UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: A prospective hospital-based observational study

Iroh Tam, PY; Chirombo, J; Henrion, M; Newberry, L; Mambule, I; Everett, D; Mwansambo, C; ... Bar-Zeev, N; + view all (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) , Article e050188. 10.1136/bmjopen-2021-050188. Green open access

[thumbnail of e050188.full.pdf]
Preview
Text
e050188.full.pdf - Published Version

Download (501kB) | Preview

Abstract

OBJECTIVE: 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. METHODS: 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. CONCLUSIONS: 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.

Type: Article
Title: Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: A prospective hospital-based observational study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bmjopen-2021-050188
Publisher version: http://dx.doi.org/10.1136/bmjopen-2021-050188
Language: English
Additional information: © 2022 BMJ Publishing Group Ltd. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/).
Keywords: epidemiology, paediatric infectious disease & immunisation, respiratory infections
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10144543
Downloads since deposit
11Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item