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Background: Neonatal sepsis is a leading cause of death in low- and middle- income countries (LMIC). Increasing antibiotic resistance in early onset (< 72 h of life) bloodstream infection (EO-BSI) pathogens in LMIC has reduced the effectiveness of the recommended empiric antibiotic regimen (ampicillin plus gentamicin)., Methods: We retrospectively analysed blood culture-confirmed EO-BSI episodes at nine neonatal units from three central and six peripheral hospitals in the Western Cape Province, South Africa between 1 January 2017 and 31 December 2018. Clinical and electronic laboratory records were reviewed to determine pathogen profile, empiric antibiotic coverage rates and factors associated with EO-BSI attributable mortality, stratified by hospital type., Results: Of the 8252 blood culture specimens submitted for the investigation of suspected EO-BSI, 136 EO-BSI episodes yielding 141 pathogens were identified with an EO-BSI rate of 1.3 and 0.5 episodes/1000 live births at central and peripheral hospitals respectively. Preterm (93/136; 68.3%) and low birth weight (84/136; 61.8%) neonates were most affected. The predominant pathogens were Streptococcus agalactiae (46/136; 34%), Klebsiella pneumoniae (17/136; 13%), Listeria monocytogenes (11/136; 8%), Acinetobacter baumannii (11/136; 8%) and Escherichia coli (11/136; 8%). The empiric antibiotic (ampicillin plus gentamicin) coverage rate was 64% (95% CI 51-74) at central hospitals and 84% (95% CI 74-94) at peripheral hospitals. Neonates with Gram-negative EO-BSI and discordant empiric antibiotic therapy had almost four-fold and three-fold higher odds of death respectively., Conclusion: Preterm and low birth weight neonates are most vulnerable to EO-BSI and have higher odds of death with Gram-negative pathogens and discordant empiric antibiotic therapy., Competing Interests: Declarations. Conflict of interest: The authors have no conflicts of interest to declare. Ethical approval: A waiver of individual informed consent was granted for this study. The Stellenbosch University Health Research Ethics Committee and the Tygerberg Hospital management reviewed and approved the study protocol SU HREC approvals N18/07/068, N20/07/070, in accordance with the Declaration of Helsinki. Funding: A.D. was supported by a NIH Fogarty Emerging Global Leader Award K43 TW010682. The WISCA analysis was supported by a grant to AD from the Science for Africa Foundation through a Data Science for Maternal Neonatal and Child Health Gates Grand Challenges grant. LB: This work is based on research supported by the South African National Research Foundation (NRF). Any opinion, finding, and conclusion or recommendation expressed in this material is that of the authors and the NRF does not accept any liability in this regard., (© 2024. The Author(s).)

Limited data exist on South African children hospitalised with COVID-19 in district hospitals. We describe the presentation and outcomes of children admitted to a level 1 and 2 hospital and compare this with children admitted to a level 2 and 3 hospital., Contribution: This study highlights that young age is an important risk factor for hospitalisation with severe COVID-19. Infants with HIV exposure and prematurity are disproportionately represented among admissions. Furthermore, we notice a high number of children with current or new tuberculosis confirming the interplay between viral infections and childhood tuberculosis., Competing Interests: The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Importance: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent., Objective: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa., Design, Setting, and Participants: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection., Exposures: Age, sex, preexisting comorbidities, and region of residence., Main Outcomes and Measures: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay., Results: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge., Conclusions and Relevance: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.

Background: Shortages in radiology services are estimated to affect 3.5-4.7 billion people worldwide. Teleradiology is a potential means of alleviating this shortage., Objective: This paper examines the practicality and sustainability of a pilot pediatric teleradiology project at the Khayelitsha District Hospital in sub-Saharan Africa. We analyze how this World Federation of Pediatric Imaging (WFPI) program fares against the global challenges described in the current literature facing these practice types., Materials and Methods: A teleradiology pilot was developed to provide coverage to the Khayelitsha District Hospital after the district pediatrician requested assistance in interpreting radiographs. This program utilized a network of WFPI volunteer pediatric radiologists, direct JPEG conversion of digital radiographic images, and an e-mail delivery system of images, referral requests and teleradiology opinion. Data were collected retrospectively from referral cards and JPEG images of radiographs, as well as from the volunteer officer database., Results: A total of 555 referral cards and 1,106 radiographs were submitted for teleradiology opinion during the course of this pilot program; 74.6% of requests for image interpretation were chest radiographs and 14.2% of those were for the evaluation of tuberculosis. There were 40 volunteer teleradiologists from 17 countries; all spoke English, and 14 were bilingual (8 fluent in Spanish, 5 in Portuguese, and 1 in Italian)., Conclusion: Teleradiology is a viable option to alleviate radiologist shortages in underserved areas, but there are many challenges to designing an adequate teleradiology system. The WFPI pilot teleradiology program can be considered a successful one.

In human immunodeficiency virus-infected children, cytomegalovirus causes retinitis alone, with dissemination, or with immune reconstitution inflammatory syndrome. We describe 6 severely immunosuppressed African children (median age, 6.7 months) with cytomegalovirus disease. Of the 6 children, 5 had clinical features suggesting ocular disease at presentation. The child in whom retinitis was detected through preemptive screening due to systemic disease achieved normal visual outcome.