0.000), no formal education of the mother (AOR = 2.398, 95% CI, 1.082-5.316, p < 0.031), and presence of history of upper respiratory tract infections (URTIs) in last 2 weeks (AOR = 2.183, 95% CI, 1.684-5.273, P < 0.049) were determinants of pneumonia. CONCLUSION Determinants of pneumonia in under-five children were multifactorial (socioeconomic, nutritional, and environmental). Addressing these factors by involving all relevant stakeholders is important to reduce pneumonia-related morbidity and mortality among under-five children in the study area.
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Affiliation(s)
- Tsegaye Alemu
- School of Public HealthHawassa UniversityHawassaEthiopia
| | | | - Mende Mensa Sorato
- Department of Pharmacy, School of MedicineKomar University of Science and TechnologySulaimaniyahIraq
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Ragwar V, Brown M. Causal factors of childhood pneumonia high mortalities and the impact of community case management on child survival in Sub-Saharan Africa: a systematic review. Public Health 2023; 223:131-138. [PMID: 37639996 DOI: 10.1016/j.puhe.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study aimed to (1) evaluate the effectiveness of community case management (CCM) and validity of its implementation in the context of Sub-Saharan Africa (SSA) region; (2) identify potential differences in pneumonia disease aetiology, geographic region and cultural factors that may impact the implementation and delivery of community-based interventions; and (3) identify strategies that public health practitioners, stakeholders and policymakers could use to implement CCM. STUDY DESIGN This was a systematic review. METHODS Comprehensive searches were conducted in Cochrane Library, MEDLINE, CINAHL and Scopus databases from 2012 to 2023. Google Scholar, World Health Organization/United Nations Children's Fund websites, unpublished grey literature, PROSPERO (International Register of Systematic Reviews) and a manual search of references lists for relevant articles. RESULTS A total of 441 articles were screened, and eight articles were included for the review. Studies were from seven countries in SSA located in three regions: East (Kenya, Tanzania, Ethiopia), West (Nigeria, Senegal, Sierra Leone) and South (South Africa). The study designs of articles included two cluster randomised control trials, four cohorts and two case-control studies. A cross-analysis of the papers identified themes under the subheadings CCM and causal factors and risk factors. CONCLUSION Successful impact of implementation and adoption of CCM in the context of SSA culture and environment can be achieved when focused on creating high-demand, dependable and quality healthcare services. Continual monitoring and evaluation of emerging high trends of viral pathogens and co-infections are critical in reducing childhood pneumonia mortalities.
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Affiliation(s)
- V Ragwar
- University of Hertfordshire, School of Life and Medical Sciences, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - M Brown
- University of Hertfordshire, Centre of Postgraduate Medicine and Public Health, School of Life and Medical Sciences, Hatfield, Hertfordshire, AL10 9AB, UK
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Yadate O, Yesuf A, Hunduma F, Habtu Y. Determinants of pneumonia among under-five children in Oromia region, Ethiopia: unmatched case-control study. Arch Public Health 2023; 81:87. [PMID: 37165410 PMCID: PMC10170023 DOI: 10.1186/s13690-023-01103-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/29/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Pneumonia is the single largest infectious disease that causes more under-five morbidity and mortality than any other infectious disease in the world, including Ethiopia. The aim of this study is to assess determinants of pneumonia among under-five children in the South West Shewa Zone, Oromia Region, Ethiopia, 2021. METHODS We used an unmatched case-control study design from March 15 to April 30, 2021, in the South West Shewa Zone, Ethiopia. A sample of 398 (199 cases and 199 controls) participated in the study. Trained data collectors through a pre-tested structured questionnaire collected data. We used Epi Info to enter data and analyzed using SPSS version 23. We described our data using descriptive statistics. We identified predictors of pneumonia using logistic regression analysis. We declared predictors of pneumonia at a P-value of 0.05 or less. RESULTS Breastfeeding for less than 6 months [AOR:3.51, 95%CI:(1.12,11.00)], lack of Vitamin A supplementation [AOR:3.56,95%CI:(1.58, 8.05)], history of URTI [AOR:9.66, 95%CI:(4.69,19.87)], family child care practices [AOR:6.46, 95%CI, (2.83,14.76)], sleeping with three to five persons in a room [AOR:2.90, 9%CI: (1.23,6.84)], having above five persons in a room [AOR: 3.88, 95%CI: 1.02,14.77), use of wood as a source of fuel [AOR = 3.02 95% CI: 1.41,6.46)] and not opening windows [AOR:2.56 95%CI: (1.21,5.41)] were independent factors of pneumonia among under five children. CONCLUSION Pneumonia is associated with breastfeeding for less than 6 months, lack of vitamin A supplementation, history of URTI, types of childcare practice, indoor overcrowding, use of wood as a source of fuel, and not opening windows. Therefore, exclusive breastfeeding, improving vitamin A supplementation, early control of respiratory tract infection through promoting good hygiene and ventilation strategies in crowded homes, and promoting how to reduce indoor air pollution through affordable clean stoves will be relevant interventions to reduce under-five pneumonia.
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Affiliation(s)
- Olana Yadate
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa City Administrative, Addis Ababa, Ethiopia
| | - Aman Yesuf
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa City Administrative, Addis Ababa, Ethiopia
| | - Fufa Hunduma
- School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa City Administrative, Addis Ababa, Ethiopia
| | - Yitagesu Habtu
- Department of Public Health, Hossana College of Health Sciences, Hossana City Administrative, Southern Ethiopia, Ethiopia.
- School of Public Health, Department of Preventive Medicine, Addis Ababa University, Addis Ababa City Administrative, Addis Ababa, Ethiopia.
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Yallew WW, Assefa S, Yemane B. Pneumonia among under - five children in Ethiopia: a retrospective analysis from an urban hospital. RESEARCH SQUARE 2023:rs.3.rs-2790057. [PMID: 37090625 PMCID: PMC10120775 DOI: 10.21203/rs.3.rs-2790057/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Background Pneumonia is the leading cause of death in under-five children in low-income countries. However, the burden of pneumonia in hospital admission is not traced systematically. This study was conducted to determine the proportion of under-five pneumonia admissions among children admitted to a hospital in Addis Ababa, Ethiopia between 2017-2021. Methods A retrospective record of pediatric admissions to the Yekatit 12 referral hospital in Addis Ababa, Ethiopia was assessed for the period 2017- 2021. The date of admission and discharge, length of stay, and outcome at discharge were collected in accordance with the Ethiopian National Classification of Diseases (NCoD). Descriptive statistics were used to assess the proportion of under-five children with pneumonia. Survival analyses using Log rank test and cox regression analysis were done to assess time to recovery (recovering from illness). Multivariable logistic regression was used to assess the influence of selected factors on pneumonia associated hospital admission. Results Between 2017-2021, 2170 children age 1 to 59 months were admitted, 564 (25.99%; 95% confidence interval 24.18% to 27.87%) were diagnosed with pneumonia. Among the sixty children who died during their hospitalization, 15 had been diagnosed with pneumonia. The median time to recover from pneumonia and discharge was 6 days. The odds of pneumonia hospital admission were higher among younger children (4.36 times higher compared to elder children with 95% CI 2.77,6.87)and were increased between the months of September to November. Conclusions Pneumonia accounts for more than a quarter of hospital admissions in under-five children and for a quarter of deaths in this urban cohort. Hospital admission due to pneumonia was higher among older children (36-59 months of age) in the months following the heavy rain months (September to November) as compared to younger children. Our data strongly support increase of vaccination to prevent under 5 pneumonia.
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Jambo A, Gashaw T, Mohammed AS, Edessa D. Treatment outcomes and its associated factors among pneumonia patients admitted to public hospitals in Harar, eastern Ethiopia: a retrospective follow-up study. BMJ Open 2023; 13:e065071. [PMID: 36792331 PMCID: PMC9933768 DOI: 10.1136/bmjopen-2022-065071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Although there is a high risk of drug resistance, empiric treatment is a common approach for pneumonia management. In this respect, it is relevant to know treatment outcomes of patients with pneumonia. This study aimed to assess treatment outcomes and its associated factors among pneumonia patients treated at two public hospitals in Harar, eastern Ethiopia. DESIGN Retrospective follow-up study. SETTING Jugal General Hospital and Hiwot Fana Specialised University Hospital in Harar, eastern Ethiopia. PARTICIPANTS Patients admitted and treated for pneumonia in the two public hospitals in eastern Ethiopia between April 2020 and April 2021. PRIMARY OUTCOME The primary outcome was unfavourable treatment outcome (died or transferred to intensive care unit) for pneumonia patients. RESULTS A total of 693 patients with pneumonia were included in the study. 88 (12.7%) of these patients had an unfavourable treatment outcome, which included 14 (2%) transfers to the intensive care unit and 74 (10.7%) deaths. Patients with comorbidity (adjusted OR, AOR=2.96; 95% CI: 1.47 to 5.97) and with clinical features including abnormal body temperature (AOR=4.03; 95% CI: 2.14 to 7.58), tachycardia (AOR=2.57; 95% CI: 1.45 to 4.55), bradypnoea or tachypnoea (AOR=3.92; 95% CI:1.94 to 7.92), oxygen saturation below 90% (AOR=2.52; 95% CI:1.37 to 4.64) and leucocytosis (AOR=2.78, 95%, CI:1.38 to 5.58) had a significantly increased unfavourable treatment outcome. CONCLUSION We found that nearly one out of eight patients with pneumonia had unfavourable treatment outcomes. It was considerably high among patients with comorbidities and apparent abnormal clinical conditions. Therefore, taking into account regionally adaptable intervention and paying close attention to pneumonia patients admitted with comorbidity and other superimposed abnormal conditions might help improve the treatment outcomes of these populations.
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Affiliation(s)
- Abera Jambo
- Clinical Pharmacy Department, Haramaya University, Dire Dawa, Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and Toxicology, Haramaya University, Dire Dawa, Ethiopia
| | | | - Dumessa Edessa
- Clinical Pharmacy Department, Haramaya University, Dire Dawa, Ethiopia
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11
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Dharel S, Shrestha B, Basel P. Factors associated with childhood pneumonia and care seeking practices in Nepal: further analysis of 2019 Nepal Multiple Indicator Cluster Survey. BMC Public Health 2023; 23:264. [PMID: 36750815 PMCID: PMC9903409 DOI: 10.1186/s12889-022-14839-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/08/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Acute Respiratory Infection (ARI) is still a major public health problem in Nepal. The prevalence of ARI among under five children was 2.1% in 2019 and many children from marginalized families suffer disproportionately and many of them die without proper care and treatment. The objective of this study was to identify factors associated with childhood pneumonia and care-seeking practices in Nepal. METHODS This was a secondary analysis of the Nepal Multiple Indicator Cluster Survey (MICS) 2019, which uses multi-stage Probability Proportional to Size sampling. Data from 6658 children were analyzed using SPSS 22. Chi-square test and logistic regression analysis were conducted with odds ratio and its corresponding 95% confidence interval after adjusting for confounders. RESULTS Children aged 0 to 23 months had1.5 times higher odds of pneumonia compared to the age group 24 to 59 months (AOR = 1.5, CI 1.0-2.3) and children from rural area had 1.9 times the odds of having pneumonia than urban children (AOR = 1.9, CI 1.2-3.2). Underweight children had 2.3 times greater odds of having pneumonia than normal weight children (AOR = 2.3, CI 1.4-3.9). The odds of having pneumonia were 2.5 higher among children of current smoking mothers compared those with non-smoking mothers (AOR = 2.5, CI 1.1-5.7). Similarly, children from disadvantaged families had 0.6 times protective odds of pneumonia than children from non-disadvantaged families (AOR = 0.6, CI 0.4-1.0). Only one quarter of children received treatment from public facilities. Of those who received treatment, nearly half of the children received inappropriate treatment for pneumonia. One in ten children with pneumonia did not receive any kind of treatment at all. CONCLUSIONS Pneumonia is still a public health problem in low-income countries. Public health program and treatment services should be targeted to younger children, careful attention should be given to underweight children, and awareness and nutrition related activities should be focused on rural areas. Addressing inequity in access to and utilization of treatment of childhood illnesses should be prioritized.
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Affiliation(s)
- Sunita Dharel
- grid.80817.360000 0001 2114 6728Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Binjwala Shrestha
- grid.80817.360000 0001 2114 6728Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prem Basel
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
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12
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Differences in diagnosis, management, and outcomes of acute febrile illness by health facility level in southern Ethiopia. Sci Rep 2022; 12:19166. [PMID: 36357441 PMCID: PMC9649757 DOI: 10.1038/s41598-022-23641-8] [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] [Received: 04/03/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
We assessed the diagnosis, management and outcomes of acute febrile illness in a cohort of febrile children aged under 5 years presenting at one urban and two rural health centres and one tertiary hospital between 11 August 2019 and 01 November 2019. Pneumonia was diagnosed in 104 (30.8%) of 338 children at health centres and 128 (65.0%) of 197 at the hospital (p < 0.001). Malaria was detected in 33 (24.3%) of 136 children at the urban health centre, and in 55 (55.6%) of 99 and 7 (7.4%) of 95 children at the rural health centres compared to 11 (11.6%) of 95 at the hospital. Antibacterials were prescribed to 20 (11.5%) of 174 children without guidelines-specified indications (overprescribing) at health centres and in 7 (33.3%) of 21 children at the hospital (p = 0.013). Antimalarials were overprescribed to 13 (7.0%) of 185 children with negative malaria microscopy at the hospital. The fever resolved by day 7 in 326 (99.7%) of 327 children at health centres compared to 177 (93.2%) of 190 at the hospital (p < 0.001). These results suggest that additional guidance to health workers is needed to optimise the use of antimicrobials across all levels of health facilities.
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13
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Under-five mortality and associated factors in southeastern Ethiopia. PLoS One 2021; 16:e0257045. [PMID: 34492085 PMCID: PMC8423275 DOI: 10.1371/journal.pone.0257045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background In the year 2019, around 5 million children under age five died and most of the deaths happened in developing countries. Though large numbers of deaths are reported in such countries, limited availability of data poses a substantial challenge on generating reliable estimates. Hence, this study aims to assess the prevalence and factors associated with under-five mortality in southeastern Ethiopia. Methods A register based cross sectional study was conducted from 1st September 2014 to July 2019 in Asella teaching and referral hospital. A total of 4901 under-five age children registered on the admission and discharge book of pediatric ward with complete information were included for the analysis. Data entry and analysis were conducted using Epidata Version 7 and SPSS version 21, respectively. Descriptive statistics were used to explore the characteristics of the study participants and their condition at discharge. Adjusted Odds Ratio (AOR) with its 95% Confidence interval and P-value less than 5% was used to decide the statistically significant association. Results The prevalence of under-five mortality among admitted children in Asella Teaching and Referral hospital was 8.7% (95% CI 7.91–9.50%). Post-Neonatal and Child mortality were found to be 9.1% and 8.18%, respectively. Moreover, large numbers of death (45.2%) were seen within the first 2 days of admission. Address (AOR:1.4(1.08–1.81)), HIV status (AOR:4.64 (2.19–9.8)), severe acute malnutrition (AOR:2.82 (2.03–3.91)), hypovolemic shock (AOR:4.32 (2.31–8.1)), type I diabetes with DKA (AOR:3.53(1.34–9.29) and length of stay in the hospital for ≤2 days (AOR: 4.28 (3.09–5.95)) as well as 3–4 days (AOR: 1.48 (1.02–2.15)) were among the identified predictors. Conclusions Though childhood mortality is swiftly decreasing, and access and utilization of health care is improving in Ethiopia, our study found large prevalence of under-five mortality, 8.7% and higher number of deaths in early days of admission. Improving the quality of service has a paramount importance in reducing the mortality and managing associated factors contributing to under-five mortality among admitted children.
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14
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Kohns Vasconcelos M, Loens K, Sigfrid L, Iosifidis E, Epalza C, Donà D, Matheeussen V, Papachristou S, Roilides E, Gijon M, Rojo P, Minotti C, Da Dalt L, Islam S, Jarvis J, Syggelou A, Tsolia M, Nyirenda Nyang'wa M, Keers S, Renk H, Gemmel AL, D'Amore C, Ciofi Degli Atti M, Rodríguez-Tenreiro Sánchez C, Martinón-Torres F, Burokienė S, Goetghebuer T, Spoulou V, Riordan A, Calvo C, Gkentzi D, Hufnagel M, Openshaw PJ, de Jong MD, Koopmans M, Goossens H, Ieven M, Fraaij PLA, Giaquinto C, Bielicki JA, Horby P, Sharland M. Aetiology of acute respiratory infection in preschool children requiring hospitalisation in Europe-results from the PED-MERMAIDS multicentre case-control study. BMJ Open Respir Res 2021; 8:8/1/e000887. [PMID: 34326154 PMCID: PMC8323363 DOI: 10.1136/bmjresp-2021-000887] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
Background Both pathogenic bacteria and viruses are frequently detected in the nasopharynx (NP) of children in the absence of acute respiratory infection (ARI) symptoms. The aim of this study was to estimate the aetiological fractions for ARI hospitalisation in children for respiratory syncytial virus (RSV) and influenza virus and to determine whether detection of specific respiratory pathogens on NP samples was associated with ARI hospitalisation. Methods 349 children up to 5 years of age hospitalised for ARI (following a symptom-based case definition) and 306 hospital controls were prospectively enrolled in 16 centres across seven European Union countries between 2016 and 2019. Admission day NP swabs were analysed by multiplex PCR for 25 targets. Results RSV was the leading single cause of ARI hospitalisations, with an overall population attributable fraction (PAF) of 33.4% and high seasonality as well as preponderance in younger children. Detection of RSV on NP swabs was strongly associated with ARI hospitalisation (OR adjusted for age and season: 20.6, 95% CI: 9.4 to 45.3). Detection of three other viral pathogens showed strong associations with ARI hospitalisation: influenza viruses had an adjusted OR of 6.1 (95% CI: 2.5 to 14.9), parainfluenza viruses (PIVs) an adjusted OR of 4.6 (95% CI: 1.8 to 11.3) and metapneumoviruses an adjusted OR of 4.5 (95% CI: 1.3 to 16.1). Influenza viruses had a PAF of 7.9%, PIVs of 6.5% and metapneumoviruses of 3.0%. In contrast, most other pathogens were found in similar proportions in cases and controls, including Streptococcus pneumoniae, which was weakly associated with case status, and endemic coronaviruses. Conclusion RSV is the predominant cause of ARI hospitalisations in young children in Europe and its detection, as well as detection of influenza virus, PIV or metapneumovirus, on NP swabs can establish aetiology with high probability. PAFs for RSV and influenza virus are highly seasonal and age dependent.
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Affiliation(s)
- Malte Kohns Vasconcelos
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK .,Institute for Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Katherine Loens
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elias Iosifidis
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Veerle Matheeussen
- Laboratory of Clinical Microbiology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Savvas Papachristou
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - Manuel Gijon
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Pablo Rojo
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Universitario 12 de Octubre and Red de Investigación Traslacional en Infectología Pediátrica (RITIP), Instituto de Investigación 12 de Octubre (imas12), Madrid, Spain
| | - Chiara Minotti
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Liviana Da Dalt
- Paediatric Emergency Department, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Samsul Islam
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
| | - Jessica Jarvis
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aggeliki Syggelou
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Maria Tsolia
- 2nd Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, P. and A. Kyriakou Children's Hospital, Athens, Greece
| | - Maggie Nyirenda Nyang'wa
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Sophie Keers
- Paediatric Department, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, UK
| | - Hanna Renk
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Anna-Lena Gemmel
- Department of Paediatric Cardiology, Pulmonology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Carmen D'Amore
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Marta Ciofi Degli Atti
- Clinical Pathways and Epidemiology Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carmen Rodríguez-Tenreiro Sánchez
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain.,Genetics, Vaccines and Infectious Diseases Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Hospital Clínico Universitario de Santiago, Servizo Galego de Saude, Santiago de Compostela, Spain.,Genetics, Vaccines and Infectious Diseases Research Group, Instituto de Investigación Sanitaria de Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Sigita Burokienė
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Tessa Goetghebuer
- Department of Paediatrics, St-Pierre Hospital Brussels, Brussels, Belgium
| | - Vana Spoulou
- 1st Department of Paediatrics, National and Kapodistrian University of Athens (NKUA) School of Medicine, Agia Sophia Children's Hospital of Athens, Athens, Greece
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases, Alder Hey Children's Hospital, Liverpool, UK
| | - Cristina Calvo
- Paediatrics and Infectious Diseases Department, La Paz University Hospital, Madrid, Spain
| | - Despoina Gkentzi
- Department of Paediatrics, University General Hospital of Patras, Patras Medical School, Patras, Greece
| | - Markus Hufnagel
- Division of Paediatric Infectious Diseases and Rheumatology, Department of Paediatrics and Adolescent Medicine, University Medical Centre, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Peter J Openshaw
- National Heart and Lung Division, Faculty of Medicine, Imperial College London, London, UK
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marion Koopmans
- Department of Viroscience, ErasmusMC, Rotterdam, The Netherlands
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Margareta Ieven
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | | | - Carlo Giaquinto
- Division of Paediatric Infectious Diseases, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Julia A Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Department of Infectious Diseases and Vaccinology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK
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Shibre G, Zegeye B, Idriss-Wheeler D, Yaya S. Trends of inequalities in care seeking behavior for under-five children with suspected pneumonia in Ethiopia: evidence from Ethiopia demographic and health surveys (2005-2016). BMC Public Health 2021; 21:258. [PMID: 33526023 PMCID: PMC7852078 DOI: 10.1186/s12889-021-10232-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 01/13/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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16
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Abate BB, Kassie AM, Kassaw MW, Aragie TG, Masresha SA. Sex difference in coronavirus disease (COVID-19): a systematic review and meta-analysis. BMJ Open 2020; 10:e040129. [PMID: 33028563 PMCID: PMC7539579 DOI: 10.1136/bmjopen-2020-040129] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the sex difference in the prevalence of COVID-19 confirmed cases. DESIGN Systematic review and meta-analysis. SETTING PubMed, Cochrane Library and Google Scholar were searched for related information. The authors developed a data extraction form on an Excel sheet and the following data from eligible studies were extracted: author, country, sample size, number of female patients and number of male patients. Using STATA V.14 for analysis, the authors pooled the overall prevalence of men and/or women using a random-effect meta-analysis model. The authors examined the heterogeneity in effect size using Q statistics and I2 statistics. Subgroup and sensitivity analyses were performed. Publication bias was also checked. PARTICIPANTS Studies on COVID-19 confirmed cases were included. INTERVENTION Sex (male/female) of COVID-19 confirmed cases was considered. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was prevalence of COVID-19 among men and women. RESULTS A total of 57 studies with 221 195 participants were used in the analysis. The pooled prevalence of COVID-19 among men was found to be 55.00 (51.43-56.58, I2=99.5%, p<0.001). Sensitivity analysis showed the findings were not dependent on a single study. Moreover, a funnel plot showed symmetrical distribution. Egger's regression test p value was not significant, which indicates absence of publication bias in both outcomes. CONCLUSIONS The prevalence of symptomatic COVID-19 was found to be higher in men than in women. The high prevalence of smoking and alcohol consumption contributed to the high prevalence of COVID-19 among men. Additional studies on the discrepancies in severity and mortality rate due to COVID-19 among men and women and the associated factors are recommended.
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Affiliation(s)
| | | | | | | | - Setamlak Adane Masresha
- College of Health Sciences, Department of Public Health, Woldia University, Woldia, Amhara, Ethiopia
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