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Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence, severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management....
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Citations
... We demonstrated that in our rural hospitals children aged <1 year had a higher CFP compared to children aged 1-4 years. Several studies have found higher all-cause mortality in children aged <1 year mainly due to their immature immune system and vulnerability to infections [12,[36][37][38][39]. We found that in our rural hospitals, children hospitalized for 5 or more days were less likely to die compared to those hospitalized for <5 days. ...
Background:
Severe acute respiratory illness (SARI) is an important cause of mortality in young children, especially in children living with HIV infection. Disparities in SARI death in children aged <5 years exist in urban and rural areas.
Objective:
To compare the factors associated with in-hospital death among children aged <5 years hospitalized with SARI in an urban vs. a rural setting in South Africa from 2009-2013.
Methods:
Data were collected from hospitalized children with SARI in one urban and two rural sentinel surveillance hospitals. Nasopharyngeal aspirates were tested for ten respiratory viruses and blood for pneumococcal DNA using polymerase chain reaction. We used multivariable logistic regression to identify patient and clinical characteristics associated with in-hospital death.
Results:
From 2009 through 2013, 5,297 children aged <5 years with SARI-associated hospital admission were enrolled; 3,811 (72%) in the urban and 1,486 (28%) in the rural hospitals. In-hospital case-fatality proportion (CFP) was higher in the rural hospitals (6.9%) than the urban hospital (1.3%, p<0.001), and among HIV-infected than the HIV-uninfected children (9.6% vs. 1.6%, p<0.001). In the urban hospital, HIV infection (odds ratio (OR):11.4, 95% confidence interval (CI):5.4-24.1) and presence of any other underlying illness (OR: 3.0, 95% CI: 1.0-9.2) were the only factors independently associated with death. In the rural hospitals, HIV infection (OR: 4.1, 95% CI: 2.3-7.1) and age <1 year (OR: 3.7, 95% CI: 1.9-7.2) were independently associated with death, whereas duration of hospitalization ≥5 days (OR: 0.5, 95% CI: 0.3-0.8) and any respiratory virus detection (OR: 0.4, 95% CI: 0.3-0.8) were negatively associated with death.
Conclusion:
We found that the case-fatality proportion was substantially higher among children admitted to rural hospitals and HIV infected children with SARI in South Africa. While efforts to prevent and treat HIV infections in children may reduce SARI deaths, further efforts to address health care inequality in rural populations are needed.
... Physical examination was performed on mothers and infants and clinical data were recorded. Gastrointestinal and respiratory infections, and malaria, based on mothers' reported symptoms, were diagnosed by clinical judgment following guidelines indication [17,18]. ...
Background
In sub-Saharan African countries Epstein Barr virus (EBV) infection occurs in early childhood. We aim to investigate the factors associated with EBV acquisition and the impact of EBV infection on the humoral response to HBV vaccination in infants born from HIV-positive, antiretroviral-treated mothers in Malawi.
Methods
A total of 149 HIV-exposed infants were included in this longitudinal study. EBV anti-VCA IgG were measured using an ELISA assay. The EBV seroconversion was correlated with the maternal viro-immunological conditions, with infant growth and immunological vulnerability, and with the humoral response to the HBV vaccine.
Results
No infant was EBV-positive at 6 months (n. 52 tested). More than a third of infants (49/115 or 42.6 %) on study beyond 6 months seroconverted at 12 months. At 24 months, out of 66 tested infants, only 13 remained EBV-uninfected, while 53 (80.3 %) acquired EBV infection, rising the total proportion of EBV seroconversion to 88.7 % (102/115 infants). EBV seroconversion was significantly associated with a low maternal educational status but had no impact on infant growth or vulnerability to infections. Reduced HBsAb levels and accelerated waning of antibodies were associated with early EBV seroconversion.
Conclusions
We found a heterogeneous timing of acquisition of EBV with the majority of infants born from HIV + mothers acquiring infection after 6 months. Anti-HBs levels were lower and appeared to wane faster in infants acquiring EBV infection.
... [116] If pulse oximetry is unavailable, administer oxygen if there is central cyanosis, grunting, restlessness, inability to drink or feed, or if respiratory rate is ≥70/breaths per minute. [117] Respiratory support High-flow humidified nasal oxygen (HFHNO) or nasal continuous positive airway pressure (nCPAP) systems provide support to children with severe respiratory disease (see below: Care of the child with pneumonia in the paediatric ICU or high care). [118,119] These can be safely provided in adequately staffed and equipped high-care areas and district hospitals. ...
Background:
Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis.
Objectives:
To produce revised guidelines for pneumonia in South African children under 5 years of age.
Methods:
The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision.
Recommendations:
Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided.
Validation:
The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.
... [21] If pulse oximetry is unavailable, administer oxygen if there is central cyanosis, grunting, restlessness, inability to drink or feed, or if respiratory rate is ≥70/breaths per minute. [22] Respiratory support High-flow humidified nasal oxygen (HFHNO) or nasal continuous positive airway pressure (nCPAP) systems provide support to children with severe respiratory disease (see below: Care of the child ...
BACKGROUND. Pneumococcal conjugate vaccine (PCV) administration and other advances have been associated with a shift in the aetiological spectrum of community-acquired pneumonia, necessitating reconsideration of empiric antibiotic treatment guidelines. Management strategies have also evolved in the last decade. OBJECTIVES. To produce revised guidelines for the treatment of pneumonia in South African (SA) children, including ambulatory, hospital and intensive care management. METHODS. An expert subgroup, reviewing evidence on the management of childhood pneumonia, was convened as part of a broader group revising SA guidelines. Evidence was graded using the British Thoracic Society (BTS) grading system and recommendations were made. RESULTS. Antibiotic treatment depends on the child's age, possible aetiology, antimicrobial resistance patterns, previous treatment, as well as factors affecting host susceptibility, including HIV, and nutritional and vaccination status. All children with signs of severe pneumonia should receive antibiotics. Children
... The result of blood culture (BC) was only positive in a small number of patients (12.5%), which is consistent with Zar et al (2005). 15 The researchers found that one of the diagnostic limitations of blood cultures in detecting childhood pneumonia is that it does not have positive outcomes in majority of the patient, which is consistent with our study. Based on the findings, it was found that, among the tests performed in the studied patients, the highest rates of positive results were related to WBC, ESR, and CRP; in this regard, Korppi et al (1997), Nohynek et al (1995), 16 Khan et al (2010), and Prat et al (2003) found that the use of ESR, CRP, and CBC in patients with moderate and severe pneumonia and hospitalized patients is helpful in determining how to respond to treatment and follow up patients. ...
Objective
The aim of this study is to determine the distribution of the results of routine laboratory tests for the diagnosis of pneumonia in children in Khorramabad.
Methods
This is a cross-sectional study and was performed on 650 children with pneumonia who were referred to Shahid Madani Hospital. From patients’ test results, the following data were recorded: whether the results were normal or not, age, sex, serotype, history of diabetes mellitus, and the presence of urinary and digestive tract symptoms.
Results
There was no difference in the prevalence of pneumonia, gender-wise, whereas 40% of the patients were under 2 years. In addition, 53.7% of the patients were presented with leukocytosis. From the blood test, blood urea nitrogen, creatinine, sodium, and potassium were normal in most of the patients. Stool examination, urine analysis, urine culture, erythrocyte sedimentation rate, C-reactive protein, and blood sugar were also normal in these patients.
Conclusion
Children under the age of 2 years are more susceptible to lung infections. Findings from blood tests such as leukocytosis are useful for making initial diagnosis other than computed tomography scan. Other lab tests might not give any useful results. In addition, a closer examination of the urinary system and digestive tract involvement is recommended, prior to urine or stool analysis.
... primarily take the form of dispersible tablets (Zar et al. 2005). The recommended treatment for diarrhoea includes oral rehydration salts, administered as a liquid solution via one of the administration devices described above (UNICEF 2010a). ...
Background: Effective infant medication administration and storage is a major public health challenge outlined by the World Health Organization. These challenges may be exacerbated in rural or limited-resource areas.
Aim: The aim of this study was to investigate infant medication administration and storage practices.
Setting: This study took place in selected communities in the Vhembe District of Limpopo Province, South Africa.
Method: Data was collected through 39 semi-structured interviews with infant caretakers and rural health workers. Interviews were recorded when permission was given by participants. Interviews were transcribed and coded using grounded theory and Tesch’s model of data analysis. Themes were agreed upon through consensus discussions with the researchers and an independent coder.
Results: Six themes that affect current infant medication administration and storage practices in the Vhembe District were identified: access to infant healthcare, the role of health workers, the devices used in the administration of infant medication, reluctance of the infant to take the medication, storage and reuse of infant medication in the rural home and hygiene practices surrounding infant medication administration.
Conclusions: Many factors were found to affect infant medication administration and storage practices in in the Vhembe District. Substantial evidence was found to suggest that the relationship between rural health workers and infant caretakers strongly influences these practices: a great amount of reliance and trust is placed in the health worker. Ensuring proper dosage of infant medication in the rural household arose as a main concern of participants. Reuse of medication in the home and home hygiene practices surrounding infant medication administration are areas of potential future research. This future research may further inform recommendations for infant medication administration and storage practices in the Vhembe District.
... After studying patients admitted at PICU for CAP we found that many points in the 2011 pediatric CAP guidelines was neglected and not followed the most common point was Tracheal Aspirates and it was done for only one case (1.7%) while many other points were followed strongly Introduction CAP is defined clinically by the presence of signs and symptoms of pneumonia in a child who was completely healthy before the onset of the disease and occured due to an acute infection (less than 14 days duration) of the lower respiratory system. CAP usually occurs below terminal bronchioles leading to cough or difficult breathing, tachypnea, and or lower chest-wall indrawing [1] . A more practical term-Acute Lower Respiratory Infection (ALRI)-is preferred, reflecting the difficulties in obtaining a chest radiograph, especially in rural areas [2] . ...
... Most guidelines recommended b-lactam antibiotics for 4 months to 5 years old children and macrolide antibiotics for 0 to 3 years and 5 to 18 years old. [13][14][15][16] The present study finding that the proportion of use was about 50%, respectively. In addition, drug selection, usage, and dosage also play an important role in effective treatment. ...
To evaluate the rationality of drug use to treat community-acquired pneumonia (CAP) in children of a Chinese hospital using a set of developed indicators.
We performed a retrospective cross-sectional study in West China Second University Hospital. Hospitalized children (0–18 years old) diagnosed with CAP from October 2015 to January 2016 were included. A set of developed indicators for assessing rational drug use (RDU) to treat CAP in children were used to evaluate the rationality of drug use. The data of the indicators were compared with the recommendations of the available guidelines, analyzing the situation of drug use in the children diagnosed with CAP.
Eight hundred ninety-four children were included, 99.4% of them received antibiotics and 87.4% received more than 1 antibiotic. Antibiotics were administered intravenously in 880 (99.0%) children. About 20 (2.2%) children received antiviral agents and 19 (2.1%) children received antiviral drugs combined with antibiotics. About 208 (23.3%) children received traditional Chinese medicines and the injection of traditional Chinese medicines was given in 20 (2.2%) children.
This study illustrated that drug use was partly not consistent with the recommendations of current guidelines, especially antibiotics. The drug use of CAP in children needs to pay more attention to.
... Seven guidelines [16][17][18][19][20][21][22] and 73 studies that met the criteria were included. Thirty-seven indicators, consisting of 4 first-rank indicators and 33 second-rank indicators were developed based on these guidelines and studies and limited to the first-round Delphi survey (Online appendix 2, http://links.lww.com/MD/ ...
Community-acquired pneumonia (CAP) is a common infectious disease in children. Rational drug use (RDU) is an important approach to reducing the disease burden and mortality rate of CAP in children. There are no monitoring indicators for assessing RDU in children. This study aimed to develop a set of indicators to assess RDU to treat CAP in children in hospitals and clinics using a modified Delphi method.
Initial indicators were generated based on a systematic review of guidelines and studies investigating CAP in children. A 3-round modified Delphi process in the form of an email survey combined with round-table discussion was then carried out, and an analytic hierarchy process (AHP) was applied to determine the weight of each indicator.
A total of 24 and 8 experts were invited to participate in the email survey and round-table discussion, respectively. A consensus was reached after 3 rounds of the Delphi survey. Three first-rank indicators and 23 second-rank indicators were developed, and each indicator was weighted. The first-rank indicators comprised drug choice (45.5%), drug usage and dosage (36.4%), and the duration of drug therapy (18.2%); the second-rank indicators were indicators related to antibiotics (63.6%), antiviral agents (18.2%), traditional Chinese medicines (4.5%), and adjuvant drugs (13.6%). The weight value of drug selection was the highest, followed by the values of drug usage and dosage and the duration of drug therapy.
The developed indicator set constitutes the first set intended to assess RDU to treat CAP in children in hospitals (including community hospitals) and clinics. The indicators were based on drug selection, drug usage and dosage and duration of drug therapy, which are associated with most therapeutic drugs for CAP in children. Monitoring these indicators will guide people towards the promotion of RDU in the absence of drug monitoring indicators for CAP. Furthermore, the indicator set constitutes a methodological reference for the development of other indicator sets.
... Pneumonia is the single greatest cause of death in children worldwide, with an estimated 1.3 million deaths in 2011 and more than 90% occurring in developing countries [1][2][3]. It is responsible for 4% of deaths in newborns and 14% of deaths in pediatric patients [4]. ...
Background
Pneumonia represents an important threat to children's health in both developed and developing countries. In the last 10 years, many national and international guidelines on the treatment of pediatric CAP have been published, in order to optimize the prescription of antibiotics and limit their cost and side effects. However, the practical implementation of these guidelines is still limited.
Main Text
We analyzed the current recommendations for the therapy of pediatric community-acquired pneumonia (CAP) that all converge on the identification of aminopenicillins and beta-lactams as the optimal treatment for CAP. We also conducted a review of the current literature on antibiotic regimens used for pediatric CAP to identify the current state of guidelines implementation in different settings. We selected 37 studies published from 2010 to 2016, including both retrospective and prospective studies, mainly cross-sectional and hospital based. The results show a global heterogeneity in the antibiotics prescription for pediatric CAP, with application of guidelines varying from 0% to more than 91% and with important differences even within the same country.
Conclusions
Our review has demonstrated that the implementation of the guidelines is still limited but also that achieving the optimal prescription is possible and can be done in both developed and developing countries.
