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Nalwanga D, Bakker C, Kiggwe A, Negash AA, Ocan M, Briend A, Maitland K, Musiiime V, Karamagi C. Mortality among non-severely under nourished children with pneumonia globally: protocol for a systematic review and meta-analysis. Wellcome Open Res 2024; 8:551. [PMID: 38404639 PMCID: PMC10891427 DOI: 10.12688/wellcomeopenres.20200.1] [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] [Accepted: 03/12/2024] [Indexed: 02/27/2024] Open
Abstract
Background Pneumonia remains the commonest cause of ill health and mortality among children worldwide. Severe undernutrition increases the mortality risk among children with pneumonia. While children with pneumonia are at increased risk of developing malnutrition, the impact of pneumonia on mortality and nutritional status of non-severely undernourished children is not well described. The impact of nutritional supplementation on mortality and nutritional status in this population is not well understood. This review will collate available evidence on the all-cause mortality and anthropometric indices outcomes following pneumonia, as well as the impact of nutritional supplementation on mortality and anthropometry among non-severely malnourished children with pneumonia. Methods The review will be done using a priori criteria developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data will be obtained from data bases, grey literature, and bibliographies. An experienced librarian will conduct article search in PUBMED, MEDLINE, EMBASE, Web of Science, Google scholar, and Scopus. Retrieved articles will be entered in Endnote ver 9.0, duplicates removed, and transferred to Epi-reviewer for screening and data abstraction. Risk of bias in the included articles will be assessed using standard criteria. Heterogeneity will be assessed using I 2-statistic and sub-group analysis will be done. Data will be analysed using both narrative and quantitative synthesis. Quantitative synthesis will be done using DeSimonian and Laird Random-effects model in STATA ver 15.0. Conclusions The results will provide baseline information about the mortality and anthropometric outcomes of pneumonia among non-severely malnourished children as well as the potential effect of nutritional supplementation on these outcomes. This will provide a basis to explore the potential for nutritional supplementation improving clinical outcomes like mortality and occurrence of severe acute malnutrition among children with severe pneumonia worldwide. Registration The review has been registered in PROSPERO (CRD42021257272; 15 July 2021).
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Affiliation(s)
- Damalie Nalwanga
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Makerere University Lung Institute, Kampala, Central Region, Uganda
| | - Caitlin Bakker
- University Libraries, University of Minnesota, Minneapolis, Minneapolis, USA
| | - Andrew Kiggwe
- Makerere University Lung Institute, Kampala, Central Region, Uganda
| | - Abel Abera Negash
- Armauer Hansen Research Institute, Addis Ababa, Addis Ababa, Ethiopia
- Department of Microbiology, Immunology and Parasitology, School of Medicine, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia
| | - Moses Ocan
- Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
| | - Andre Briend
- School Of Medicine, University of Tampere, Tampere, Finland
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark
| | - Kathryn Maitland
- Clinical, KERMI Wellcome Trust Research Programme, Kilifi, Kilifi, Po Box 230, Kenya
- Department of Infectious Disease and Institute of Global Health and Innovation, Imperial College London, London, England, UK
| | - Victor Musiiime
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Research Department, Joint Clinical Research Centre, Kampala, Uganda
| | - Charles Karamagi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
- Clinical Epidemiology Unit, Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
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Lencha B, Urgessa M, Lemessa F, Minda Z, Beressa G, Ganfure G, Degno S. Severe Acute Malnutrition among Children in Bale Zone Southeast Ethiopia: Treatment Outcome and its Determinant Factors. J Pediatr 2024; 264:113743. [PMID: 37722556 DOI: 10.1016/j.jpeds.2023.113743] [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: 04/21/2023] [Revised: 08/12/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To assess the treatment outcomes of severe acute malnutrition (SAM) and its associated factors in children aged 6-59 months in Bale zone, Southeast Ethiopia. DESIGN A multi-institutionally-based, retrospective cross-sectional study design was conducted, based on records from September 11, 2014 to September 11, 2017. Simple random sampling was used to select the records. A pretested extraction format was used to collect information from the logbook and patient records. Treatment outcome was dichotomized into recovery and censored. Bivariate and multivariable logistic regression analyses were used to analyze the data. Odds ratios with 95% CIs were calculated to determine the association between each independent variable and treatment outcome. RESULTS A total of 763 records were completed and reviewed. Of these, 711 (93.2%) were recovered from SAM. Provision of deworming treatment (aOR = 6.5; 95% CI: 2.8-15.1), education given to the mother/caregiver (aOR = 8.8; 95% CI: 4.2-18.4), age range 6-24 months (aOR = 0.37; 95% CI: 0.17-0.81), presence of anemia (aOR = 0.33; 95% CI: 0.14-0.78), and use of nasogastric (NG) tube (aOR = 0.42; 95% CI: (0.21-0.85) were associated with recovery from SAM. CONCLUSIONS Recovery rate of SAM children in this study was in line with international standards. Deworming, maternal education status, child's age, anemia, and NG tube use were associated with recovery. Attention should be given to deworming all children, disease control, and prevention of anemia and other comorbidities.
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Affiliation(s)
- Bikila Lencha
- Department of Public Health, Shashemene campus, Madda Walabu University, Shashemene, Ethiopia
| | - Megersso Urgessa
- Department of Public Health, Shashemene campus, Madda Walabu University, Shashemene, Ethiopia.
| | - Feyyissa Lemessa
- Department of Nursing, Paulos Hospital and Millenium Medical College, Addis Ababa, Ethiopia
| | - Zenebe Minda
- Department of Public Health, Goba Referral Hospital, Madda walabu University, Bale-Goba, Ethiopia
| | - Girma Beressa
- Department of Public Health, Goba Referral Hospital, Madda walabu University, Bale-Goba, Ethiopia
| | | | - Sisay Degno
- Department of Public Health, Shashemene campus, Madda Walabu University, Shashemene, Ethiopia
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Kedy Koum DC, Eposse C, Kojom Foko LP, Mbono Betoko R, Ismaila Z, Njanseb Nfanleu CL, Noukeu Njinkui D, Penda CI. Prevalence and predictors of mortality among hospitalized children with severe acute malnutrition in a hospital in North Cameroon. J Trop Pediatr 2023; 69:fmad042. [PMID: 38007622 DOI: 10.1093/tropej/fmad042] [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] [Indexed: 11/27/2023]
Abstract
BACKGROUND Severe acute malnutrition (SAM) is a major public health concern responsible for paediatric hospitalizations and more than one-third of deaths across the world. In 2013, SAM caused ≥20% of deaths in severely malnourished infants in Douala, the economic capital of Cameroon. There is little data on SAM in economically, sanitary and socially disadvantaged Cameroonian regions including the North region. OBJECTIVES To determine the prevalence and potential predictors of mortality among children with SAM in a reference health facility in Garoua, North region, Cameroon. METHODS A cross-sectional analytical study was conducted from November 2021 to May 2022 at the paediatric ward of Garoua Regional hospital. Data collected on sociodemographic, clinical and therapeutic characteristics in this study were questionnaire based. RESULTS A total of 6769 children were admitted for hospitalization during the study period, among them 701 SAM cases, giving a hospital prevalence of 10.4%. Of the 347 children included, 51% of the study population were males and 87.6% were children aged 6-23 months. Seven predictors of mortality were identified: orphan status [adjusted odds ratios (AOR) = 8.70, p = 0.021], vomiting (AOR = 3.40, p < 0.0001), marasmus-kwashiorkor (AOR = 7.30, p = 0.005), lack of appetite (AOR = 56.10, p < 0.0001), cutaneous lesions (AOR = 5.50, p = 0.014), lethargy (AOR = 4.50, p = 0.001) and nasogastric rehydration (AOR = 6.50, p = 0.004). CONCLUSION Practitioners in the northern region of Cameroon should address these locally identified mortality factors to intervene with, and hopefully prevent and adequately manage malnutrition and SAM in this and similar contexts.
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Affiliation(s)
- Danièle Christiane Kedy Koum
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Littoral Region 24157, Cameroon
- Deido District Hospital, Douala, Littoral Region 8037, Cameroon
| | - Charlotte Eposse
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Littoral Region 24157, Cameroon
| | - Loick Pradel Kojom Foko
- Department of Animal Organisms, Faculty of Sciences, University of Douala, Douala, Littoral Region 24157, Cameroon
| | - Ritha Mbono Betoko
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Littoral Region 24157, Cameroon
| | - Zeinabou Ismaila
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Littoral Region 24157, Cameroon
| | | | - Diomède Noukeu Njinkui
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, West Region 96, Cameroon
| | - Calixte Ida Penda
- Department of Clinical Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Littoral Region 24157, Cameroon
- Douala General Hospital, Douala, Littoral Region 4856, Cameroon
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Gamal Y, Mahmoud AO, Mohamed SAA, I. Mohamed J, Raheem YFA. Prevalence and impact of malnutrition on outcomes and mortality of under-five years children with pneumonia: a study from Upper Egypt. Eur J Pediatr 2023; 182:4583-4593. [PMID: 37542670 PMCID: PMC10587326 DOI: 10.1007/s00431-023-05138-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
Malnutrition has adverse impacts on under-five children with pneumonia. The purpose of this study was to address the prevalence and impact of malnutrition on under-five years children with pneumonia, admitted to a tertiary large children hospital in Upper Egypt. This study is a prospective case-control study. All under-five children diagnosed with pneumonia who were admitted to Assiut University Children's Hospital (AUCH) from January 1st to December 31st, 2021, were enrolled. Based on their nutritional assessment, the studied participants were classified into 2 groups: (1): Children with pneumonia and with nutritional deficiency considered as cases, and (2): Children with pneumonia and without nutritional deficiency considered as controls. Three hundred-fifty cases and 154 control subjects were enrolled, respectively. 93.4%, 31.1%, and 61.7% of the cases had underweight, stunting, and wasting, respectively. Among those cases, there were significant differences between survivors and non-survivors with regard to some clinicodemographic factors, laboratory parameters, and anthropometric parameters. Lack of compulsory vaccination, presence of sepsis, and blood transfusion (OR 2.874, 95% CI 0.048 - 2.988, p = 0.004, 2.627, 0.040 - 2.677, p = 0.009, and 4.108, 0.134 - 3.381, p < 0.001, respectively) were significant independent predictors for mortality among malnourished children with pneumonia. Conclusion: Malnutrition has a high prevalence in under-five children with pneumonia in our locality. It has adverse effects on the outcomes and in-hospital mortality of those children. Lack of compulsory vaccination, presence of sepsis, and blood transfusion were significant independent predictors of mortality in malnourished children with pneumonia. Larger multicenter studies are warranted. What is Known: • Malnutrition has adverse impacts on under-five children with pneumonia. • Malnutrition could be a reason for in-hospital mortality among under-five children with pneumonia. What is New: • Malnutrition has a high prevalence in under-five children with pneumonia in Upper Egypt, with its adverse effects on the outcomes and mortality of those children. • Lack of vaccination, presence of sepsis, and blood transfusion are significant independent predictors of mortality in malnourished children with pneumonia in Upper Egypt.
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Affiliation(s)
- Yasser Gamal
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, 71516 Egypt
| | - Asmaa O. Mahmoud
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, 71516 Egypt
| | - Sherif A. A. Mohamed
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, 71516 Egypt
| | - Jaafar I. Mohamed
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, 71516 Egypt
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Mamun GMS, Zou M, Sarmin M, Brintz BJ, Rahman ASMMH, Parvin I, Ackhter MM, Chisti MJ, Leung DT, Shahrin L. Derivation and validation of a clinical prediction model for risk-stratification of children hospitalized with severe pneumonia in Bangladesh. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002216. [PMID: 37527232 PMCID: PMC10393146 DOI: 10.1371/journal.pgph.0002216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023]
Abstract
Children with severe pneumonia in low- and middle-income countries (LMICs) suffer from high rates of treatment failure despite appropriate World Health Organization (WHO)-directed antibiotic treatment. Developing a clinical prediction rule for treatment failure may allow early identification of high-risk patients and timely intervention to decrease mortality. We used data from two separate studies conducted at the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) to derive and externally validate a clinical prediction rule for treatment failure of children hospitalized with severe pneumonia. The derivation dataset was from a randomized clinical trial conducted from 2018 to 2019, studying children aged 2 to 59 months hospitalized with severe pneumonia as defined by WHO. Treatment failure was defined by the persistence of danger signs at the end of 48 hours of antibiotic treatment or the appearance of any new danger signs within 24 hours of enrollment. We built a random forest model to identify the top predictors. The top six predictors were the presence of grunting, room air saturation, temperature, the presence of lower chest wall indrawing, the presence of respiratory distress, and central cyanosis. Using these six predictors, we created a parsimonious model with a discriminatory performance of 0.691, as measured by area under the receiving operating curve (AUC). We performed external validation using a temporally distinct dataset from a cohort study of 191 similarly aged children with severe acute malnutrition and pneumonia. In external validation, discriminatory performance was maintained with an improved AUC of 0.718. In conclusion, we developed and externally validated a parsimonious six-predictor model using random forest methods to predict treatment failure in young children with severe pneumonia in Bangladesh. These findings can be used to further develop and validate parsimonious and pragmatic prognostic clinical prediction rules for pediatric pneumonia, particularly in LMICs.
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Affiliation(s)
- Gazi Md. Salahuddin Mamun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Michael Zou
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ben J. Brintz
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | | | - Irin Parvin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mst Mahmuda Ackhter
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel T. Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Division of Microbiology & Immunology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Mamun GMS, Sarmin M, Shahid ASMSB, Nuzhat S, Shahrin L, Afroze F, Saha H, Shaima SN, Sultana MS, Ahmed T, Chisti MJ. Burden, predictors, and outcome of unconsciousness among under-five children hospitalized for community-acquired pneumonia: A retrospective study from a developing country. PLoS One 2023; 18:e0287054. [PMID: 37343025 DOI: 10.1371/journal.pone.0287054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/28/2023] [Indexed: 06/23/2023] Open
Abstract
Despite the reduction of death from pneumonia over recent years, pneumonia has still been the leading infectious cause of death in under-five children for the last several decades. Unconsciousness is a critical condition in any child resulting from any illness. Once it occurs during a pneumonia episode, the outcome is perceived to be fatal. However, data on children under five with pneumonia having unconsciousness are scarce. We've retrospectively analyzed the data of under-five children admitted at the in-patient ward of Dhaka Hospital of icddr,b during 1 January 2014 and 31 December 2017 with World Health Organization classified pneumonia or severe pneumonia. Children presented with or without unconsciousness were considered as cases and controls respectively. Among a total of 3,876 children fulfilling the inclusion criteria, 325 and 3,551 were the cases and the controls respectively. A multivariable logistic regression analysis revealed older children (8 months vs. 7.9 months) (adjusted odds ratio, aOR 1.02, 95% CI: 1.004-1.04, p = 0.015), hypoxemia (aOR 3.22, 95% CI: 2.39-4.34, p<0.001), severe sepsis (aOR 4.46, 95% CI: 3.28-6.06, p<0.001), convulsion (aOR 8.90, 95% CI: 6.72-11.79, p<0.001), and dehydration (aOR 2.08, 95% CI: 1.56-2.76, p<0.001) were found to be independently associated with the cases. The cases more often had a fatal outcome than the controls (23% vs. 3%, OR 9.56, 95% CI: 6.95-13.19, p<0.001). If the simple predicting factors of unconsciousness in children under five hospitalized for pneumonia with different severity can be initially identified and adequately treated with prompt response, pneumonia-related deaths can be reduced more effectively, especially in resource-limited settings.
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Affiliation(s)
- Gazi Md Salahuddin Mamun
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Sharika Nuzhat
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Haimanti Saha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shamsun Nahar Shaima
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mst Shahin Sultana
- National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Diagnostic, Management, and Research Considerations for Pediatric Acute Respiratory Distress Syndrome in Resource-Limited Settings: From the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2023; 24:S148-S159. [PMID: 36661443 DOI: 10.1097/pcc.0000000000003166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Diagnosis of pediatric acute respiratory distress syndrome (PARDS) in resource-limited settings (RLS) is challenging and remains poorly described. We conducted a review of the literature to optimize recognition of PARDS in RLS and to provide recommendations/statements for clinical practice and future research in these settings as part of the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2). DATA SOURCES MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost). STUDY SELECTION We included studies related to precipitating factors for PARDS, mechanical ventilation (MV), pulmonary and nonpulmonary ancillary treatments, and long-term outcomes in children who survive PARDS in RLS. DATA EXTRACTION Title/abstract review, full-text review, and data extraction using a standardized data collection form. DATA SYNTHESIS The Grading of Recommendations Assessment, Development, and Evaluation approach was used to identify and summarize evidence and develop recommendations. Seventy-seven studies were identified for full-text extraction. We were unable to identify any literature on which to base recommendations. We gained consensus on six clinical statements (good practice, definition, and policy) and five research statements. Clinicians should be aware of diseases and comorbidities, uncommon in most high-income settings, that predispose to the development of PARDS in RLS. Because of difficulties in recognizing PARDS and to avoid underdiagnosis, the PALICC-2 possible PARDS definition allows exclusion of imaging criteria when all other criteria are met, including noninvasive metrics of hypoxemia. The availability of MV support, regular MV training and education, as well as accessibility and costs of pulmonary and nonpulmonary ancillary therapies are other concerns related to management of PARDS in RLS. Data on long-term outcomes and feasibility of follow-up in PARDS survivors from RLS are also lacking. CONCLUSIONS To date, PARDS remains poorly described in RLS. Clinicians working in these settings should be aware of common precipitating factors for PARDS in their patients. Future studies utilizing the PALICC-2 definitions are urgently needed to describe the epidemiology, management, and outcomes of PARDS in RLS.
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Francis F, Robertson RC, Bwakura-Dangarembizi M, Prendergast AJ, Manges AR. Antibiotic use and resistance in children with severe acute malnutrition and human immunodeficiency virus infection. Int J Antimicrob Agents 2023; 61:106690. [PMID: 36372343 DOI: 10.1016/j.ijantimicag.2022.106690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/12/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
Severe acute malnutrition (SAM) and human immunodeficiency virus (HIV) infection underlie a major proportion of the childhood disease burden in low- and middle-income countries. These diseases commonly co-occur and lead to higher risk of other endemic infectious diseases, thereby compounding the risk of mortality and morbidity. The widespread use of antibiotics as treatment and prophylaxis in childhood SAM and HIV infections, respectively, has reduced mortality and morbidity but canlead to increasing antibiotic resistance. Development of antibiotic resistance could render future infections untreatable. This review summarises the endemic co-occurrence of undernutrition, particularly SAM, and HIV in children, and current treatment practices, specifically WHO-recommended antibiotic usage. The risks and benefits of antibiotic treatment, prophylaxis and resistance are reviewed in the context of patients with SAM and HIV and associated sub-populations. Finally, the review highlights possible research areas and populations where antibiotic resistance progression can be studied to best address concerns associated with the future impact of resistance. Current antibiotic usage is lifesaving in complicated SAM and HIV-infected populations; nevertheless, increasing baseline resistance and infection remain a significant concern. In conclusion, antibiotic usage currently addresses the immediate needs of children in SAM and HIV endemic regions; however, it is prudent to evaluate the impact of antibiotic use on resistance dynamics and long-term child health.
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Affiliation(s)
- Freddy Francis
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | | | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, U.K; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe..
| | - Amee R Manges
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada.
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Mvalo T, Smith AG, Eckerle M, Hosseinipour MC, Kondowe D, Vaidya D, Liu Y, Corbett K, Nansongole D, Mtimaukanena TA, Lufesi N, McCollum ED. Antibiotic treatment failure in children aged 1 to 59 months with World Health Organization-defined severe pneumonia in Malawi: A CPAP IMPACT trial secondary analysis. PLoS One 2022; 17:e0278938. [PMID: 36516197 PMCID: PMC9750006 DOI: 10.1371/journal.pone.0278938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pneumonia is a leading cause of mortality in children <5 years globally. Early identification of hospitalized children with pneumonia who may fail antibiotics could improve outcomes. We conducted a secondary analysis from the Malawi CPAP IMPACT trial evaluating risk factors for antibiotic failure among children hospitalized with pneumonia. METHODS Participants were 1-59 months old with World Health Organization-defined severe pneumonia and hypoxemia, severe malnutrition, and/or HIV exposure/infection. All participants received intravenous antibiotics per standard care. First-line antibiotics were benzylpenicillin and gentamicin for five days. Study staff assessed patients for first-line antibiotic failure daily between days 3-6. When identified, patients failing antibiotics were switched to second-line ceftriaxone. Analyses excluded children receiving ceftriaxone and/or deceased by hospital day two. We compared characteristics between patients with and without treatment failure and fit multivariable logistic regression models to evaluate associations between treatment failure and admission characteristics. RESULTS From June 2015-March 2018, 644 children were enrolled and 538 analyzed. Antibiotic failure was identified in 251 (46.7%) participants, and 19/251 (7.6%) died. Treatment failure occurred more frequently with severe malnutrition (50.2% (126/251) vs 28.2% (81/287), p<0.001) and amongst those dwelling ≥10km from a health facility (22.3% (56/251) vs 15.3% (44/287), p = 0.026). Severe malnutrition occurred more frequently among children living ≥10km from a health facility than those living <10km (49.0% (49/100) vs 35.7% (275/428), p = 0.014). Children with severe malnutrition (adjusted odds ratio (aOR) 2.2 (95% CI 1.52, 3.24), p<0.001) and pre-hospital antibiotics ((aOR 1.47, 95% CI 1.01, 2.14), p = 0.043) had an elevated aOR for antibiotic treatment failure. CONCLUSION Severe malnutrition and pre-hospital antibiotic use predicted antibiotic treatment failure in this high-risk severe pneumonia pediatric population in Malawi. Our findings suggest addressing complex sociomedical conditions like severe malnutrition and improving pneumonia etiology diagnostics will be key for better targeting interventions to improve childhood pneumonia outcomes.
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Affiliation(s)
- Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | - Andrew G. Smith
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital, Cincinnati, OH, United States of America
| | - Mina C. Hosseinipour
- University of North Carolina Project Malawi, Lilongwe, Malawi
- Division of Infectious Disease, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Davie Kondowe
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Dhananjay Vaidya
- Department of Medicine, Epidemiology and the BEAD Core, Johns Hopkins University, Baltimore, MD, United States of America
| | - Yisi Liu
- Department of Pediatrics and the BEAD Core, Johns Hopkins University, Baltimore, MD, United States of America
| | - Kelly Corbett
- Department of Pediatrics, Section of Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Dan Nansongole
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | | | | | - Eric D. McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Global Program for Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
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10
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Argent AC, Ranjit S, Peters MJ, Andre-von Arnim AVS, Chisti MJ, Jabornisky R, Musa NL, Kissoon N. Factors to be Considered in Advancing Pediatric Critical Care Across the World. Crit Care Clin 2022; 38:707-720. [PMID: 36162906 DOI: 10.1016/j.ccc.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This article reviews the many factors that have to be taken into account as we consider the advancement of pediatric critical care (PCC) in multiple settings across the world. The extent of PCC and the range of patients who are cared for in this environment are considered. Along with a review of the ongoing treatment and technology advances in the PCC setting, the structures and systems required to support these services are also considered. Finally the question of how PCC can be made sustainable in a volatile world with the impacts of global crises such as climate change is addressed.
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Affiliation(s)
- Andrew C Argent
- Department of Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Suchitra Ranjit
- Pediatric ICU, Apollo Children's Hospital, 15, Shafee Mhd Road, Chennai 600006, India
| | - Mark J Peters
- University College London Great Ormond Street Institute of Child Health, London, WC1N 3JH, UK; Paediatric Intensive Care Unit, Great Ormond Street Hospital NHS Foundation Trust, London, WC1N 1EH, UK
| | - Amelie von Saint Andre-von Arnim
- Department of Pediatrics, Division of Pediatric Critical Care, University of Washington, Seattle Children's, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA; Department of Global Health, University of Washington, Seattle Children's, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA
| | - Md Jobayer Chisti
- ARI Ward, Dhaka Hospital, Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Roberto Jabornisky
- Universidad Nacional Del Nordeste, Argentina. Pediatric Intensive Care Unit (Hospital Juan Pablo II and Hospital Olga Stuky) Argentina, Sociedad Latinoamericana de Cuidados Intensivos Pediátricos, LARed Network, Universidad Nacional Del Nordeste, 1420 Mariano Moreno, Corrientes 3400, Argentina
| | - Ndidiamaka L Musa
- Paediatric Critical Care, University of Washington, 4800 Sand Point Way NorthEast, Seattle, WA 98105, USA
| | - Niranjan Kissoon
- British Columbia Children's Hospital and The University of British Columbia, Vancouver, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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11
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Shaly NJ, Pervez MM, Huq S, Ahmed D, Ahsan CR, Sarmin M, Afroze F, Nuzhat S, Chisti MJ, Ahmed T. Invasive Fungal Infections in Under-Five Diarrheal Children: Experience from an Urban Diarrheal Disease Hospital. LIFE (BASEL, SWITZERLAND) 2022; 12:life12010094. [PMID: 35054490 PMCID: PMC8777596 DOI: 10.3390/life12010094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/31/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
Invasive fungal infections (IFIs) are opportunistic, especially in immunocompromised and hospitalized patients. Children with IFIs are more vulnerable to a fatal outcome. For early diagnosis and treatment, knowledge of the spectrum and frequency of IFIs among children is prerequisite. In this prospective observational study, we enrolled 168 children of 2–59 months old of either sex from March 2018 to December 2019 admitted to the Dhaka hospital, icddr,b. Study participants with suspected IFIs were with or without severe acute malnutrition (SAM) along with sepsis/pneumonia and fulfilled any of the following criteria: (i) failure to respond to injectable antibiotics, (ii) development of a late-onset hospital-acquired infection, (iii) needed ICU care for >7 days, (iv) took steroids/antibiotics for >2 weeks before hospitalization, and (v) developed thrush after taking injectable antibiotics. The comparison group included non-SAM (weight-for-length Z score ≥ −2) children with diarrhea and fever <3 days in the absence of co-morbidity. We performed real-time PCR, ELISA, and blood culture for the detection of fungal pathogen. Study group children with SAM, positive ELISA and PCR considered to have a IFIs. In the study group, 15/138 (10.87%) children had IFIs. Among IFIs, invasive candidiasis, aspergillosis, histoplasmosis detected in 6 (4.53%), 11 (7.97%), and 1 (0.72%) children, respectively, and (3/15 [2.17%]) children had both candidiasis and aspergillosis. Children with IFIs more often encountered septic shock (26.7% vs. 4.9%; p = 0.013) and had a higher death rate (46.7% vs. 8.9%; p < 0.001) than those without IFIs. IFIs were independently associated with female sex (OR = 3.48; 95% CI = 1.05, 11.55; p = 0.042) after adjusting for potential confounders. Our findings thus implicate that, malnourished children with septic shock require targeted screening for the early diagnosis and prompt management of IFIs that may help to reduce IFIs related deaths.
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Affiliation(s)
- Nusrat Jahan Shaly
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
| | - Mohammed Moshtaq Pervez
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
| | - Sayeeda Huq
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
| | - Dilruba Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
| | | | - Monira Sarmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
| | - Sharika Nuzhat
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
- Correspondence:
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh; (N.J.S.); (M.M.P.); (S.H.); (D.A.); (M.S.); (F.A.); (S.N.); (T.A.)
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12
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Shaima SN, Alam T, Bin Shahid ASMS, Shahrin L, Sarmin M, Afroze F, Parvin I, Nuzhat S, Jahan Y, Mamun GMS, Saha H, Ackhter MM, Islam MZ, Shahunja KM, Islam S, Ahmed T, Chisti MJ. Prevalence, Predictive Factors, and Outcomes of Respiratory Failure in Children With Pneumonia Admitted in a Developing Country. Front Pediatr 2022; 10:841628. [PMID: 35601439 PMCID: PMC9115563 DOI: 10.3389/fped.2022.841628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/29/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pneumonia has been the leading infectious cause of morbidity and mortality in children under 5 years of age for the last several decades. Although most of these deaths occur due to respiratory failure, published data are limited regarding predicting factors and outcomes of respiratory failure in children hospitalized with pneumonia or severe pneumonia. OBJECTIVE This study aimed to explore the prevalence, predicting factors, and outcomes of respiratory failure in children under-five with pneumonia or severe pneumonia. METHODS In this retrospective chart analysis, we enrolled children under 5 years of age hospitalized with pneumonia or severe pneumonia in the Dhaka Hospital of International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) between August 2013 and December 2017. Comparisons were made between children with respiratory failure (n = 212) and those without respiratory failure (n = 4,412). Respiratory failure was defined when the oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) was <315. RESULTS A total of 4,625 children with pneumonia or severe pneumonia were admitted during this study period. Among them, 212 (4.6%) children developed respiratory failure and formed the case group. A total of 4,412 (95.3%) children did not develop respiratory failure and formed the comparison group. In logistic regression analysis, after adjusting with potential confounders, severe sepsis [adjusted odds ratio (aOR): 12.68, 95% CI: 8.74-18.40], convulsion (aOR: 4.52, 95% CI: 3.06-6.68), anemia (aOR: 1.76, 95% CI: 1.20-2.57), and severe underweight (aOR: 1.97, 95% CI: 1.34-2.89) were found to be independently associated with respiratory failure. As expected, children with respiratory failure more often had fatal outcome than without respiratory failure (74, 1%, p < 0.001). CONCLUSION The results of our analyses revealed that prevalence of respiratory failure was 4.6% among under-five children hospitalized for pneumonia or severe pneumonia. Severe sepsis, convulsion, anemia, and severe underweight were the independent predictors for respiratory failure in such children and their case-fatality rate was significantly higher than those without respiratory failure. Early recognition of these predicting factors of respiratory failure may help clinicians imitating prompt treatment that may further help to reduce deaths in such children, especially in resource-limited settings.
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Affiliation(s)
- Shamsun Nahar Shaima
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Irin Parvin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharika Nuzhat
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Yasmin Jahan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Gazi Md Salahuddin Mamun
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Haimanti Saha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mst Mahmuda Ackhter
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Zahidul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K M Shahunja
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
| | - Sufia Islam
- Department of Pharmacy, East West University, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,Office of the Executive Director, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Bitew ZW, Ayele EG, Worku T, Alebel A, Alemu A, Worku F, Yesuf A. Determinants of mortality among under-five children admitted with severe acute malnutrition in Addis Ababa, Ethiopia. Nutr J 2021; 20:94. [PMID: 34930311 PMCID: PMC8691009 DOI: 10.1186/s12937-021-00750-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Management of severe acute malnutrition (SAM) has been a program priority in Ethiopia, but it remains the leading cause of mortality in under-five children. Hence, this study aimed to identify the incidence density rate of mortality and determinants among under-five children with severe acute malnutrition in St. Paul's Hospital Millennium Medical College, 2012 to 2019. METHODS A retrospective cohort study was conducted and data were collected using a structured checklist from 673 charts, of which 610 charts were included in the final analysis. The Kaplan-Meier survival curve with Log-rank test was used to estimate the survival time. Bi-variable and multi-variable Cox proportional hazard regression models were fitted to identify determinants of death. Schoenfeld residuals test was used to check a proportional hazard assumption. Goodness of fit of the final model was checked using Nelson Aalen cumulative hazard function against Cox-Snell residual. RESULTS In this study, 61 (10%) children died making the incidence density rate of death 5.6 (95% CI: 4.4, 7.2) per 1000 child-days. Shock (Adjusted Hazard Ratio) [AHR] =3.2; 95% CI: 1.6, 6.3)), IV fluid infusion (AHR = 5.2; 95% CI: 2.4, 10.4), supplementing F100 (AHR = 0.12; 95%CI: 0.06, 0.23) and zinc (AHR = 0.45; 95% CI: 0.22, 0.93) were determinants of death. CONCLUSION The overall proportion of deaths was within the range put forth by the Sphere standard and the national SAM management protocol. Shock and IV fluid infusion increased the hazard of death, whereas F100 & zinc were found to decrease the likelihood death. Children with SAM presented with shock should be handled carefully and IV fluids should be given with precautions.
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Affiliation(s)
- Zebenay Workneh Bitew
- St. Paul's Hospital Millennium Medical College, P.O. Box 1271, Addis Ababa, Ethiopia.
| | - Ermias Getaneh Ayele
- St. Paul's Hospital Millennium Medical College, P.O. Box 1271, Addis Ababa, Ethiopia
| | - Teshager Worku
- College of Health and Medical Sciences, School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
| | - Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | - Frehiwot Worku
- Millennium Medical College, Department of Public Health, St. Paul's Hospital, Addis Ababa, Ethiopia
| | - Aman Yesuf
- Millennium Medical College, Department of Public Health, St. Paul's Hospital, Addis Ababa, Ethiopia
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Shahrin L, Chisti MJ, Sarmin M, Rahman ASMMH, Shahid ASMSB, Islam MZ, Afroze F, Huq S, Ahmed T. Intravenous Amoxicillin Plus Intravenous Gentamicin for Children with Severe Pneumonia in Bangladesh: An Open-Label, Randomized, Non-Inferiority Controlled Trial. Life (Basel) 2021; 11:1299. [PMID: 34947830 PMCID: PMC8707665 DOI: 10.3390/life11121299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
The World Health Organization (WHO) recommends intravenous (IV) ampicillin and gentamicin as first-line therapy to treat severe pneumonia in children under five years of age. Ampicillin needs to be administered at a six-hourly interval, which requires frequent nursing intervention and bed occupancy for 5-7 days, limiting its utility in resource-poor settings. We compared the efficacy of IV amoxicillin over IV ampicillin, which is a potential alternative drug in treating severe pneumonia in children between 2-59 months. We conducted an unblinded, randomized, controlled, non-inferiority trial in the Dhaka hospital of icddr,b from 1 January 2018 to 31 October 2019. Children from 2-59 months of age presenting with WHO defined severe pneumonia with respiratory danger signs were randomly assigned 1:1 to either 50 mg/kg ampicillin or 40 mg/kg amoxicillin per day with 7.5 mg/kg gentamicin. The primary outcome was treatment failure as per the standard definition of persistence of danger sign(s) of severe pneumonia beyond 48 h or deterioration within 24 h of therapy initiation. The secondary outcomes were: (i) time required for resolution of danger signs since enrolment, (ii) length of hospital stay, (iii) death during hospitalization, and (iv) rate of nosocomial infections. Among 308 enrolled participants, baseline characteristics were similar among the two groups. Sixty-two (20%) children ended up with treatment failure, 21 (14%) in amoxicillin, and 41 (27%) in ampicillin arm, which is statistically significant (relative risk [RR] 0.51, 95% CI 0.32-0.82; p = 0.004). We reported 14 deaths for serious adverse events, 4 (3%) and 10 (6%) among amoxicillin and ampicillin arm, respectively. IV amoxicillin and IV gentamicin combination is not inferior to combined IV ampicillin and IV gentamicin in treating severe pneumonia in under-five children in Bangladesh. Considering the less frequent dosing and more compliance, IV amoxicillin is a better choice for treating children with severe pneumonia in resource-limited settings.
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Affiliation(s)
- Lubaba Shahrin
- Head Acute Respiratory Infection Unit, Dhaka Hospital, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh
| | - Mohammod Jobayer Chisti
- Head Clinical Research Unit, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh;
| | - Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Abu Sayem Mirza Md. Hasibur Rahman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Abu Sadat Mohammad Sayeem Bin Shahid
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Md. Zahidul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Sayeeda Huq
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh; (M.S.); (A.S.M.M.H.R.); (A.S.M.S.B.S.); (M.Z.I.); (F.A.); (S.H.)
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1000, Bangladesh;
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15
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Souza DCD, Oliveira CFD, Lanziotti VS. Pediatric sepsis research in low- and middle-income countries: overcoming challenges. Rev Bras Ter Intensiva 2021; 33:341-345. [PMID: 35107544 PMCID: PMC8555391 DOI: 10.5935/0103-507x.20210062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Daniela Carla de Souza
- Unidade de Terapia Intensiva Pediátrica, Hospital Universitário, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Vanessa Soares Lanziotti
- Unidade de Terapia Intensiva Pediátrica, Divisão de Pesquisa e Ensino, Programa de Pós-Graduação em Saúde Materno-Infantil, Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
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16
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Mortality in relation to profiles of clinical features in Ghanaian severely undernourished children aged 0-59 months: an observational study. Br J Nutr 2021; 125:1157-1165. [PMID: 32873346 DOI: 10.1017/s0007114520003396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Severe acute malnutrition (SAM) is associated with a complex pattern of various clinical conditions. We investigated how risk factors cluster in children with SAM, the relationship between clusters of risk factors and mortality as well as length of stay in children with SAM. A prospective observational study design was used. Data were extracted from medical records of 601 infants and children aged 0-59 months admitted and treated for SAM in three Ghanaian referral hospital between June 2013 and June 2018. Among the 601 medical records extracted, ninety-nine died. Three clusters of medical features clearly emerged from data analyses. Firstly, an association was defined by eye signs, pallor, diarrhoea and vomiting with gastrointestinal infections and malaria. In this cluster, pallor and eye signs were related to 2- to 5-fold increased mortality risk. Secondly, HIV, oedema, fast pulse, respiratory infections and tuberculosis; among those features, HIV increased child mortality risk by 2-fold. Thirdly, shock, convulsions, dermatitis, cold hands and feet, weak pulse, urinary tract infections and irritability were clustered. Among those features, cold hands and feet, dermatitis, convulsions and shock increased child mortality risk in a range of 2- to 9-fold. Medical conditions and clinical signs in children diagnosed with SAM associate in patterns and are related to clinical outcomes.
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17
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Seizure in Children Under Five Presenting With Pneumonia in a Critical Care Ward in Bangladesh: Prevalence, Associated Factors, and Outcome. Pediatr Infect Dis J 2021; 40:389-393. [PMID: 33979116 DOI: 10.1097/inf.0000000000003068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pneumonia is the leading infectious cause of deaths in children under 5 for the last few decades. Development of seizure in those children is common and associated with increased risk of deaths. We therefore investigated the prevalence, associated factors and outcome of seizure in children hospitalized with pneumonia. METHODS We conducted a retrospective chart analysis in the intensive care unit of the Dhaka Hospital of icddr,b. Children under 5 with World Health Organization (WHO) classified clinical (excluding seizure as 1 of the clinical diagnostics) and radiologic pneumonia, admitted to the intensive care unit at Dhaka Hospital of icddr,b between August 2013 and December 2017 were analyzed. We initially identified the children with pneumonia who had seizure. For comparison, we have taken 2 folds randomly selected controls from rest of the children with pneumonia having no seizure. Prevalence and outcome of children with pneumonia and seizure were measured. Factors associated with seizure in children with pneumonia compared with those without seizure were also identified. Seizure was characterized by sudden, violent, involuntary, and abnormal repetitive movements with or without loss or impairment of consciousness confirmed by attending physician. RESULTS Among a total of 4101 children with pneumonia, 514 (12.5%) had seizure. Compared with children with pneumonia alone children having pneumonia and seizure more often developed respiratory failure (18% vs. 3%, P < 0.001) and died (13% vs. 3%, P < 0.001) during hospitalization. In logistic regression analysis hypoxemia (95% CI: 1.59-3.17, P < 0.001), severe pneumonia (95% CI: 2.13-6.52, P < 0.001), severe sepsis (95% CI: 1.30-2.88, P = 0.001), and hypernatremia (95% CI: 5.31-10.93, P < 0.001) were found to be independent risk factors for seizure. On the contrary, children with pneumonia having seizure were less likely to have severe acute malnutrition (95% CI: 0.26-0.50, P < 0.001). CONCLUSIONS Early identification of risk factors for seizure in children with pneumonia may be helpful for clinicians to promptly treat them and therefore may have potential to reduce deaths in those children especially in resource limited settings.
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18
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Wei E, Fang X, Jia P, Li M, Jin P, Li F, Wang H, Gao D. Ginsenoside Rb1 Alleviates Lipopolysaccharide-Induced Inflammatory Injury by Downregulating miR-222 in WI-38 Cells. Cell Transplant 2021; 30:9636897211002787. [PMID: 33900120 PMCID: PMC8085372 DOI: 10.1177/09636897211002787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pneumonia is a serious respiratory tract infection disease in children, which threatens to the health or life of children patients. Ginsenoside Rb1 (Rb1) is a principle active ingredient extracted from the root of Panax notoginseng (Burk.) F.H. Chen with anti-inflammatory effect. Our study aimed to determine the effects and molecular mechanisms of Rb1 on lipopolysaccharide (LPS)-induced inflammatory injury of lung fibroblasts WI-38 cells. Cell viability and apoptosis were evaluated by CCK-8 and flow cytometry, respectively. The production of inflammatory cytokines were measured by ELISA and RT-qPCR. miR-222 expression was examined by RT-qPCR. The expression levels of the nuclear factor-kappa B (NF-κB) p65 and phosphorylated p65 were detected by western blot. We found that LPS stimulation induced WI-38 cell inflammatory injury by inhibiting cell viability, and inducing apoptosis and inflammatory cytokine production, while treatment with Rb1 significantly attenuated LPS-induced inflammatory injury in WI-38 cells. Additionally, Rb1 decreased LPS-induced upregulation of miR-222 and activation of the NF-κB pathway in WI-38 cells. Overexpression of miR-222 abolished the inhibitory effects of Rb1 on LPS-induced viability reduction, apoptosis, inflammatory cytokine production and activation of the NF-κB pathway. In conclusion, Rb1 alleviated LPS-induced inflammatory injury in WI-38 cells via downregulating miR-222 and inactivation of the NF-kB pathway.
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Affiliation(s)
- Erhu Wei
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Fang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Jia
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingxia Li
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peina Jin
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fengyan Li
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huaili Wang
- Department of Pediatrics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dan Gao
- Department of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Negussie AS, Tadesse AW. Predictors of undesirable treatment outcomes of severe acute malnutrition among inpatient children in Addis Ababa, Ethiopia: a retrospective cohort study. BMC Public Health 2020; 20:1532. [PMID: 33036594 PMCID: PMC7547421 DOI: 10.1186/s12889-020-09645-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background In 2018, malnutrition contributed to 45% of all global cause of child death. These early child deaths were due to conditions that could either be prevented or treated with basic interventions. Hence, this study intended to provide a quantitative estimate of factors associated with undesirable treatment outcomes of severe acute malnutrition (SAM). Methods We studied a retrospective cohort of 304 children aged 6–59 months with complicated SAM admitted to Yekatit 12 Hospital Medical College from 2013 to 2016. We extracted data from hospital records on nutritional status, socio-demographic factors and medical conditions during admission. The analysis was carried out using SPSS version 20. The Kaplan-Meier estimator was employed to analyze the recovery rate of the children treated for SAM and multivariable Cox regression was used to determine factors that predict inpatient undesirable treatment outcomes. Result From a total of 304 children 6–59 months with SAM, 133 (51.4%) were boys. Marasmus was the most common type (132 (51%)) of severe acute malnutrition. The recovery, death and defaulter rate were 70.4, 12.2 and 8.2% respectively. The main predictors of undesirable treatment outcomes were found to be the presence of HIV antibody (AHR = 3.208; 95% CI: [1.045–9.846]) and sepsis (AHR = 7.677, 95% CI: [2.320–25.404]). Conclusion The study revealed that the overall treatment outcomes were below the SPHERE standard recommendation. The main predictors of undesirable treatment outcomes among inpatient children treated for SAM were HIV and sepsis. Intervention to reduce undesirable treatment outcomes should focus on comorbidities, especially HIV and sepsis.
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Richards M, Le Roux D, Cooke L, Argent A. The Influence of High Flow Nasal Cannulae on the Outcomes of Severe Respiratory Disease in Children Admitted to a Regional Hospital in South Africa. J Trop Pediatr 2020; 66:612-620. [PMID: 32533147 DOI: 10.1093/tropej/fmaa024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In settings where access to paediatric intensive care unit (PICU) facilities is constrained and transfer capacity is limited, High Flow Nasal Cannulae (HFNC) might fill an important service gap. The aim of this study was to document the effect of HFNC on the outcomes of children admitted with severe respiratory disease at a regional hospital without a PICU in Cape Town, South Africa. It is a 4-year retrospective analysis documenting two periods of 2 years each, one before (2013-15) and one after (2016-18) the initiation of HFNC use. Patients were between the ages of 2 months and 13 years and had been admitted to a paediatric ward. Outcomes were defined by the need for transfer to a tertiary hospital, the need for invasive ventilation and death. There were 90 instances of HFNC use with a significant reduction in the number of children who were transferred (59 vs. 31), invasively ventilated (20 vs. 6, p ≤ 0.01) and who died (3 vs. 0, p = 0.02). Before HFNC implementation, there was also a significantly greater proportion of transferred children who remained on low flow nasal cannulae (15 vs. 2, p ≤ 0.001) at the tertiary hospital. Children who failed HFNC use tended to do this within a day of initiation (Median 11 vs. 60 h for success, p ≤ 0.001). There were no complications related to its use. We believe that in our setting the utilization of HFNC has helped to timeously and accurately identify children needing to be transferred and may mitigate against severe respiratory disease progression.
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Affiliation(s)
- Mark Richards
- Department of Paediatrics and Child Health, New Somerset Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa
| | - David Le Roux
- Department of Paediatrics and Child Health, New Somerset Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa
| | - Louise Cooke
- Department of Paediatrics and Child Health, New Somerset Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa
| | - Andrew Argent
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, 7700, Cape Town, South Africa
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Karunaratne R, Sturgeon JP, Patel R, Prendergast AJ. Predictors of inpatient mortality among children hospitalized for severe acute malnutrition: a systematic review and meta-analysis. Am J Clin Nutr 2020; 112:1069-1079. [PMID: 32885807 PMCID: PMC7528552 DOI: 10.1093/ajcn/nqaa182] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/12/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Malnutrition underlies 45% of under-5 deaths globally. Severe acute malnutrition (SAM) is the most serious form of undernutrition, characterized by wasting with or without edema. Mortality remains high (10%-40%) among children requiring hospitalization for complicated SAM. OBJECTIVES We aimed to systematically document the factors independently associated with inpatient mortality in children with SAM. METHODS Embase, Ovid MEDINE, the Cochrane Library, and clinicaltrials.gov were searched for articles published between January 2000 and January 2020, using a prespecified protocol. Eligible studies included children aged ≤59 mo hospitalized with SAM and used multivariable analysis to assess the baseline factors independently associated with inpatient mortality. Random-effects meta-analysis, stratified by the stated measure of effect, was used where >20% of studies included the same factor in analyses. RESULTS Twenty-eight of 1432 studies fulfilled inclusion criteria: 19 studies included all children with SAM and 9 included specific subgroups of children with SAM. All 19 main studies were from 8 countries across Africa, with a median of 400 children/study. The mean inpatient mortality was 15.7% (95% CI: 10.4%, 21.0%) and HIV prevalence ranged from 2.1% to 51%. Nine factors were included in the meta-analysis, stratified by HR and OR. HIV infection (HR: 4.32; 95% CI: 2.31, 8.08), weight-for-height z score (WHZ) (OR: 0.44; 95% CI: 0.24, 0.80), diarrhea (HR: 2.84; 95% CI: 1.40, 5.75), pneumonia (HR: 1.89; 95% CI: 1.19, 3.02), presence of shock (HR: 3.67; 95% CI: 2.24, 6.03), and lack of appetite (HR: 2.16; 95% CI: 1.48, 3.16) were associated with increased mortality, whereas child age and sex were not. The association between edema and mortality was difficult to ascertain from the available studies. CONCLUSIONS HIV infection, diarrhea, pneumonia, shock, lack of appetite, and lower WHZ are independent predictors of inpatient mortality in children with SAM. These factors may help to risk-stratify children being hospitalized with complicated SAM.This systematic review/meta-analysis protocol was registered at www.crd.york.ac.uk/prospero as CRD42019152267.
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Affiliation(s)
| | - Jonathan P Sturgeon
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Rajvi Patel
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Andrew J Prendergast
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, United Kingdom
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Nalwanga D, Musiime V, Kizito S, Kiggundu JB, Batte A, Musoke P, Tumwine JK. Mortality among children under five years admitted for routine care of severe acute malnutrition: a prospective cohort study from Kampala, Uganda. BMC Pediatr 2020; 20:182. [PMID: 32331517 PMCID: PMC7181483 DOI: 10.1186/s12887-020-02094-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 04/20/2020] [Indexed: 02/07/2023] Open
Abstract
Background Mortality among children under 5 years of age admitted to malnutrition units in sub-Saharan Africa remains high. The burden of HIV infection, a major risk factor for mortality among patients with severe acute malnutrition (SAM), has reduced due to concerted prevention and treatment strategies. None the less, anecdotal reports from the malnutrition unit at Uganda’s National Referral Hospital (NRH) indicate that there is high mortality among patients with severe acute malnutrition (SAM) in routine care. Uganda has recently adopted the revised World Health Organization (WHO) treatment guidelines for SAM to improve outcomes. The mortality among children with SAM in routine care has not been recently elucidated. We report the magnitude and factors associated with mortality among children under 5 years of age admitted to the NRH for routine care of SAM. Methods This was a cohort study of all severely malnourished children admitted to the NRH between June and October 2017. The primary outcome was two-week mortality. Mortality was calculated using simple proportions and Cox regression analysis was used to determine factors associated with time to mortality. Data was entered into Epidata and analysed using Stata v14. Results Two-hundred-sixty (98.5%) children: 59.6% male; mean age 14.4 (SD 9.4) months, completed two weeks of follow-up. Of these, 25.2% (95% CI 19.9–30.4%) died. In-hospital mortality was 20.7% (95% CI15.9–25.6%). The prevalence of HIV infection was 12.2%. Factors associated with mortality included: positive HIV status (AHR 2.2, (95% CI; 1.2–4.2), p = 0.014), bacteraemia (AHR 9 (95% CI 3.4–23.0), p < 0.001, and low glomerular filtration rate (eGFR), AHR 3.2; (95% CI 1.7–6.3), p = 0.001). Conclusions A 25% mortality among children with severe malnutrition remains unacceptably high despite significant reduction in HIV prevalence. Children with SAM who are HIV infected, have eGFR below 60 mL/min/1.73m2 or have bacteraemia, are more likely to die. Further studies to explore the relationship between eGFR and mortality among children with SAM are needed. Studies to establish efficacious antibiotics are urgently required to inform treatment guidelines for children with SAM.
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Affiliation(s)
- Damalie Nalwanga
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Victor Musiime
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.,Research Department, Joint Clinical Research Centre, P. O. Box 10005, Kampala, Uganda
| | - Samuel Kizito
- Clinical Epidemiology Unit, Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, P. O Box 7072, Kampala, Uganda
| | - John Baptist Kiggundu
- Clinical Epidemiology Unit, Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, P. O Box 7072, Kampala, Uganda
| | - Anthony Batte
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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Zangenberg M, Abdissa A, Johansen ØH, Tesfaw G, Girma T, Kurtzhals JAL. Metronidazole-sensitive organisms in children with severe acute malnutrition: an evaluation of the indication for empiric metronidazole treatment. Clin Microbiol Infect 2019; 26:255.e7-255.e11. [PMID: 31185294 DOI: 10.1016/j.cmi.2019.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/13/2019] [Accepted: 05/25/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Children with severe acute malnutrition (SAM) are treated with empiric amoxicillin or penicillin and gentamicin because of the high risk of severe infections. Experts have suggested, based on available evidence, adding metronidazole to cover anaerobic bacteraemia and diarrhoea caused by Giardia duodenalis or Clostridium difficile. The objective of this study was to assess the importance of these infections in children with SAM. METHODS Children from 6 months to 15 years with SAM were enrolled and followed clinically. Aerobic and, when patient weight permitted, anaerobic blood cultures were done using Bactec® system, and isolates identified with matrix-assisted laser desorption ionization-time of flight mass spectrometry. Stool samples were tested for C. difficile, G. duodenalis and Entamoeba histolytica by PCR. RESULTS A total of 334 children were enrolled and 174 out of 331 (53%) for which data on this was available had diarrhoea. Of 273 patients tested by blood culture, 11 had bacteraemia (4.0%, 95% CI 2.3-7.1%) but none with strict anaerobic bacteria (0/153, 95% CI 0-2.4%). There was no difference in the prevalence of C. difficile between children with (5/128, 4%) and without (7/87, 8%) diarrhoea (OR 0.47, 95% CI 0.14-1.53), and no difference in the prevalence of Giardia between these groups (78/138, 60% vs. 46/87, 53%; OR 1.34, 95% CI 0.77-2.32). Children with C. difficile had higher mortality than those without this infection (3/11, 27%, vs. 7/186, 4%; OR 43, 95% CI 3.9-483). CONCLUSION Our results do not provide support for empiric metronidazole to cover for anaerobic bacteraemia. Trials evaluating the effect of empiric treatment and its effect on G. duodenalis and C. difficile are warranted.
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Affiliation(s)
- M Zangenberg
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - A Abdissa
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Ethiopia
| | - Ø H Johansen
- Department of Clinical Science, University of Bergen, Norway; Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - G Tesfaw
- Department of Medical Laboratory Sciences and Pathology, Jimma University, Ethiopia
| | - T Girma
- Department of Paediatrics and Child Health, Faculty of Medical Sciences, Jimma University, Ethiopia
| | - J A L Kurtzhals
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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Bacterial Resistance in Pneumonia in Developing Countries-A Role for Iron Chelation. Trop Med Infect Dis 2019; 4:tropicalmed4020059. [PMID: 30974759 PMCID: PMC6631655 DOI: 10.3390/tropicalmed4020059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/24/2022] Open
Abstract
Pneumonia represents one of the major infectious diseases in developing countries and is associated with high mortality, in particular in children under the age of five. The main causative bacterial agents are Streptococcus pneumoniae and Haemophilus influenzae type B, accounting for 33% and 16%, respectively, of the mortality in under-fives. Iron modulates the immune response in infectious diseases and increased iron levels can lead to complications such as sepsis and multiorgan failure. This review will look into the use of iron chelators in order to reduce microbial growth and attenuate a dysregulated immune response during infection. Our hypothesis is that temporary restriction of iron will lessen the incidence and complication rate of infections like pneumonia and result in a decrease of mortality and morbidity.
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25
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Williams PCM, Berkley JA. Guidelines for the treatment of severe acute malnutrition: a systematic review of the evidence for antimicrobial therapy. Paediatr Int Child Health 2018; 38:S32-S49. [PMID: 29790840 PMCID: PMC5972636 DOI: 10.1080/20469047.2017.1409453] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/04/2017] [Indexed: 12/31/2022]
Abstract
Background Severe acute malnutrition (SAM) affects nearly 20 million children worldwide and is responsible for up to 1 million deaths per year in children under the age of 5 years. Current WHO guidelines recommend oral amoxicillin for children with uncomplicated malnutrition and parenteral benzylpenicillin and gentamicin for those with complicated malnutrition. Because of cost pressures and increasing antimicrobial resistance, the administration of empirical antibiotics for children with SAM has recently been debated. Methods A systematic review of the current published literature was undertaken to assess the efficacy, safety, cost-effectiveness and pharmacokinetics of antimicrobial treatment of children with SAM in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results The initial search found 712 papers, eight of which met the inclusion criteria. Quality assessment of the studies was performed as per the Grading of Recommendations Assessment, Development and Evaluation guidelines. International guidelines and clinical data registries were also reviewed which identified inconsistencies in current first- and second-line therapies and dosing regimens. Conclusion Current evidence supports the continued use of broad-spectrum oral amoxicillin for treating children with uncomplicated SAM as outpatients. There is no strong evidence to justify changing the current parenteral therapy guidelines for children admitted with complicated SAM, although they should be clarified to harmonise the dosage regimen of amoxicillin for the treatment of SAM to 40 mg/kg twice daily, and to continue parenteral antimicrobials beyond 2 days if indicated by the clinical condition.
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Affiliation(s)
| | - James A. Berkley
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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26
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Predictors of mortality among hospitalized children with severe acute malnutrition: a prospective study from Uganda. Pediatr Res 2018; 84:92-98. [PMID: 29795207 DOI: 10.1038/s41390-018-0016-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 09/11/2017] [Accepted: 09/12/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND We determined the predictors of mortality among children admitted with severe acute malnutrition (SAM). METHODS This was a prospective study nested in a randomized trial among 6-59-month-old children admitted with SAM. Socio-demographic and medical history data were collected using questionnaires and clinical examination, anthropometry and laboratory tests were performed. They were monitored daily until discharge or death during hospitalization while receiving care according to national guidelines. Predictors of death were assessed using Cox regression. RESULTS Of 400 children, 9.8% (n = 39) died during hospitalization. Predictors of mortality included diarrhoea at admission [hazard ratio [HR] 2.19, 95% confidence interval (CI): 1.06; 4.51], lack of appetite [HR 4.50, 95% CI: 1.76; 11.50], suspected sepsis [HR 2.23, 95% CI: 1.18; 4.24] and skin ulcers [HR 4.23, 95% CI: 1.26; 4.17]. Chest indrawing [HR 5.0, 95% CI: 1.53; 16.3], oxygen saturation below 94% [HR 3.92, 95% CI: 1.42; 10.83] and confirmed HIV infection [HR 3.62, 95% CI: 1.69; 7.77] also predicted higher mortality. CONCLUSION Infections were major contributors to mortality. This underscores the need for improved prevention and management of these infections among children with severe malnutrition.
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27
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Ferdous F, Ahmed S, Das SK, Chisti MJ, Nasrin D, Kotloff KL, Levine MM, Nataro JP, Ma E, Muhsen K, Wagatsuma Y, Ahmed T, Faruque ASG. Pneumonia mortality and healthcare utilization in young children in rural Bangladesh: a prospective verbal autopsy study. Trop Med Health 2018; 46:17. [PMID: 29875615 PMCID: PMC5970515 DOI: 10.1186/s41182-018-0099-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/20/2018] [Indexed: 02/03/2023] Open
Abstract
Background The present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh. A prospective autopsy study was conducted among guardians of children aged 4 weeks to 59 months in Mirzapur, Bangladesh, from 2008 to 2012. Results Pneumonia was the primary cause of death, accounting for 26.4% (n = 81) of all 307 deaths. Of the pneumonia deaths, 58% (n = 47) deaths occurred in younger infants (aged 4 weeks to < 6 months) and 24.7% (n = 20) in older infants (aged 6–11 months). The median duration of illness before pneumonia death was 8 days (interquartile range [IQR] 3–20 days). Prior to death, 91.4% (n = 74) children with pneumonia sought treatment, and of those who sought treatment, 52.7% (n = 39) sought treatment ≥ 2 days after the onset of disease. Younger infants of 4 weeks to < 6 months old were at 5.5-time (95% confidence interval [CI] 2.5, 12.0) and older infants aged 6–11 months were at 3-time (1.2, 7.5) greater risk of dying from pneumonia than older children aged 12–59 months. Children with a prolonged duration of illness (2–10 days) prior to death were at more risk for death by pneumonia than those who died from other causes (5.8 [2.1, 16.1]). Children who died from pneumonia sought treatment 3.4-time more than children who died from other causes. Delayed treatment seeking (≥ 2 days) behavior was 4.9-time more common in children who died from pneumonia than those who died from other causes. Children who died from pneumonia more often had access to care from multiple sources (5.7-time) than children who died from other causes. Conclusions Delay in seeking appropriate care and access to multiple sources for treatment are the underlying risk factors for pneumonia death in young children in Bangladesh. These results indicate the perplexity in guardians’ decisions to secure appropriate treatment for children with pneumonia. Therefore, it further underscores the importance of focusing on mass media coverage that can outline the benefits of seeking care early in the progression of pneumonia and the potential negative consequences of seeking care late. Electronic supplementary material The online version of this article (10.1186/s41182-018-0099-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farzana Ferdous
- 1Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Shahnawaz Ahmed
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,3School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mohammod Jobayer Chisti
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Nasrin
- 4Center for Vaccine Development and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD USA
| | - Karen L Kotloff
- 5Center for Vaccine Development, Department of Pediatrics and Medicine, University of Maryland School of Medicine, Baltimore, MD USA
| | - Myron M Levine
- 5Center for Vaccine Development, Department of Pediatrics and Medicine, University of Maryland School of Medicine, Baltimore, MD USA
| | - James P Nataro
- 5Center for Vaccine Development, Department of Pediatrics and Medicine, University of Maryland School of Medicine, Baltimore, MD USA.,6Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Enbo Ma
- 7Health Promotion Center, Fukushima Medical University, Fukushima, Japan.,9Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Khitam Muhsen
- 8Department of Epidemiology and Prevention Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Yukiko Wagatsuma
- 9Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tahmeed Ahmed
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syed Golam Faruque
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,10Nutrition and Clinical Services Division, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
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Tosif S, Duke T. Evidence to Support Oxygen Guidelines for Children with Emergency Signs in Developing Countries: A Systematic Review and Physiological and Mechanistic Analysis. J Trop Pediatr 2017; 63:402-413. [PMID: 28158795 DOI: 10.1093/tropej/fmw100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There are currently no evidence-based oxygen saturation targets for treating children with life-threatening conditions. We reviewed evidence of SpO2 targets for oxygen therapy in children with emergency signs as per WHO Emergency Triage Assessment and Treatment guidelines. We systematically searched for physiological data and international guidelines that would inform a safe approach. Our findings suggest that in children with acute lung disease who do not require resuscitation, a threshold SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery. Although there is no empirical evidence regarding oxygen saturation to target in children with emergency signs from developing countries, a SpO2 of ≥ 94% during resuscitation may help compensate for common situations of reduced oxygen delivery. In children who do not require resuscitation or are stable post resuscitation with only lung disease, a lower limit of SpO2 for commencing oxygen of 90% will provide adequate oxygen delivery and save resources.
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Affiliation(s)
- Shidan Tosif
- Centre for International Child Health, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
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Smith AG, Eckerle M, Mvalo T, Weir B, Martinson F, Chalira A, Lufesi N, Mofolo I, Hosseinipour M, McCollum ED. CPAP IMPACT: a protocol for a randomised trial of bubble continuous positive airway pressure versus standard care for high-risk children with severe pneumonia using adaptive design methods. BMJ Open Respir Res 2017; 4:e000195. [PMID: 28883928 PMCID: PMC5531309 DOI: 10.1136/bmjresp-2017-000195] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/16/2017] [Accepted: 06/09/2017] [Indexed: 01/24/2023] Open
Abstract
Introduction Pneumonia is a leading cause of mortality among children in low-resource settings. Mortality is greatest among children with high-risk conditions including HIV infection or exposure, severe malnutrition and/or severe hypoxaemia. WHO treatment recommendations include low-flow oxygen for children with severe pneumonia. Bubble continuous positive airway pressure (bCPAP) is a non-invasive support modality that provides positive end-expiratory pressure and oxygen. bCPAP is effective in the treatment of neonates in low-resource settings; its efficacy is unknown for high-risk children with severe pneumonia in low-resource settings. Methods and analysis CPAP IMPACT is a randomised clinical trial comparing bCPAP to low-flow oxygen in the treatment of severe pneumonia among high-risk children 1–59 months of age. High-risk children are stratified into two subgroups: (1) HIV infection or exposure and/or severe malnutrition; (2) severe hypoxaemia. The trial is being conducted in a Malawi district hospital and will enrol 900 participants. The primary outcome is in-hospital mortality rate of children treated with standard care as compared with bCPAP. Ethics and dissemination CPAP IMPACT has approval from the Institutional Review Boards of all investigators. An urgent need exists to determine whether bCPAP decreases mortality among high-risk children with severe pneumonia to inform resource utilisation in low-resource settings. Trial registration number NCT02484183; Pre-results.
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Affiliation(s)
- Andrew G Smith
- Paediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Michelle Eckerle
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Brian Weir
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | - Mina Hosseinipour
- Division of Infectious Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric D McCollum
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Alam T, Ahmed T, Sarmin M, Shahrin L, Afroze F, Sharifuzzaman, Akhter S, Shahunja KM, Shahid ASMSB, Bardhan PK, Chisti MJ. Risk Factors for Death in Bangladeshi Children Under 5 Years of Age Hospitalized for Diarrhea and Severe Respiratory Distress in an Urban Critical Care Ward. Glob Pediatr Health 2017; 4:2333794X17696685. [PMID: 28491923 PMCID: PMC5406149 DOI: 10.1177/2333794x17696685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/15/2022] Open
Abstract
Children with diarrhea hospitalized for respiratory distress often have fatal outcome in resource-limited settings, although data are lacking on risk factors for death in such children. We sought to evaluate clinical predictors for death in such children. In this prospective cohort study, we enrolled under-5 children with diarrhea admitted with severe respiratory distress to the intensive care unit of Dhaka Hospital of International Centre for Diarhoeal Disease Research, Bangladesh, from September 2014 through September 2015. We compared clinical and laboratory characteristics between study children those who died (n = 29) and those who survived (n = 62). In logistic regression analysis, after adjusting for potential confounders, the independent predictors for death in children hospitalized for diarrhea and severe respiratory distress were severe sepsis and hypoglycemia (P < .05 for all). Thus, recognition of these simple parameters may help clinicians identify children with diarrhea at risk of deaths in order to initiate prompt management for the better outcome, especially in resource-poor settings.
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Affiliation(s)
- Tahmina Alam
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sharifuzzaman
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shamima Akhter
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K M Shahunja
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Pradip Kumar Bardhan
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Guo XH, Sun YF, Wang JB, Han SZ, Miao J, Cui M. [Value of nutritional risk screening in evaluating adverse clinical outcomes in children with severe pneumonia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:322-326. [PMID: 28302205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
OBJECTIVE To investigate the nutritional risk in children with severe pneumonia using the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the association between nutritional risk and adverse clinical outcomes. METHODS According to the STAMP score, 216 children with severe pneumonia were classified into high nutritional risk group (HR group; n=98), moderate nutritional risk group (MR group; n=65), and low nutritional risk group (LR group; n=53). Fasting blood samples were collected to measure the levels of insulin-like growth factor-1 (IGF-1), adiponectin, leptin, non-esterified fatty acid (NEFA), albumin, transferrin, prealbumin, and retinol binding protein (RBP). The adverse clinical outcomes were recorded. RESULTS Compared with the MR and LR groups, the HR group had significantly lower serum levels of IGF-1, leptin, adiponectin, prealbumin, and RBP, as well as a significantly higher serum level of NEFA (P<0.05). Compared with the MR and LR groups, the HR group had a significantly higher proportion of children admitted to the intensive care unit and a significantly longer duration of mechanical ventilation (P<0.05). The HR group had a significantly longer mean hospital stay and a significantly higher incidence rate of complications compared with the LR and MR groups (P<0.05). CONCLUSIONS Nutritional risk screening has an important value in evaluating the clinical outcome of children with severe pneumonia, and children at a higher nutritional risk tend to have more adverse clinical outcomes.
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Affiliation(s)
- Xiao-Hui Guo
- Department of Pediatrics, The People's Hospital of Binzhou, Binzhou, Shandong 256610, China.
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Karim T, Muhit M, Khandaker G. Interventions to prevent respiratory diseases - Nutrition and the developing world. Paediatr Respir Rev 2017; 22:31-37. [PMID: 27793738 DOI: 10.1016/j.prrv.2016.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 01/22/2023]
Abstract
Malnutrition is a major cause of morbidity and mortality in developing countries and nutrition plays a critical role in both acute and chronic respiratory conditions. Inadequacies in the nutritional requirements of a developing lung in utero and in early life can compromise the respiratory system integrity and result in poor lung function, reduced protection against infections, greater likelihood of acute illnesses in childhood and chronic illness in adulthood. Nutritional interventions harness great potential in reducing respiratory illness related morbidity and mortality in the developing world. In this review we have summarized the findings from published systematic reviews/meta-analysis, experimental and observational studies that looked into different nutritional interventions for preventing respiratory diseases in developing countries.
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Affiliation(s)
- Tasneem Karim
- CSF Global, Dhaka, Bangladesh; Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh; Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Gulam Khandaker
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh; Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia.
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Incidence of Refeeding Syndrome and Its Associated Factors in South African Children Hospitalized with Severe Acute Malnutrition. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.8297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Becker TK, Hansoti B, Bartels S, Bisanzo M, Jacquet GA, Lunney K, Marsh R, Osei‐Ampofo M, Trehan I, Lam C, Levine AC, Anderson RE, Armstrong P, Aschkenasy M, Balhara KS, Boyd M, Chan J, Dickason RM, Grover E, Hauswald M, Hayward AS, Hexom B, House E, Jenson A, Kearney A, Keefe DM, Kivlehan S, Machen HE, Mahal J, Marsh RH, Millikan DJ, Modi P, Nicholson B, Rahman N, Rybarczyk M, Schroeder ED, Selvam A, Silvestri D, Trehan I, Tyler Winders W. Global Emergency Medicine: A Review of the Literature From 2015. Acad Emerg Med 2016; 23:1183-1191. [PMID: 27146277 DOI: 10.1111/acem.12999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS This year 12,435 articles written in six languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. A total of 723 articles were deemed appropriate by at least one reviewer and approved by their editor for formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS A total of 723 articles met our predetermined inclusion criteria and underwent full review. Sixty percent were categorized as emergency care in resource-limited settings (ECRLS), 17% as EM development (EMD), and 23% as disaster and humanitarian response (DHR). Twenty-four articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability between reviewers gave an intraclass correlation coefficient of 0.71 (95% confidence interval = 0.66 to 0.75). Studies and reviews with a focus on infectious diseases, trauma, and the diagnosis and treatment of diseases common in resource-limited settings represented the majority of articles selected for final review. CONCLUSIONS In 2015, there were almost twice as many articles found by our search compared to the 2014 review. The number of EMD articles increased, while the number ECRLS articles decreased. The number of DHR articles remained stable. As in prior years, the majority of articles focused on infectious diseases.
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Affiliation(s)
- Torben K. Becker
- Department of Critical Care Medicine University of Pittsburgh Medical Center Pittsburgh PA
| | - Bhakti Hansoti
- Department of Emergency Medicine Johns Hopkins University Baltimore MD
| | - Susan Bartels
- Department of Emergency Medicine Queen's University Kingston Ontario Canada
- Harvard Humanitarian Initiative Cambridge MA
| | - Mark Bisanzo
- Department of Emergency Medicine University of Massachusetts Worcester MA
| | - Gabrielle A. Jacquet
- Department of Emergency Medicine Boston University School of Medicine, and Boston University Center for Global Health and Development Boston MA
| | - Kevin Lunney
- Medical Corps US Navy Department of Emergency Medicine Navy Hospital Camp Lejeune Camp Lejeune NC
| | - Regan Marsh
- Department of Emergency Medicine Brigham and Women's Hospital Boston MA
- Partners In Health Boston MA
| | - Maxwell Osei‐Ampofo
- Accident & Emergency Department Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Indi Trehan
- Department of Pediatrics and Institute for Public Health Washington University in St. Louis St. Louis MO
- Department of Pediatrics and Child Health University of Malawi Blantyre Malawi
| | - Christopher Lam
- Warren Alpert Medical School of Brown University Providence RI
| | - Adam C. Levine
- Department of Emergency Medicine Warren Alpert Medical School of Brown University Providence RI
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