Search

Respiratory syncytial virus (RSV) is a major cause of pneumonia and bronchiolitis among infants and children globally (1,2). Although immune responses develop in those who have had RSV infection during [...]

OBJECTIVE: Little data has been published on the presenting symptoms and signs among ill infants aged 1.5 kg and were admitted over an 18-month period. The same data were collected prospectively from infants recruited to a contemporaneous hospital birth cohort who became ill and were assessed and treated as outpatients at the same hospital. FINDINGS: Data on 467 outpatient consultations and 769 inpatient episodes were available for analysis. These data highlighted the importance of findings in the history, particularly breathing difficulties, abnormal feeding, and abnormal behaviour, as well as clinical signs in the evaluation of young infants. They indicated possible important differences in the panel of signs useful for detecting severe illness in infants aged 0-6 days and those aged 7-59 days. They also showed that some simplification of current guidelines that still preserved the sensitivity and specificity for detecting very severe disease might be possible. CONCLUSION: Simple clinical features may allow distinction between severe and non-severe illness to be made with reasonable confidence. Prospective studies on an adequate scale are needed urgently to provide current integrated management of childhood illness guidelines for young infants with an adequate evidence base.

Pneumonia is a major cause of illness and death among children We report results of a retrospective cohort analysis of children admitted to a rural district hospital in Kenya using [...]

A study was conducted to evaluate and determine the viral etiology of severe pneumonia among Kenyan infants and children using molecular diagnostic techniques. Results indicated that respiratory syncytial virus (RSV) was the predominant viral pathogen in the case of these patients.

Objective To describe the prevalence of hypoxaemia in children admitted to a hospital in Kenya for the purpose of identifying clinical signs of hypoxaemia for emergency triage assessment, and to test the hypothesis that such signs lead to correct identification of hypoxaemia in children, irrespective of their diagnosis. Methods From 2002 to 2005 we prospectively collected clinical data and pulse oximetry measurements for all paediatric admissions to Kilifi District Hospital, Kenya, irrespective of diagnosis, and assessed the prevalence of hypoxaemia in relation to the WHO clinical syndromes of "pneumonia" on admission and the final diagnoses made at discharge. We used the data collected over the first three years to derive signs predictive of hypoxaemia, and data from the fourth year to validate those signs. Findings Hypoxaemia was found in 977 of 15 289 (6.4%) of all admissions (5% to 19% depending on age group) and was strongly associated with inpatient mortality (age-adjusted risk ratio: 4.5; 95% confidence interval, CI: 3.8-5.3). Although most hypoxaemic children aged [greater than or equal to] 60 days met the WHO criteria for a syndrome of "pneumonia" on admission, only 215 of the 693 (31%) such children had a final diagnosis of lower respiratory tract infection (LRTI). The most predictive signs for hypoxaemia included shock, a heart rate < 80 beats per minute, irregular breathing, a respiratory rate > 60 breaths per minute and impaired consciousness. However, 5-15% of the children who had hypoxaemia on admission were missed, and 18% of the children were incorrectly identified as hypoxaemic. Conclusion The syndromes of pneumonia make it possible to identify most hypoxaemic children, including those without LRTI. Shock, bradycardia and irregular breathing are important predictive signs, and severe malaria with respiratory distress is a common cause of hypoxaemia. Overall, however, clinical signs are poor predictors of hypoxaemia, and using pulse oximetry in resource-poor health facilities to target oxygen therapy is likely to save costs. Objectif Decrire la prevalence de l&apos;hypoxemie chez les enfants admis dans un hopital kenyan en vue d&apos;identifier les signes cliniques de l&apos;hypoxemie utilisables pour l&apos;evaluation dans le cadre du triage d&apos;urgence et tester l&apos;hypothese selon laquelle ces signes permettraient une identification correcte des enfants atteints d&apos;hypoxemie, independamment du diagnostic qui doit leur etre affecte. Methodes De 2002 a 2005, nous avons recueilli prospectivement des donnees cliniques et des mesures par oxymetrie pulsee pour l&apos;ensemble des admissions pediatriques a l&apos;hopital de district de Kilifi au Kenya, independamment du diagnostic concernant ces enfants, et evalue la prevalence de l&apos;hypoxemie en relation avec la presence d&apos;un syndrome clinique de type pneumonie selon l&apos;OMS lors de l&apos;admission et du diagnostic final de sortie. Nous avons utilise les donnees collectees sur les trois premieres annees pour determiner les signes predictifs de l&apos;hypoxemie et les donnees de la quatrieme annee pour valider ces signes. Resultats Nous avons releve une hypoxemie chez 977 des 15289 enfants hospitalises (soit 6,4 %, chiffre variant entre 5 a 19 % selon la tranche d&apos;age) et une association forte entre hypoxemie et mortalite des patients hospitalises (rapport de risques ajuste selon l&apos;age: 4,5; intervalle de confiance a 95 %, IC: 3,8-5,3). Si la plupart des enfants hypoxemiques de 60 jours et plus remplissaient, lors de leur admission, les criteres OMS de definition du syndrome de type pneumonie, seuls 215 ales 693 enfants hypoxemiques de 60 jours et plus (31%) ont finalement ete diagnostiques comme atteints d&apos;une infection des voies respiratoires inferieures (IVRI). Parmi les signes les plus predictifs de l&apos;hypoxemie figuraient l&apos;etat de choc, une frequence cardiaque inferieure a 80 battements par minute, une respiration irreguliere, une frequence respiratoire superieure a 60 respirations par minute et un etat de conscience alteree. Neanmoins, 5 a 15 % des enfants hypoxemiques Iors de leur admission n&apos;ont pas ete reperes et 18 % des enfants ont ete identifies a tort comme hypoxemiques. Conclusion Le recours au syndrome de type pneumonie permet d&apos;identifier la plupart des enfants hypoxemiques, y compris ceux atteints d&apos;une IVRI. l&apos;etat de choc, la bradycardie et l&apos;irregularite respiratoire sont des signes predictifs importants et le paludisme grave, avec detresse respiratoire, est une cause courante d&apos;hypoxemie. Globalement neanmoins, les signes cliniques n&apos;ont pas une grande valeur predictive pour l&apos;hypoxemie et li est probable que l&apos;utilisation de l&apos;oxymetrie pulsee par les etablissements de soins qui manquent de moyens pour identifier les patients devant beneficier d&apos;un traitement par l&apos;oxygene permettra de realiser des economies. Objetivo Describir la prevalencia de hipoxemia en ninos ingresados en un hospital de Kenya a fin de identificar los signos clinicos de la misma para un triaje de emergencia, y contrastar la hipotesis de que esos signos permiten detectar correctamente la hipoxemia en los ninos, independientemente del diagnostico. Metodos Entre 2002 y 2005 se reunieron prospectivamente datos clinicos y de oximetria de pulso para todos los ingresos pediatricos en el Hospital de Distrito de Kilifi, Kenya, con independencia del diagnostico, determinandose la prevalencia de hipoxemia en relacion con el sindrome clinico de << neumonia >> definido por la OMS en el momento del ingreso y con el diagnostico final en el momento del alta. Los datos recogidos durante los tres primeros anos se usaron para determinar los signos predictivos de hipoxemia, y los datos reunidos a partir del cuarto ano fueron utilizados para validar esos signos. Resultados Se detecto hipoxemia en 977 de 15 289 (6,4%) ninos ingresados (5%-19% segun el grupo de edad), muy estrechamente asociada a mortalidad hospitalaria (razon de riesgos ajustada por edad: 4,5; intervalo de confianza [IC] del 95%: 3,8-5,3). Aunque la mayoria de los ninos hipoxemicos con [mayor que o igual a] 60 dias de edad cumplian los criterios de la OMS para que pudiera diagnosticarse un sindrome de <> en el momento del ingreso, solo 215 de los 693 (31%) ninos hipoxemicos de esa edad recibieron un diagnostico final de infeccion de las vias respiratorias inferiores (IVRI). Los signos mas predictivos de hipoxemia fueron el choque, una frecuencia cardiaca < 80 latidos por minuto, una respiracion irregular, una frecuencia respiratoria > 60 respiraciones por minuto y un deterioro de la conciencia. Sin embargo, no se detecto la hipoxemia en un 5%-15% de los ninos que la sufrian en el momento del ingreso, y un 18% de los ninos fueron considerados hipoxemicos incorrectamente. Conclusion Los sindromes de neumonia permiten identificar a la mayoria de los ninos hipoxemicos, incluidos los que no presentan IVRI. Un cuadro de choque, la bradicardia y una respiracion irregular son signos predictivos importantes, y la malaria grave con distres respiratorio es una causa comun de hipoxemia. Sin embargo, en general los signos clinicos son poco fiables como factores predictivos de la hipoxemia, y es probable que, en los servicios de salud con recursos escasos, el uso de la oximetria de pulso como criterio para aplicar oxigenoterapia permita ahorrar costos., Introduction Recognizing and correcting poor oxygenation early is an essential aspect of paediatric emergency care. The management of hypoxaemia includes establishing an open airway and alveolar ventilatjon, providing supplemental oxygen, [...]

Abstract Background Our understanding of the transmission dynamics of respiratory syncytial virus (RSV) infection will be better informed with improved data on the patterns of shedding in cases not limited only to hospital admissions. Methods In a household study, children testing RSV positive by direct immunofluorescent antibody test (DFA) were enrolled. Nasal washings were scheduled right away, then every three days until day 14, every 7 days until day 28 and every 2 weeks until a maximum of 16 weeks, or until the first DFA negative RSV specimen. The relationship between host factors, illness severity and viral shedding was investigated using Cox regression methods. Results From 151 families a total of 193 children were enrolled with a median age of 21 months (range 1-164 months), 10% infants and 46% male. The rate of recovery from infection was 0.22/person/day (95% CI 0.19-0.25) equivalent to a mean duration of shedding of 4.5 days (95%CI 4.0-5.3), with a median duration of shedding of 4 days (IQR 2-6, range 1-14). Children with a history of RSV infection had a 40% increased rate of recovery i.e. shorter duration of viral shedding (hazard ratio 1.4, 95% CI 1.01-1.86). The rate of cessation of shedding did not differ significantly between males and females, by severity of infection or by age. Conclusion We provide evidence of a relationship between the duration of shedding and history of infection, which may have a bearing on the relative role of primary versus re-infections in RSV transmission in the community.

Background Monovalent rotavirus vaccine, Rotarix (GlaxoSmithKline), was introduced in Kenya in July 2014 and is recommended to infants as oral doses at ages 6 and 10 weeks. A multisite study was established in 2 population-based surveillance sites to evaluate vaccine impact on the incidence of rotavirus-associated hospitalizations (RVHs). Methods Hospital-based surveillance was conducted from January 2010 to June 2017 for acute diarrhea hospitalizations among children aged <5 years in 2 health facilities in Kenya. A controlled interrupted time-series analysis was undertaken to compare RVH pre– and post–vaccine introduction using rotavirus-negative cases as a control series. The change in incidence post–vaccine introduction was estimated from a negative binomial model that adjusted for secular trend, seasonality, and multiple health worker industrial actions (strikes). Results Between January 2010 and June 2017 there were 1513 and 1652 diarrhea hospitalizations in Kilifi and Siaya; among those tested for rotavirus, 28% (315/1142) and 23% (197/877) were positive, respectively. There was a 57% (95% confidence interval [CI], 8–80%) reduction in RVHs observed in the first year post–vaccine introduction in Kilifi and a 59% (95% CI, 20–79%) reduction in Siaya. In the second year, RVHs decreased further at both sites, 80% (95% CI, 46–93%) reduction in Kilifi and 82% reduction in Siaya (95% CI. 61–92%); this reduction was sustained at both sites into the third year. Conclusions A substantial reduction in RVHs and all-cause diarrhea was observed in 2 demographic surveillance sites in Kenya within 3 years of vaccine introduction. [ABSTRACT FROM AUTHOR]

Background Rotavirus remains a leading cause of pediatric diarrheal illness and death worldwide. Data on rotavirus vaccine effectiveness in sub-Saharan Africa are limited. Kenya introduced monovalent rotavirus vaccine (RV1) in July 2014. We assessed RV1 effectiveness against rotavirus-associated hospitalization in Kenyan children. Methods Between July 2014 and December 2017, we conducted surveillance for acute gastroenteritis (AGE) in 3 Kenyan hospitals. From children age-eligible for ≥1 RV1 dose, with stool tested for rotavirus and confirmed vaccination history we compared RV1 coverage among rotavirus positive (cases) vs rotavirus negative (controls) using multivariable logistic regression and calculated effectiveness based on adjusted odds ratio. Results Among 677 eligible children, 110 (16%) were rotavirus positive. Vaccination data were available for 91 (83%) cases; 51 (56%) had 2 RV1 doses and 33 (36%) 0 doses. Among 567 controls, 418 (74%) had vaccination data; 308 (74%) had 2 doses and 69 (16%) 0 doses. Overall 2-dose effectiveness was 64% (95% confidence interval [CI], 35%–80%); effectiveness was 67% (95% CI, 30%–84%) for children aged <12 months and 72% (95% CI, 10%–91%) for children aged ≥12 months. Significant effectiveness was seen in children with normal weight for age, length/height for age and weight for length/height; however, no protection was found among underweight, stunted, or wasted children. Conclusions RV1 in the Kenyan immunization program provides significant protection against rotavirus-associated hospitalization which persisted beyond infancy. Malnutrition appears to diminish vaccine effectiveness. Efforts to improve rotavirus uptake and nutritional status are important to maximize vaccine benefit. [ABSTRACT FROM AUTHOR]

Background: Snakebite clinical trials have often used heterogeneous outcome measures and there is an urgent need for standardisation., Method: A globally representative group of key stakeholders came together to reach consensus on a globally relevant set of core outcome measurements. Outcome domains and outcome measurement instruments were identified through searching the literature and a systematic review of snakebite clinical trials. Outcome domains were shortlisted by use of a questionnaire and consensus was reached among stakeholders and the patient group through facilitated discussions and voting., Results: Five universal core outcome measures should be included in all future snakebite clinical trials: mortality, WHO disability assessment scale, patient-specific functional scale, acute allergic reaction by Brown criteria, and serum sickness by formal criteria. Additional syndrome-specific core outcome measures should be used depending on the biting species., Conclusion: This core outcome measurement set provides global standardisation, supports the priorities of patients and clinicians, enables meta-analysis, and is appropriate for use in low-income and middle-income settings., (Copyright © 2023 SFMTSI.)