Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009-2013.
Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009-2013.
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DOI：
10.1371/journal.pone.0255941
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Cohen C
中科院分区：
文献类型：
--
作者：
Ayeni OA;Walaza S;Tempia S;Groome M;Kahn K;Madhi SA;Cohen AL;Moyes J;Venter M;Pretorius M;Treurnicht F;Hellferscee O;von Gottberg A;Wolter N;Cohen C
严重急性呼吸道疾病（SARI）是幼儿死亡的一个重要原因，特别是在感染艾滋病毒的儿童中。城市和农村地区5岁以下儿童SARI死亡率存在差异。比较2009-2013年南非城市与农村地区5岁以下SARI住院儿童的院内死亡相关因素。数据收集自一个城市和两个农村哨点监测医院的SARI住院儿童。使用聚合酶链反应检测鼻咽抽吸物中的10种呼吸道病毒和血液中的肺炎球菌DNA。我们使用多变量逻辑回归来确定与院内死亡相关的患者和临床特征。从2009年到2013年，有5，297名5岁以下的儿童因SARI住院; 3，811名（72%）在城市医院，1，486名（28%）在农村医院。住院病死率农村医院（6.9%）高于城市医院（1.3%），HIV感染儿童（9.6%）高于非HIV感染儿童（1.6%），P<0.001。在城市医院，HIV感染（优势比（OR）：11.4，95%置信区间（CI）：5.4-24.1）和存在任何其他基础疾病（OR：3.0，95% CI：1.0-9.2）是与死亡独立相关的唯一因素。在农村医院，艾滋病毒感染（OR：4.1，95% CI：2.3-7.1）和年龄<1岁（OR：3.7，95%CI：1.9-7.2）与死亡独立相关，而住院时间≥5天（OR：0.5，95% CI：0.3-0.8）和任何呼吸道病毒检测（OR：0.4，95% CI：0.3-0.8）与死亡呈负相关。我们发现，南非农村医院收治的儿童和感染艾滋病毒的SARI儿童的病死率要高得多。虽然预防和治疗儿童艾滋病毒感染的努力可能会减少SARI死亡，但需要进一步努力解决农村人口的保健不平等问题。
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. 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. 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. 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. 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.
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影响因子：
3.8
作者：
Chiappini, Elena;Galli, Luisa;de Martino, Maurizio
通讯作者：
de Martino, Maurizio
影响因子：
168.9
作者：
Ashworth, A;Chopra, M;Schofield, C
通讯作者：
Schofield, C
影响因子：
168.9
作者：
Liu, Li;Oza, Shefali;Hogan, Dan;Chu, Yue;Perin, Jamie;Zhu, Jun;Lawn, Joy E.;Cousens, Simon;Mathers, Colin;Black, Robert E.
通讯作者：
Black, Robert E.
影响因子：
120.7
作者：
de Martino, M;Tovo, PA;Pezzotti, P
通讯作者：
Pezzotti, P
DOI：
10.1097/inf.0000000000000478
发表时间：
2015-01
期刊：
The Pediatric infectious disease journal
影响因子：
--
作者：
Cohen C;Walaza S;Moyes J;Groome M;Tempia S;Pretorius M;Hellferscee O;Dawood H;Chhagan M;Naby F;Haffejee S;Variava E;Kahn K;Nzenze S;Tshangela A;von Gottberg A;Wolter N;Cohen AL;Kgokong B;Venter M;Madhi SA
通讯作者：
Madhi SA