Iroh Tam, Pui-Ying, Chirombo, James, Henrion, Marc ORCID: 0000-0003-1242-839X, Newberry, Laura, Mambule, Ivan, Everett, Dean, Mwansambo, Charles, Cunliffe, Nigel
ORCID: 0000-0002-5449-4988, French, Neil
ORCID: 0000-0003-4814-8293, Heyderman, Robert S et al (show 1 more authors)
(2022)
Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: a prospective hospital-based observational study.
BMJ Open, 12 (2).
e050188-e050188.
ISSN 2044-6055, 2044-6055
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Abstract
<jats:sec><jats:title>Objective</jats:title><jats:p>Assess characteristics of clinical pneumonia after introduction of pneumococcal conjugate vaccine (PCV), by HIV exposure status, in children hospitalised in a governmental hospital in Malawi.</jats:p></jats:sec><jats:sec><jats:title>Methods and findings</jats:title><jats:p>We evaluated 1139 children ≤5 years old hospitalised with clinical pneumonia: 101 HIV-exposed, uninfected (HEU) and 1038 HIV-unexposed, uninfected (HUU). Median age was 11 months (IQR 6–20), 59% were male, median mid-upper arm circumference (MUAC) was 14 cm (IQR 13–15) and mean weight-for-height z score was −0.7 (±2.5). The highest Respiratory Index of Severity in Children (RISC) scores were allocated to 10.4% of the overall cohort. Only 45.7% had fever, and 37.2% had at least one danger sign at presentation. The most common clinical features were crackles (54.7%), nasal flaring (53.5%) and lower chest wall indrawing (53.2%). Compared with HUU, HEU children were significantly younger (9 months vs 11 months), with lower mean birth weight (2.8 kg vs 3.0 kg) and MUAC (13.6 cm vs 14.0 cm), had higher prevalence of vomiting (32.7% vs 22.0%), tachypnoea (68.4% vs 49.8%) and highest RISC scores (20.0% vs 9.4%). Five children died (0.4%). However, clinical outcomes were similar for both groups.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In this post-PCV setting where prevalence of HIV and malnutrition is high, children hospitalised fulfilling the WHO Integrated Management of Childhood Illness criteria for clinical pneumonia present with heterogeneous features. These vary by HIV exposure status but this does not influence either the frequency of danger signs or mortality. The poor performance of available severity scores in this population and the absence of more specific diagnostics hinder appropriate antimicrobial stewardship and the rational application of other interventions.</jats:p></jats:sec>
Item Type: | Article |
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Uncontrolled Keywords: | epidemiology, paediatric infectious disease & immunisation, respiratory infections |
Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences |
Depositing User: | Symplectic Admin |
Date Deposited: | 10 Jun 2022 14:00 |
Last Modified: | 06 Dec 2024 19:36 |
DOI: | 10.1136/bmjopen-2021-050188 |
Open Access URL: | https://bmjopen.bmj.com/content/12/2/e050188 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3156181 |
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Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: a prospective hospital-based observational study. (deposited 03 Mar 2022 09:46)
- Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: a prospective hospital-based observational study. (deposited 10 Jun 2022 14:00) [Currently Displayed]