Professor of Paediatrics and Consultant Paediatrician Phone: +234 8057 369 737 Address: Head of Infectious Diseases Unit, Department of Paediatrics, Ahmadu Bello University Teaching Hospital Zaria, Nigeria
Ceftriaxone is a third-generation cephalosporin with a wide spectrum of activity against both gra... more Ceftriaxone is a third-generation cephalosporin with a wide spectrum of activity against both gram-negative and gram-positive organisms. Ceftriaxone has proven efficacy against severe and difficult-to-treat community-acquired infections including typhoid fever and other sepsis syndromes caused by multi-drug resistant organisms. Several studies including prospective studies exist in the literature that described the accumulation of sonographically demonstrable sludge (or precipitates) in the gallbladder and sometimes in the urinary tract. The accumulation of sludge occurs during therapy for severe infections in some children identified with certain predisposing factors. The condition is often asymptomatic but might be associated with clinical features that could mimic disease progression in patients with intra-abdominal manifestations of infection such as typhoid fever. Five Nigerian children aged between 4 and 11 years developed demonstrable gallbladder sludge (precipitate) while on treatment for typhoid fever with ceftriaxone. Three of the children manifested clinical features suggestive of gallbladder precipitate accumulation following commencement of the antibiotic, while the other two did not. Ceftriaxone therapy was continued to completion in all the cases along with conservative management. Four of the children recovered and had resolution of the sludge, while the fifth died of multi-organ failure after surgery for intestinal perforation. Although several studies exist in the literature regarding this condition, our search using Medline and Google Scholar did not identify such reports from children in Nigeria or sub-Saharan Africa. The cases are presented to create awareness on the possibility of occurrence of a drug-induced biliary precipitate formation in children.
Necrotising pneumonia (NP) is a rare complication of bacterial pneumonia which is associated with... more Necrotising pneumonia (NP) is a rare complication of bacterial pneumonia which is associated with severe morbidity and mortality. Pneumonia of polymicrobial aetiology predicts worse pathology with fulminating clinical course. Reports of necrotising pneumonia from multiple bacterial infections are scanty in published literature. We report a case of a toddler with NP in whom Klebsiella pneumonia and Staphylococcus aureus, two pathogens which are well documented in its aetiopathogenesis, were isolated concurrently from his sputum and blood. Severe pneumonia, which shows slow response to recommended antibiotics treatment, should raise the suspicion of NP and possibly one of the polymicrobial origins. Even in resource-constrained settings, prompt institution of antibiotics and supportive care can result in resolution of pulmonary lesions.
Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance... more Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance, and treatment failure. Assessment of prescribing practices helps monitor the utilization of medicines. Objectives: The aim of this study was to evaluate the prescribing pattern and utilization of antibiotics for children attending outpatient units. Materials and Methods: This was a descriptive, retrospective study of outpatient pediatric prescriptions received at the pharmacy of a Nigerian teaching hospital, using the World Health Organization (WHO) core prescribing indicators and Index of Rational Drug Prescribing (IRDP). Prescription information for a 2-year period was collected on a standardized prescribing form. Computer data entry was made into Microsoft Excel 2010 spreadsheet. Data analysis was done using SPSS Version 20(IBM, Corp., Armonk, NY, USA). Results were compared with the WHO core prescribing indicators and presented as means, frequencies, proportions, contingency tables, and charts comparing with published standards. Results: There were 3445 eligible prescriptions, with mean child age of 3.2 (±2.9) years. An average of 2.4 (±1.6) drugs were prescribed per encounter, with 48.2% written in generic names. Prescriptions containing oral antibiotics and antibiotic injections constituted 50.2% and 41.2%, respectively. Medicines prescribed were available in the essential medicines list in 95.5% of cases. The IRDP was 2.98 against the ideal of 5. Majority (71.3%) of antibiotic-containing prescriptions had one antibiotic prescribed while β-lactam penicillins and cephalosporins were the most prescribed, with ampicillin/cloxacillin being the most common combination. Conclusion: Irrational prescribing and inappropriate antibiotic use were prevalent in this tertiary hospital. Similar studies are needed to describe the trends in all Nigerian tertiary hospitals, along with retraining on rational prescribing.
The Paediatric Association of Nigeria first published management guidelines for com- munity-acqui... more The Paediatric Association of Nigeria first published management guidelines for com- munity-acquired pneumonia in 2015 and covered available evidence at that time.
This update represents a review of available recent evidence statements regarding the management of pneumonia in children while at the same time incorporating relevant materials from the first edition of the guideline.
The guideline is developed to as- sist clinicians in caring for children with CAP. The recommendations provided in this guideline may not be the only approach to management since there are considerable variations among children in the clinical course of CAP. This guideline aims to reduce the morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians in making timely diagnoses and instituting appropriate antibiotic therapy. Summarised below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided, and the grade of the recommendation is indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.
The Paediatric Association of Nigeria first published management guideline for community-acquired... more The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia (CAP) in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to as- sist clinicians in the care of chil- dren with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among chil- dren in the clinical course of CAP. The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by provid- ing recommendations that may be relevant in assisting clinicians to make timely diagnosis and insti- tute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.
Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and o... more Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consor...
Supplemental content
IMPORTANCE Little is known about COVID-19 outcomes among children and adoles... more Supplemental content IMPORTANCE Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. CONCLUSIONS AND RELEVANCE In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
ABSTRACT
Article Metrics
Date submitted: Date Accepted: Date Published:
15/06/2021
21/06/2021
20... more ABSTRACT Article Metrics Date submitted: Date Accepted: Date Published: 15/06/2021 21/06/2021 20/08/2021 Background: A major impediment in the management and control of tuberculosis is the time frame required for accurate diagnosis. Routine microscopy has low sensitivity while culture, which is the gold standard, has a longer turnaround time and biosafety challenges. The Xpert MTb/Rif (Cepheid), on the other hand, is a newer molecular technology aimed at rapidly improving the diagnosis of tuberculosis (Tb), by being used as the initial test in individuals suspected of having multidrug resistant Tb or HIV associated Tb. The assay is able to amplify the DNA in mycobacterium and detect genetic mutations associated with resistance to the drug rifampicin within two hours. This study aimed to determine the prevalence of tuberculosis in a tertiary hospital in Northwestern Nigeria using Xpert MTb/Rif assay. Methodology: This was a retrospective laboratory based study conducted at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, from July 2015 to July 2017 on one thousand and forty seven (1047) body fluid specimen submitted at the medical microbiology laboratory for processing using the Xpert MTB/Rif assay. Data was recorded and analysed using Microsoft Excel and SPSS version 20.0. Descriptive statistics was done and results represented in charts and tables. Results: Of the one thousand and forty seven (1047) patients' specimens tested using Xpert MTB/RIF, 94(9%) were positive for Mycobacterium tuberculosis. 19 (20.2%) had HIV/TB co-infection while 4/ (4.3%) had rifampicin resistant tuberculosis. Conclusion: The prevalence of tuberculosis and Rifampicin resistant tuberculosis as obtained from this study were 9.4% and 4.3% respectively. Xpert MTB/RIF assay is a valuable alternative for diagnosis of drug sensitive and MDR-TB which will enhance early detection and prevent transmission at all levels of health care. Keywords: Xpert MTB/RIF, Tuberculosis, Diagnosis, HIV, MDR
Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and o... more Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respira- tory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and co-infections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries. Keywords. SARS-CoV-2; COVID-19; children; neonates; Africa.
IMPORTANCE: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan... more IMPORTANCE: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES: Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. CONCLUSIONS AND RELEVANCE: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
Background. Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Afric... more Background. Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. Methods. We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. Results. Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42– 4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44–2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08–3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20–3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17–2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79–14.13). Conclusions. Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women. Keywords. COVID-19; pregnancy; maternal; neonate; Africa.
Multicystic dysplastic kidney (MCDK) is one of the most common forms of congenital cystic disease... more Multicystic dysplastic kidney (MCDK) is one of the most common forms of congenital cystic diseases of the kidney that usually occurs sporadically and may rarely be associated with concomitant anomalies of the heart, spine, brain, and gastrointestinal system. The disorder is known to be commonly associated with a normally situated functional contralateral kidney and without significant symptoms. We report a case of an infant who presented with acute urinary tract infection on a background of an unusual association of normally positioned but nonfunctional MCDK and functional ectopic (pelvic) kidney on the contralateral side. We suggest the inclusion of diagnostic ultrasound as a routine investigation for pregnant women during antenatal care at all levels of health care to aid prenatal detection of renal abnormalities and a multidisciplinary approach to early management.
Purpura fulminans is a rare consequence of sepsis that could be complicated by DIC and gangrene. ... more Purpura fulminans is a rare consequence of sepsis that could be complicated by DIC and gangrene. We report the case of a 2-months-old infant who developed gangrenous limbs. He presented with fever, diarrhoea, vomiting and irritability for 5 days and was dehydrated and unconscious with global hypertonia. With a clinical impression of sepsis antibiotics, IV fluids and supportive care were commenced. He developed purpuric rashes over the trunk and feet, the latter of which gradually ascended over the legs, with swellings and ischemic skin changes up to the knees. A diagnosis of purpura fulminans was made and further evaluation revealed deranged haematologic parameters, features of Disseminated Intravascular Coagulopathy (DIC), hypernatraemia, azotaemia and arterial occlusion. Despite blood transfusions and supportive care gangrene emerged and progressively ascended towards the knees. Parents however rejected offer for surgical amputation and left against medical advice. The coexistence...
Ceftriaxone is a third-generation cephalosporin with a wide spectrum of activity against both gra... more Ceftriaxone is a third-generation cephalosporin with a wide spectrum of activity against both gram-negative and gram-positive organisms. Ceftriaxone has proven efficacy against severe and difficult-to-treat community-acquired infections including typhoid fever and other sepsis syndromes caused by multi-drug resistant organisms. Several studies including prospective studies exist in the literature that described the accumulation of sonographically demonstrable sludge (or precipitates) in the gallbladder and sometimes in the urinary tract. The accumulation of sludge occurs during therapy for severe infections in some children identified with certain predisposing factors. The condition is often asymptomatic but might be associated with clinical features that could mimic disease progression in patients with intra-abdominal manifestations of infection such as typhoid fever. Five Nigerian children aged between 4 and 11 years developed demonstrable gallbladder sludge (precipitate) while on treatment for typhoid fever with ceftriaxone. Three of the children manifested clinical features suggestive of gallbladder precipitate accumulation following commencement of the antibiotic, while the other two did not. Ceftriaxone therapy was continued to completion in all the cases along with conservative management. Four of the children recovered and had resolution of the sludge, while the fifth died of multi-organ failure after surgery for intestinal perforation. Although several studies exist in the literature regarding this condition, our search using Medline and Google Scholar did not identify such reports from children in Nigeria or sub-Saharan Africa. The cases are presented to create awareness on the possibility of occurrence of a drug-induced biliary precipitate formation in children.
Necrotising pneumonia (NP) is a rare complication of bacterial pneumonia which is associated with... more Necrotising pneumonia (NP) is a rare complication of bacterial pneumonia which is associated with severe morbidity and mortality. Pneumonia of polymicrobial aetiology predicts worse pathology with fulminating clinical course. Reports of necrotising pneumonia from multiple bacterial infections are scanty in published literature. We report a case of a toddler with NP in whom Klebsiella pneumonia and Staphylococcus aureus, two pathogens which are well documented in its aetiopathogenesis, were isolated concurrently from his sputum and blood. Severe pneumonia, which shows slow response to recommended antibiotics treatment, should raise the suspicion of NP and possibly one of the polymicrobial origins. Even in resource-constrained settings, prompt institution of antibiotics and supportive care can result in resolution of pulmonary lesions.
Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance... more Background: Rational prescribing is essential to prevent medication errors, antibiotic resistance, and treatment failure. Assessment of prescribing practices helps monitor the utilization of medicines. Objectives: The aim of this study was to evaluate the prescribing pattern and utilization of antibiotics for children attending outpatient units. Materials and Methods: This was a descriptive, retrospective study of outpatient pediatric prescriptions received at the pharmacy of a Nigerian teaching hospital, using the World Health Organization (WHO) core prescribing indicators and Index of Rational Drug Prescribing (IRDP). Prescription information for a 2-year period was collected on a standardized prescribing form. Computer data entry was made into Microsoft Excel 2010 spreadsheet. Data analysis was done using SPSS Version 20(IBM, Corp., Armonk, NY, USA). Results were compared with the WHO core prescribing indicators and presented as means, frequencies, proportions, contingency tables, and charts comparing with published standards. Results: There were 3445 eligible prescriptions, with mean child age of 3.2 (±2.9) years. An average of 2.4 (±1.6) drugs were prescribed per encounter, with 48.2% written in generic names. Prescriptions containing oral antibiotics and antibiotic injections constituted 50.2% and 41.2%, respectively. Medicines prescribed were available in the essential medicines list in 95.5% of cases. The IRDP was 2.98 against the ideal of 5. Majority (71.3%) of antibiotic-containing prescriptions had one antibiotic prescribed while β-lactam penicillins and cephalosporins were the most prescribed, with ampicillin/cloxacillin being the most common combination. Conclusion: Irrational prescribing and inappropriate antibiotic use were prevalent in this tertiary hospital. Similar studies are needed to describe the trends in all Nigerian tertiary hospitals, along with retraining on rational prescribing.
The Paediatric Association of Nigeria first published management guidelines for com- munity-acqui... more The Paediatric Association of Nigeria first published management guidelines for com- munity-acquired pneumonia in 2015 and covered available evidence at that time.
This update represents a review of available recent evidence statements regarding the management of pneumonia in children while at the same time incorporating relevant materials from the first edition of the guideline.
The guideline is developed to as- sist clinicians in caring for children with CAP. The recommendations provided in this guideline may not be the only approach to management since there are considerable variations among children in the clinical course of CAP. This guideline aims to reduce the morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians in making timely diagnoses and instituting appropriate antibiotic therapy. Summarised below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided, and the grade of the recommendation is indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.
The Paediatric Association of Nigeria first published management guideline for community-acquired... more The Paediatric Association of Nigeria first published management guideline for community-acquired pneumonia (CAP) in 2015 and covered available evidence at that time. This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline. The guideline is developed to as- sist clinicians in the care of chil- dren with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among chil- dren in the clinical course of CAP. The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by provid- ing recommendations that may be relevant in assisting clinicians to make timely diagnosis and insti- tute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.
Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and o... more Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consor...
Supplemental content
IMPORTANCE Little is known about COVID-19 outcomes among children and adoles... more Supplemental content IMPORTANCE Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. CONCLUSIONS AND RELEVANCE In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
ABSTRACT
Article Metrics
Date submitted: Date Accepted: Date Published:
15/06/2021
21/06/2021
20... more ABSTRACT Article Metrics Date submitted: Date Accepted: Date Published: 15/06/2021 21/06/2021 20/08/2021 Background: A major impediment in the management and control of tuberculosis is the time frame required for accurate diagnosis. Routine microscopy has low sensitivity while culture, which is the gold standard, has a longer turnaround time and biosafety challenges. The Xpert MTb/Rif (Cepheid), on the other hand, is a newer molecular technology aimed at rapidly improving the diagnosis of tuberculosis (Tb), by being used as the initial test in individuals suspected of having multidrug resistant Tb or HIV associated Tb. The assay is able to amplify the DNA in mycobacterium and detect genetic mutations associated with resistance to the drug rifampicin within two hours. This study aimed to determine the prevalence of tuberculosis in a tertiary hospital in Northwestern Nigeria using Xpert MTb/Rif assay. Methodology: This was a retrospective laboratory based study conducted at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, from July 2015 to July 2017 on one thousand and forty seven (1047) body fluid specimen submitted at the medical microbiology laboratory for processing using the Xpert MTB/Rif assay. Data was recorded and analysed using Microsoft Excel and SPSS version 20.0. Descriptive statistics was done and results represented in charts and tables. Results: Of the one thousand and forty seven (1047) patients' specimens tested using Xpert MTB/RIF, 94(9%) were positive for Mycobacterium tuberculosis. 19 (20.2%) had HIV/TB co-infection while 4/ (4.3%) had rifampicin resistant tuberculosis. Conclusion: The prevalence of tuberculosis and Rifampicin resistant tuberculosis as obtained from this study were 9.4% and 4.3% respectively. Xpert MTB/RIF assay is a valuable alternative for diagnosis of drug sensitive and MDR-TB which will enhance early detection and prevent transmission at all levels of health care. Keywords: Xpert MTB/RIF, Tuberculosis, Diagnosis, HIV, MDR
Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and o... more Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respira- tory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and co-infections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries. Keywords. SARS-CoV-2; COVID-19; children; neonates; Africa.
IMPORTANCE: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan... more IMPORTANCE: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. OBJECTIVE: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. EXPOSURES: Age, sex, preexisting comorbidities, and region of residence. MAIN OUTCOMES AND MEASURES: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. RESULTS: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. CONCLUSIONS AND RELEVANCE: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
Background. Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Afric... more Background. Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. Methods. We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. Results. Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42– 4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44–2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08–3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20–3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17–2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79–14.13). Conclusions. Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women. Keywords. COVID-19; pregnancy; maternal; neonate; Africa.
Multicystic dysplastic kidney (MCDK) is one of the most common forms of congenital cystic disease... more Multicystic dysplastic kidney (MCDK) is one of the most common forms of congenital cystic diseases of the kidney that usually occurs sporadically and may rarely be associated with concomitant anomalies of the heart, spine, brain, and gastrointestinal system. The disorder is known to be commonly associated with a normally situated functional contralateral kidney and without significant symptoms. We report a case of an infant who presented with acute urinary tract infection on a background of an unusual association of normally positioned but nonfunctional MCDK and functional ectopic (pelvic) kidney on the contralateral side. We suggest the inclusion of diagnostic ultrasound as a routine investigation for pregnant women during antenatal care at all levels of health care to aid prenatal detection of renal abnormalities and a multidisciplinary approach to early management.
Purpura fulminans is a rare consequence of sepsis that could be complicated by DIC and gangrene. ... more Purpura fulminans is a rare consequence of sepsis that could be complicated by DIC and gangrene. We report the case of a 2-months-old infant who developed gangrenous limbs. He presented with fever, diarrhoea, vomiting and irritability for 5 days and was dehydrated and unconscious with global hypertonia. With a clinical impression of sepsis antibiotics, IV fluids and supportive care were commenced. He developed purpuric rashes over the trunk and feet, the latter of which gradually ascended over the legs, with swellings and ischemic skin changes up to the knees. A diagnosis of purpura fulminans was made and further evaluation revealed deranged haematologic parameters, features of Disseminated Intravascular Coagulopathy (DIC), hypernatraemia, azotaemia and arterial occlusion. Despite blood transfusions and supportive care gangrene emerged and progressively ascended towards the knees. Parents however rejected offer for surgical amputation and left against medical advice. The coexistence...
Uploads
Keywords: Antibiotics, children, essential medicines, outpatient, rational prescribing, tertiary hospital
This update represents a review of available recent evidence statements regarding the management of pneumonia in children while at the same time incorporating relevant materials from the first edition of the guideline.
The guideline is developed to as- sist clinicians in caring for children with CAP. The recommendations provided in this guideline may not be the only approach to management since there are considerable variations among children in the clinical course of CAP. This guideline aims to reduce the morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians in making timely diagnoses and instituting appropriate antibiotic therapy. Summarised below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided, and the grade of the recommendation is indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.
This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline.
The guideline is developed to as- sist clinicians in the care of chil- dren with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among chil- dren in the clinical course of CAP. The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by provid- ing recommendations that may be relevant in assisting clinicians to make timely diagnosis and insti- tute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.
IMPORTANCE Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent.
OBJECTIVE To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.
DESIGN, SETTING, AND PARTICIPANTS This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection.
EXPOSURES Age, sex, preexisting comorbidities, and region of residence.
MAIN OUTCOMES AND MEASURES An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.
RESULTS Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio
[asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.
CONCLUSIONS AND RELEVANCE In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
Article Metrics
Date submitted: Date Accepted: Date Published:
15/06/2021
21/06/2021
20/08/2021
Background: A major impediment in the management and control of tuberculosis is the time frame required for accurate diagnosis. Routine microscopy has low sensitivity while culture, which is the gold standard, has a longer turnaround time and biosafety challenges. The Xpert MTb/Rif (Cepheid), on the other hand, is a newer molecular technology aimed at rapidly improving the diagnosis of tuberculosis (Tb), by being used as the initial test in individuals suspected of having multidrug resistant Tb or HIV associated Tb. The assay is able to amplify the DNA in mycobacterium and detect genetic mutations associated with resistance to the drug rifampicin within two hours. This study aimed to determine the prevalence of tuberculosis in a tertiary hospital in Northwestern Nigeria using Xpert MTb/Rif assay.
Methodology: This was a retrospective laboratory based study conducted at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, from July 2015 to July 2017 on one thousand and forty seven (1047) body fluid specimen submitted at the medical microbiology laboratory for processing using the Xpert MTB/Rif assay. Data was recorded and analysed using Microsoft Excel and SPSS version 20.0. Descriptive statistics was done and results represented in charts and tables.
Results: Of the one thousand and forty seven (1047) patients' specimens tested using Xpert MTB/RIF, 94(9%) were positive for Mycobacterium tuberculosis. 19 (20.2%) had HIV/TB co-infection while 4/ (4.3%) had rifampicin resistant tuberculosis.
Conclusion: The prevalence of tuberculosis and Rifampicin resistant tuberculosis as obtained from this study were 9.4% and 4.3% respectively. Xpert MTB/RIF assay is a valuable alternative for diagnosis of drug sensitive and MDR-TB which will enhance early detection and prevent transmission at all levels of health care.
Keywords: Xpert MTB/RIF, Tuberculosis, Diagnosis, HIV, MDR
Keywords. SARS-CoV-2; COVID-19; children; neonates; Africa.
OBJECTIVE: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection.
EXPOSURES: Age, sex, preexisting comorbidities, and region of residence.
MAIN OUTCOMES AND MEASURES: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.
RESULTS: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio
[asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.
CONCLUSIONS AND RELEVANCE: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
Methods. We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models.
Results. Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42– 4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44–2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08–3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20–3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17–2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79–14.13).
Conclusions. Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.
Keywords. COVID-19; pregnancy; maternal; neonate; Africa.
Keywords: Antibiotics, children, essential medicines, outpatient, rational prescribing, tertiary hospital
This update represents a review of available recent evidence statements regarding the management of pneumonia in children while at the same time incorporating relevant materials from the first edition of the guideline.
The guideline is developed to as- sist clinicians in caring for children with CAP. The recommendations provided in this guideline may not be the only approach to management since there are considerable variations among children in the clinical course of CAP. This guideline aims to reduce the morbidity and mortality rate of CAP in children by providing recommendations that may be relevant in assisting clinicians in making timely diagnoses and instituting appropriate antibiotic therapy. Summarised below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided, and the grade of the recommendation is indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.
This update represents a review of available recent evidence statements regarding the management of pneumonia in children, while at the same time incorporating relevant materials from the first edition of the guideline.
The guideline is developed to as- sist clinicians in the care of chil- dren with CAP. The recommendations provided in this guideline may not be the only approach to management, since there are considerable variations among chil- dren in the clinical course of CAP. The goal of this guideline is to reduce morbidity and mortality rate of CAP in children by provid- ing recommendations that may be relevant in assisting clinicians to make timely diagnosis and insti- tute appropriate antibiotic therapy of children with CAP. Summarized below are recommendations made in the new 2021 CAP guideline. As part of the recommendations, the quality of the evidence is provided and the grade of the recommendation indicated. The details of the background, methods and evidence summaries that support each of these recommendations can be found in the full text of the guideline.
IMPORTANCE Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent.
OBJECTIVE To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.
DESIGN, SETTING, AND PARTICIPANTS This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection.
EXPOSURES Age, sex, preexisting comorbidities, and region of residence.
MAIN OUTCOMES AND MEASURES An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.
RESULTS Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio
[asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.
CONCLUSIONS AND RELEVANCE In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
Article Metrics
Date submitted: Date Accepted: Date Published:
15/06/2021
21/06/2021
20/08/2021
Background: A major impediment in the management and control of tuberculosis is the time frame required for accurate diagnosis. Routine microscopy has low sensitivity while culture, which is the gold standard, has a longer turnaround time and biosafety challenges. The Xpert MTb/Rif (Cepheid), on the other hand, is a newer molecular technology aimed at rapidly improving the diagnosis of tuberculosis (Tb), by being used as the initial test in individuals suspected of having multidrug resistant Tb or HIV associated Tb. The assay is able to amplify the DNA in mycobacterium and detect genetic mutations associated with resistance to the drug rifampicin within two hours. This study aimed to determine the prevalence of tuberculosis in a tertiary hospital in Northwestern Nigeria using Xpert MTb/Rif assay.
Methodology: This was a retrospective laboratory based study conducted at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, from July 2015 to July 2017 on one thousand and forty seven (1047) body fluid specimen submitted at the medical microbiology laboratory for processing using the Xpert MTB/Rif assay. Data was recorded and analysed using Microsoft Excel and SPSS version 20.0. Descriptive statistics was done and results represented in charts and tables.
Results: Of the one thousand and forty seven (1047) patients' specimens tested using Xpert MTB/RIF, 94(9%) were positive for Mycobacterium tuberculosis. 19 (20.2%) had HIV/TB co-infection while 4/ (4.3%) had rifampicin resistant tuberculosis.
Conclusion: The prevalence of tuberculosis and Rifampicin resistant tuberculosis as obtained from this study were 9.4% and 4.3% respectively. Xpert MTB/RIF assay is a valuable alternative for diagnosis of drug sensitive and MDR-TB which will enhance early detection and prevent transmission at all levels of health care.
Keywords: Xpert MTB/RIF, Tuberculosis, Diagnosis, HIV, MDR
Keywords. SARS-CoV-2; COVID-19; children; neonates; Africa.
OBJECTIVE: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection.
EXPOSURES: Age, sex, preexisting comorbidities, and region of residence.
MAIN OUTCOMES AND MEASURES: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay.
RESULTS: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio
[asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge.
CONCLUSIONS AND RELEVANCE: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
Methods. We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models.
Results. Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42– 4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44–2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08–3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20–3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17–2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79–14.13).
Conclusions. Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.
Keywords. COVID-19; pregnancy; maternal; neonate; Africa.