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Chisti MJ, Clemens JD, K M S, Shahid ASMSB, Sarmin M, Afroze F, Shaly NJ, Kabir F, Rahman AE, El Arifeen S, Ahmed T, Duke T. Implementation of bubble continuous positive airway pressure for children with severe pneumonia and hypoxemia in intensive care unit of Dhaka Hospital, Bangladesh-Effect on pneumonia mortality. Pediatr Pulmonol 2024. [PMID: 38265176 DOI: 10.1002/ppul.26881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/04/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND After the completion of a randomized trial at Dhaka Hospital in 2013, bubble continuous positive airway pressure (BCPAP) oxygen therapy was incorporated as the part of the standard treatment for children with severe pneumonia with hypoxemia in an intensive care unit at Dhaka Hospital in August 2013 instead of World Health Organization (WHO) standard low flow oxygen therapy. OBJECTIVE To understand the long-term effectiveness of the introduction of bCPAP oxygen therapy by comparing pneumonia mortality in the post-trial period (August 2013 to December 2017) with the pre-trial (February 2009 to July 2011) and trial periods (August 2011 to July 2013). METHODS It was a retrospective analysis of prospectively collected hospital data of all admissions. Mortality rates of all children with WHO-defined pneumonia, and the subset of children with severe pneumonia and hypoxemia (oxygen saturation <90%) were evaluated. RESULTS The analysis covered 10,107 children with pneumonia: 2523 in the pre-trial (414 with severe pneumonia and hypoxemia; none of them received bCPAP), 2959 during the trial (376 with severe pneumonia and hypoxemia; 79 received bCPAP), and 4625 in the post-trial period (1208 with severe pneumonia and hypoxemia; 1125 had bCPAP). The risk of death from pneumonia in the post-trial period was lower than in pre-trial (adjusted risk ratio [RR] = 0.73, 95% confidence interval [CI] = 0.58-0.92; p = 0.007), among children with severe pneumonia and hypoxemia, the risk of death was lower in the post-trial period than in the pre-trial (adjusted RR = 0.46, 95% CI = 0.37-0.58, p < 0.001), and the trial period (adjusted RR = 0.70, 95% CI = 0.51-0.95; p = 0.023). CONCLUSION After the introduction of bCPAP oxygen therapy as part of the routine management of severe pneumonia and hypoxemia in the ICU of the Dhaka hospital, we observed significantly lower mortality, even after accounting for measurable confounding.
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Affiliation(s)
- Mohammod J Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - John D Clemens
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- International Vaccine Institute, Seoul, Korea
- UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Shahunja K M
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
| | - Abu S M S B Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nusrat J Shaly
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhad Kabir
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ahmed E Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Trevor Duke
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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Kirolos A, Blacow RM, Parajuli A, Welton NJ, Khanna A, Allen SJ, McAllister DA, Campbell H, Nair H. The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-007411. [PMID: 34848440 PMCID: PMC8634228 DOI: 10.1136/bmjgh-2021-007411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/09/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Childhood malnutrition is widespread in low-income and middle-income countries (LMICs) and increases the frequency and severity of infections such as pneumonia. We aimed to identify studies investigating pneumonia deaths in malnourished children and estimate mortality risk by malnutrition severity. METHODS We conducted a systematic review of MEDLINE, EMBASE and Global Health databases to identify relevant studies. We used a network meta-analysis to derive ORs of death from pneumonia for moderately and severely underweight children using low weight-for-age, the most reported measure of malnutrition. We compared meta-estimates of studies conducted before and after 2000 to assess changes in mortality risk over time. We estimated the prevalence of underweight hospitalised children from hospital-based cohort studies and calculated the population attributable fraction of in-hospital pneumonia deaths from being underweight using our results. RESULTS Our network meta-analysis included 33 544 underweight children from 23 studies. The estimated OR of death from pneumonia was 2.0 (95% CI 1.6 to 2.6) and 4.6 (95% CI 3.7 to 5.9) for children moderately and severely underweight, respectively. The OR of death from pneumonia for those severely underweight was 5.3 (95% CI 3.9 to 7.4) pre-2000 and remained high post-2000 at 4.1 (95% CI 3.0 to 6.0). Prevalence of underweight children hospitalised with pneumonia varied (median 40.2%, range 19.6-66.3) but was high across many LMIC settings. We estimated a median 18.3% (range 10.8-34.6) and 40.9% (range 14.7-69.9) of in-hospital pneumonia deaths were attributable to being moderately and severely underweight, respectively. CONCLUSIONS The risk of death from childhood pneumonia dramatically increases with malnutrition severity. This risk has remained high in recent years with an estimated over half of in-hospital pneumonia deaths attributable to child malnutrition. Prevention and treatment of all child malnutrition must be prioritised to maintain progress on reducing pneumonia deaths.
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Affiliation(s)
- Amir Kirolos
- University of Liverpool Department of Women's and Children's Health, Liverpool, UK .,Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,The University of Edinburgh Usher Institute, Edinburgh, UK
| | | | - Arun Parajuli
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Nicky J Welton
- University of Bristol Bristol Population Health Science Institute, Bristol, UK
| | - Alisha Khanna
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Stephen J Allen
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | | | - Harry Campbell
- The University of Edinburgh Usher Institute, Edinburgh, UK
| | - Harish Nair
- The University of Edinburgh Usher Institute, Edinburgh, UK
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3
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Chua PLC, Ng CFS, Rivera AS, Salva EP, Salazar MA, Huber V, Hashizume M. Association between Ambient Temperature and Severe Diarrhoea in the National Capital Region, Philippines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8191. [PMID: 34360484 PMCID: PMC8346076 DOI: 10.3390/ijerph18158191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Epidemiological studies have quantified the association between ambient temperature and diarrhoea. However, to our knowledge, no study has quantified the temperature association for severe diarrhoea cases. In this study, we quantified the association between mean temperature and two severe diarrhoea outcomes, which were mortality and hospital admissions accompanied with dehydration and/or co-morbidities. Using a 12-year dataset of three urban districts of the National Capital Region, Philippines, we modelled the non-linear association between weekly temperatures and weekly severe diarrhoea cases using a two-stage time series analysis. We computed the relative risks at the 95th (30.4 °C) and 5th percentiles (25.8 °C) of temperatures using minimum risk temperatures (MRTs) as the reference to quantify the association with high- and low-temperatures, respectively. The shapes of the cumulative associations were generally J-shaped with greater associations towards high temperatures. Mortality risks were found to increase by 53.3% [95% confidence interval (CI): 29.4%; 81.7%)] at 95th percentile of weekly mean temperatures compared with the MRT (28.2 °C). Similarly, the risk of hospitalised severe diarrhoea increased by 27.1% (95% CI: 0.7%; 60.4%) at 95th percentile in mean weekly temperatures compared with the MRT (28.6 °C). With the increased risk of severe diarrhoea cases under high ambient temperature, there may be a need to strengthen primary healthcare services and sustain the improvements made in water, sanitation, and hygiene, particularly in poor communities.
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Affiliation(s)
- Paul L. C. Chua
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, Nagasaki 852-8102, Japan; (C.F.S.N.); (M.H.)
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Alliance for Improving Health Outcomes, Inc., Rm. 406, Veria I Bldg., 62 West Avenue, Barangay West Triangle, Quezon City 1104, Philippines;
| | - Chris Fook Sheng Ng
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, Nagasaki 852-8102, Japan; (C.F.S.N.); (M.H.)
| | - Adovich S. Rivera
- Institute for Public Health and Management, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street, 20th Floor, Chicago, IL 60611, USA;
| | - Eumelia P. Salva
- San Lazaro Hospital, Quiricada St., Santa Cruz, Manila 1003, Philippines;
| | - Miguel Antonio Salazar
- Alliance for Improving Health Outcomes, Inc., Rm. 406, Veria I Bldg., 62 West Avenue, Barangay West Triangle, Quezon City 1104, Philippines;
- Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Veronika Huber
- Department of Physical, Chemical and Natural Systems, Universidad Pablo de Olavide, Ctra Utrera km 1, 41013 Sevilla, Spain;
| | - Masahiro Hashizume
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, Nagasaki 852-8102, Japan; (C.F.S.N.); (M.H.)
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Seizure in Children Under Five Presenting With Pneumonia in a Critical Care Ward in Bangladesh: Prevalence, Associated Factors, and Outcome. Pediatr Infect Dis J 2021; 40:389-393. [PMID: 33979116 DOI: 10.1097/inf.0000000000003068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pneumonia is the leading infectious cause of deaths in children under 5 for the last few decades. Development of seizure in those children is common and associated with increased risk of deaths. We therefore investigated the prevalence, associated factors and outcome of seizure in children hospitalized with pneumonia. METHODS We conducted a retrospective chart analysis in the intensive care unit of the Dhaka Hospital of icddr,b. Children under 5 with World Health Organization (WHO) classified clinical (excluding seizure as 1 of the clinical diagnostics) and radiologic pneumonia, admitted to the intensive care unit at Dhaka Hospital of icddr,b between August 2013 and December 2017 were analyzed. We initially identified the children with pneumonia who had seizure. For comparison, we have taken 2 folds randomly selected controls from rest of the children with pneumonia having no seizure. Prevalence and outcome of children with pneumonia and seizure were measured. Factors associated with seizure in children with pneumonia compared with those without seizure were also identified. Seizure was characterized by sudden, violent, involuntary, and abnormal repetitive movements with or without loss or impairment of consciousness confirmed by attending physician. RESULTS Among a total of 4101 children with pneumonia, 514 (12.5%) had seizure. Compared with children with pneumonia alone children having pneumonia and seizure more often developed respiratory failure (18% vs. 3%, P < 0.001) and died (13% vs. 3%, P < 0.001) during hospitalization. In logistic regression analysis hypoxemia (95% CI: 1.59-3.17, P < 0.001), severe pneumonia (95% CI: 2.13-6.52, P < 0.001), severe sepsis (95% CI: 1.30-2.88, P = 0.001), and hypernatremia (95% CI: 5.31-10.93, P < 0.001) were found to be independent risk factors for seizure. On the contrary, children with pneumonia having seizure were less likely to have severe acute malnutrition (95% CI: 0.26-0.50, P < 0.001). CONCLUSIONS Early identification of risk factors for seizure in children with pneumonia may be helpful for clinicians to promptly treat them and therefore may have potential to reduce deaths in those children especially in resource limited settings.
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Saha H, Shahrin L, Sarmin M, Ahmed T, Chisti MJ. Bacteremia in Diarrheal Children With Severe Pneumonia. Glob Pediatr Health 2019; 6:2333794X19862462. [PMID: 31321258 PMCID: PMC6628537 DOI: 10.1177/2333794x19862462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives. Diarrhea and pneumonia are the leading causes of
under-5 childhood mortality. However, there is limited information on bacterial
etiology of severe pneumonia in children with diarrhea. We analyzed bacterial
pathogens from the blood of children under the age of 5 years.
Methods. In this retrospective cross-sectional study, we
studied all children having severe pneumonia with or without diarrhea admitted
to the icddr,b (International Centre for Diarrheal Disease Research, Bangladesh)
who had their blood culture done during January 2014 to December 2014.
Results. Among a total of 159 study children, 118 had
diarrhea. There were 13 bacterial isolates, and predominant organisms were
gram-negative bacteria (11/13, 85%). Children with diarrhea coexisting with
severe pneumonia proportionately had higher bacteremia (12/141 [10.16%] vs 1/41
[2.43%]), but the difference was not statistically insignificant
(P = .186). Conclusion. We recognized that
the coexistence of diarrhea and severe pneumonia had proportionately higher
bacteremia, especially gram-negative bacteria compared with those without
diarrhea. The results emphasize the trend of bacterial etiology of pneumonia in
children with diarrhea and may warrant revised antibiotics guideline for their
management.
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Affiliation(s)
- Haimanti Saha
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Monira Sarmin
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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6
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Ashraf H, Alam NH, Sultana M, Jahan SA, Begum N, Farzana S, Chisti MJ, Kamal M, Shamsuzzaman A, Ahmed T, Khan JAM, Fuchs GJ, Duke T, Gyr N. Day clinic vs. hospital care of pneumonia and severe malnutrition in children under five: a randomised trial. Trop Med Int Health 2019; 24:922-931. [PMID: 31046165 DOI: 10.1111/tmi.13242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate the clinical outcomes and costs of managing pneumonia and severe malnutrition in a day clinic (DC) management model (outpatient) vs. hospital care (inpatient). METHODS Randomised clinical trial where children aged 2 months to 5 years with pneumonia and severe malnutrition were randomly allocated to DC or inpatient hospital care. We used block randomisation of variable length from 8 to 20 and produced computer-generated random numbers that were assigned to one of the two interventions. Successful management was defined as resolution of clinical signs of pneumonia and being discharged from the model of care (DC or hospital) without need for referral to a hospital (DC), or referral to another hospital. All the children in both DC and hospital received intramuscular ceftriaxone, daily nutrition support and micronutrients. RESULTS Four hundred and seventy children were randomly assigned to either DC or hospital care. Successful management was achieved for 184 of 235 (78.3%) by DC alone, vs. 201 of 235 (85.5%) by hospital inpatient care [RR (95% CI) = 0.79 (0.65-0.97), P = 0.02]. During 6 months of follow-up, 30/235 (12.8%) in the DC group and 36/235 (15.3%) required readmission to hospital in the hospital care group [RR (95% CI) = 0.89 (0.67-1.18), P = 0.21]. The average overall healthcare and societal cost was 34% lower in DC (US$ 188 ± 11.7) than in hospital (US$ 285 ± 13.6) (P < 0.001), and costs for households were 33% lower. CONCLUSIONS There was a 7% greater probability of successful management of pneumonia and severe malnutrition when inpatient hospital care rather than the outpatient day clinic care was the initial method of care. However, where timely referral mechanisms were in place, 94% of children with pneumonia and severe malnutrition were successfully managed initially in a day clinic, and costs were substantially lower than with hospital admission.
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Affiliation(s)
- Hasan Ashraf
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nur H Alam
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Marufa Sultana
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Selina A Jahan
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nurshad Begum
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Sharmin Farzana
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Mohammod J Chisti
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Mohiuddin Kamal
- Radda Maternal and Child Health Family Planning Centre, Dhaka, Bangladesh
| | - Abu Shamsuzzaman
- Institute of Child Health and Shishu, Sasthya Foundation Hospital, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Jahangir A M Khan
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, UK
| | - George J Fuchs
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Niklaus Gyr
- Faculty of Medicine, University of Basel, Basel, Switzerland
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7
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Bacterial Resistance in Pneumonia in Developing Countries-A Role for Iron Chelation. Trop Med Infect Dis 2019; 4:tropicalmed4020059. [PMID: 30974759 PMCID: PMC6631655 DOI: 10.3390/tropicalmed4020059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 11/24/2022] Open
Abstract
Pneumonia represents one of the major infectious diseases in developing countries and is associated with high mortality, in particular in children under the age of five. The main causative bacterial agents are Streptococcus pneumoniae and Haemophilus influenzae type B, accounting for 33% and 16%, respectively, of the mortality in under-fives. Iron modulates the immune response in infectious diseases and increased iron levels can lead to complications such as sepsis and multiorgan failure. This review will look into the use of iron chelators in order to reduce microbial growth and attenuate a dysregulated immune response during infection. Our hypothesis is that temporary restriction of iron will lessen the incidence and complication rate of infections like pneumonia and result in a decrease of mortality and morbidity.
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Ferdous F, Ahmed S, Das SK, Chisti MJ, Nasrin D, Kotloff KL, Levine MM, Nataro JP, Ma E, Muhsen K, Wagatsuma Y, Ahmed T, Faruque ASG. Pneumonia mortality and healthcare utilization in young children in rural Bangladesh: a prospective verbal autopsy study. Trop Med Health 2018; 46:17. [PMID: 29875615 PMCID: PMC5970515 DOI: 10.1186/s41182-018-0099-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/20/2018] [Indexed: 02/03/2023] Open
Abstract
Background The present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh. A prospective autopsy study was conducted among guardians of children aged 4 weeks to 59 months in Mirzapur, Bangladesh, from 2008 to 2012. Results Pneumonia was the primary cause of death, accounting for 26.4% (n = 81) of all 307 deaths. Of the pneumonia deaths, 58% (n = 47) deaths occurred in younger infants (aged 4 weeks to < 6 months) and 24.7% (n = 20) in older infants (aged 6–11 months). The median duration of illness before pneumonia death was 8 days (interquartile range [IQR] 3–20 days). Prior to death, 91.4% (n = 74) children with pneumonia sought treatment, and of those who sought treatment, 52.7% (n = 39) sought treatment ≥ 2 days after the onset of disease. Younger infants of 4 weeks to < 6 months old were at 5.5-time (95% confidence interval [CI] 2.5, 12.0) and older infants aged 6–11 months were at 3-time (1.2, 7.5) greater risk of dying from pneumonia than older children aged 12–59 months. Children with a prolonged duration of illness (2–10 days) prior to death were at more risk for death by pneumonia than those who died from other causes (5.8 [2.1, 16.1]). Children who died from pneumonia sought treatment 3.4-time more than children who died from other causes. Delayed treatment seeking (≥ 2 days) behavior was 4.9-time more common in children who died from pneumonia than those who died from other causes. Children who died from pneumonia more often had access to care from multiple sources (5.7-time) than children who died from other causes. Conclusions Delay in seeking appropriate care and access to multiple sources for treatment are the underlying risk factors for pneumonia death in young children in Bangladesh. These results indicate the perplexity in guardians’ decisions to secure appropriate treatment for children with pneumonia. Therefore, it further underscores the importance of focusing on mass media coverage that can outline the benefits of seeking care early in the progression of pneumonia and the potential negative consequences of seeking care late. Electronic supplementary material The online version of this article (10.1186/s41182-018-0099-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Farzana Ferdous
- 1Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Shahnawaz Ahmed
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,3School of Public Health, The University of Queensland, Brisbane, Australia
| | - Mohammod Jobayer Chisti
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Dilruba Nasrin
- 4Center for Vaccine Development and Department of Medicine, University of Maryland School of Medicine, Baltimore, MD USA
| | - Karen L Kotloff
- 5Center for Vaccine Development, Department of Pediatrics and Medicine, University of Maryland School of Medicine, Baltimore, MD USA
| | - Myron M Levine
- 5Center for Vaccine Development, Department of Pediatrics and Medicine, University of Maryland School of Medicine, Baltimore, MD USA
| | - James P Nataro
- 5Center for Vaccine Development, Department of Pediatrics and Medicine, University of Maryland School of Medicine, Baltimore, MD USA.,6Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Enbo Ma
- 7Health Promotion Center, Fukushima Medical University, Fukushima, Japan.,9Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Khitam Muhsen
- 8Department of Epidemiology and Prevention Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Yukiko Wagatsuma
- 9Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tahmeed Ahmed
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syed Golam Faruque
- 2International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,10Nutrition and Clinical Services Division, icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
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9
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Chisti MJ, Shahunja KM, Afroze F, Shahid AS, Sharifuzzaman, Ahmed T. Hypoxaemia and septic shock were independent risk factors for mechanical ventilation in Bangladeshi children hospitalised for diarrhoea. Acta Paediatr 2017; 106:1159-1164. [PMID: 28316105 DOI: 10.1111/apa.13836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 02/24/2017] [Accepted: 03/14/2017] [Indexed: 01/20/2023]
Abstract
AIM In Bangladesh, approximately 6% of children under five years of age die due to diarrhoea. We evaluated the admission and hospitalisation risk factors for mechanical ventilation and outcomes in children with diarrhoea. METHODS This retrospective case-control chart analysis was conducted in the intensive care unit of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. We enrolled 219 children with diarrhoea aged 0-59 months between August 2009 and July 2013. The 73 cases were children who were initially identified as requiring mechanical ventilation during the study period, and the 146 controls were randomly selected from those who did not require mechanical ventilation. We compared the groups to determine the risk factors for mechanical ventilation. RESULTS Mortality was significantly higher among the cases than the controls (p < 0.001). In the logistic regression analysis carried out for two separate time points, the independent risk factors for mechanical ventilation on admission were hypoxaemia (p < 0.001) and septic shock (p = 0.004) and during hospitalisation, they were intake of intravenous fluid (p = 0.015), hypokalaemia (p = 0.018), hyperkalaemia (p = 0.005) and septic shock (p = 0.001). CONCLUSION Children under five with diarrhoea who required mechanical ventilation frequently had hypoxaemia and septic shock and were more likely to die than unventilated controls.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - KM Shahunja
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - Farzana Afroze
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - Abu S.M.S.B. Shahid
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - Sharifuzzaman
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
| | - Tahmeed Ahmed
- Nutrition & Clinical Services Division (NCSD); International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); Dhaka Bangladesh
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Shahunja KM, Ahmed T, Hossain MI, Das SK, Faruque ASG, Islam MM, Shahid ASMSB, Das J, Sarker MHR, Chisti MJ. Factors Associated With Pneumonia Among Overweight and Obese Under-Five Children in an Urban Hospital of a Developing Country. Glob Pediatr Health 2016; 3:2333794X16672528. [PMID: 27790628 PMCID: PMC5072332 DOI: 10.1177/2333794x16672528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022] Open
Abstract
To our knowledge, there are no data on the role of overweight and obesity in childhood pneumonia. We sought to determine that impact of overweight and obesity in such children. In this retrospective chart analysis, we enrolled hospitalized children aged 6 to 59 months in the Dhaka Hospital of the icddr,b, Bangladesh (International Centre for Diarrhoeal Disease Research, Bangladesh), from January 2010 to June 2014. Children with pneumonia having overweight and obesity (body mass index Z score [BMIZ] >2.00) constituted cases (n = 25), and those who had pneumonia without overweight and obesity (BMIZ -2.00 to 2.00) constituted controls (n = 75). Controls were 3-fold of the cases and were randomly selected. Demographic, clinical, and laboratory data of the cases and the controls were compared. The cases more often had diarrhea and dehydration (36% vs 12%, P = .013), hypoxemia (SpO2 < 90% in room air; 28% vs 7%, P = .009) on admission, and required to change antibiotics (32% vs 11%, P = .023) during hospitalization compared to the controls. However, in logistic regression analysis the cases were independently associated with diarrhea (P < .001) and hypoxemia (P = .024) on admission. Our data suggest that overweight and obesity in children with pneumonia is prone to be associated with hypoxemia on admission, which may guide clinicians in promptly managing pneumonia in order to evade its ramification in such children. However, future research with larger samples is imperative to consolidate or refute our observation.
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Affiliation(s)
- K. M. Shahunja
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Iqbal Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sumon Kumar Das
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Md. Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Jui Das
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Factors Associated with Klebsiella Bacteremia and Its Outcome in Under-Five Children Admitted with Diarrhea. Int J Pediatr 2016; 2016:4760610. [PMID: 27651802 PMCID: PMC5019881 DOI: 10.1155/2016/4760610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/01/2016] [Indexed: 12/29/2022] Open
Abstract
Although Klebsiella bacteremia in children is perceived to be associated with fatal consequences, data are scarce on those children presenting with diarrhea. We evaluated the factors associated with Klebsiella bacteremia in such children. In this retrospective chart analysis, data of all diarrheal children was retrieved from electronic medical record system (named as SHEBA) of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from January 1, 2010, to December 31, 2012, who had their blood culture done. This was a study having a case-control design where comparison of clinical and laboratory characteristics was done among children with Klebsiella bacteremia (cases = 30) and those without any bacteraemia (controls = 90). Controls were selected randomly. The cases more often had fatal outcome (p < 0.001). In logistic regression analysis, after adjusting for potential confounders such as young age, severe dehydration, severe wasting, abnormal mentation, hypotension, and fast breathing, the cases were independently associated with hospital-acquired infection and positive stool growth (for all, p < 0.05). The study highlights the importance of obtaining blood cultures in hospitalized children under five years old with diarrheal illness in the presence of either hospital-acquired infection or positive stool culture to have better outcome.
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Shahunja KM, Ahmed T, Faruque ASG, Shahid ASMSB, Das SK, Shahrin L, Hossain MI, Islam MM, Chisti MJ. Experience With Nosocomial Infection in Children Under 5 Treated in an Urban Diarrheal Treatment Center in Bangladesh. Glob Pediatr Health 2016; 3:2333794X16634267. [PMID: 27336005 PMCID: PMC4905154 DOI: 10.1177/2333794x16634267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 01/25/2015] [Accepted: 01/30/2015] [Indexed: 12/04/2022] Open
Abstract
We aimed to evaluate the factors associated with nosocomial infections (NIs) in under-5 children and in bacterial isolates from their blood, urine, and stool. We reviewed all under-5 hospitalized children with clinically diagnosed NIs in the inpatient ward at Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, between January and December 2012. Comparison was made among the children with (cases = 71) and without NI (controls = 142). NI was defined as the development of new infection 48 hours after admission. Bacterial isolates in urine, blood, and stool were found in 11/52 (21%), 9/69 (13%), and 2/16 (12%) respectively. In logistic regression analysis, the children with NI were independently associated with severe acute malnutrition, congenital anomaly, invasive diarrhea, urinary tract infection on admission, and use of intravenous cannula during hospitalization. Thus, identification of these simple clinical parameters may help in preventive measures being taken to reduce the rate of NIs in such children.
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Affiliation(s)
- K M Shahunja
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syeed Golam Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Sumon Kumar Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Yoshimatsu S, Sugaya T, Hossain MI, Islam MM, Chisti MJ, Kamoda T, Fukushima T, Wagatsuma Y, Sumazaki R, Ahmed T. Urinary L-FABP as a mortality predictor in <5-year-old children with sepsis in Bangladesh. Pediatr Int 2016. [PMID: 26214495 DOI: 10.1111/ped.12765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although sepsis is often associated with high mortality in severely malnourished children, data are very limited on appropriate diagnostic tools to predict mortality. We examined the role of urinary liver-type fatty acid-binding protein (L-FABP) in children <5 years old with sepsis who died. METHODS This prospective observational study was conducted at the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. Children aged 6-59 months admitted with sepsis from April 2010 to December 2011 were enrolled. Comparison of clinical and laboratory characteristics was made between children who survived (n = 83) and those who did not survive (n = 22). RESULTS On multiple Poisson regression analysis, after adjusting for potential confounders such as mid-upper arm circumference < 115 mm, plasma albumin < 2.5 g/dL, potassium > 5.0 mmol/L, and blood urea nitrogen > 20 mg/dL on admission, first urine L-FABP ≥ 370 ng/mL (relative risk [RR], 2.76; 95%CI: 1.22-6.25), weight-for-length/height z score < -3 (RR, 2.54; 95%CI: 1.26-5.09), capillary refilling time > 2.0 s (RR, 5.16; 95%CI: 1.46-18.3), and sodium > 160 mmol/L (RR, 2.72; 95%CI: 1.07-6.90) were identified as significant risk factors of mortality in children with sepsis. Diagnostic performance of first urine L-FABP was analyzed using receiver operating characteristic curve, and the area under the curve was 0.647 (95%CI: 0.500-0.795). CONCLUSION Urinary L-FABP may be a useful predictor of mortality in septic children. Urinary examination is non-invasive and easy to apply at the bedside.
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Affiliation(s)
- Shoji Yoshimatsu
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Tokyo, Japan
| | | | - Md Iqbal Hossain
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Munirul Islam
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tomohiro Kamoda
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Fukushima
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yukiko Wagatsuma
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryo Sumazaki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Chisti MJ, Salam MA, Bardhan PK, Faruque ASG, Shahid ASMSB, Shahunja KM, Das SK, Hossain MI, Ahmed T. Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia. PLoS One 2015; 10:e0140327. [PMID: 26451603 PMCID: PMC4599910 DOI: 10.1371/journal.pone.0140327] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 09/24/2015] [Indexed: 11/07/2022] Open
Abstract
Background Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM) children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO) recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children. Methods We prospectively enrolled SAM children aged 0–59 months, admitted to the Intensive Care Unit (ICU) or Acute Respiratory Infection (ARI) ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111) and without WHO defined danger signs of severe pneumonia (n = 296). The outcomes of interest were treatment failure (if a child required changing of antibiotics) and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths. Results SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; p<0.001) and fatal outcome (21% vs. 4%; p<0.001) compared to those without danger signs. Only 6/111 (5.4%) SAM children with danger signs of severe pneumonia and 12/296 (4.0%) without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (p<0.01). Conclusion and Significance The result suggests that SAM children with cough or respiratory difficulty and radiologic pneumonia who had WHO-defined danger signs of severe pneumonia more often had treatment failure and fatal outcome compared to those without the danger signs. In addition to danger signs of severe pneumonia, other common causes of both treatment failure and deaths were dehydration, hypocalcaemia, and bacteraemia on admission. The result underscores the importance for further research especially a randomized, controlled clinical trial to validate standard WHO therapy in SAM children with pneumonia especially with danger signs of severe pneumonia to reduce treatment failures and deaths.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Mohammed Abdus Salam
- Research & Clinical Administration and Strategy (RCAS), icddr,b, Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. G. Faruque
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S. M. S. B. Shahid
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K. M. Shahunja
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Chisti MJ, Salam MA, Bardhan PK, Faruque ASG, Shahid ASMSB, Shahunja KM, Das SK, Hossain MI, Ahmed T. Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study. PLoS One 2015; 10:e0139966. [PMID: 26440279 PMCID: PMC4595075 DOI: 10.1371/journal.pone.0139966] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/18/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM) children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children. METHODS In this retrospective case-control study SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50) with those without severe sepsis (controls = 354). Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline. RESULTS The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001). In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons). CONCLUSION AND SIGNIFICANCE We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Mohammed Abdus Salam
- Research & Clinical Administration and Strategy (RCAS), icddr,b, Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. G. Faruque
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S. M. S. B. Shahid
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K. M. Shahunja
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0136166. [PMID: 26372640 PMCID: PMC4570717 DOI: 10.1371/journal.pone.0136166] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/31/2015] [Indexed: 02/03/2023] Open
Abstract
Objective To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC). Design Systematic review and meta-analysis. Study Selection Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC. Data Sources Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015. Risk of Bias Assessment Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger’s test to evaluate publication bias. Results Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90% associated with significantly increased odds of death from ALRI (OR 5.47, 95% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92% associated with a similar increased risk of mortality (OR 3.66, 95% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude. Conclusions The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92% and 90% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI.
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Shahunja KM, Leung DT, Ahmed T, Bardhan PK, Ahmed D, Qadri F, Ryan ET, Chisti MJ. Factors Associated with Non-typhoidal Salmonella Bacteremia versus Typhoidal Salmonella Bacteremia in Patients Presenting for Care in an Urban Diarrheal Disease Hospital in Bangladesh. PLoS Negl Trop Dis 2015; 9:e0004066. [PMID: 26361076 PMCID: PMC4567379 DOI: 10.1371/journal.pntd.0004066] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 08/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Non-typhoidal Salmonella (NTS) and Salmonella enterica serovar Typhi bacteremia are the causes of significant morbidity and mortality worldwide. There is a paucity of data regarding NTS bacteremia in South Asia, a region with a high incidence of typhoidal bacteremia. We sought to determine clinical predictors and outcomes associated with NTS bacteremia compared with typhoidal bacteremia. METHODOLOGY We performed a retrospective age-matched case-control study of patients admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, between February 2009 and March 2013. We compared demographic, clinical, microbiological, and outcome variables of NTS bacteremic patients with age-matched S. Typhi bacteremic patients, and a separate comparison of patients with NTS bacteremia and patients with NTS gastroenteritis. PRINCIPAL FINDINGS Of 20 patients with NTS bacteremia, 5 died (25% case fatality), compared to none of 60 age-matched cases of S. Typhi bacteremia. In univariate analysis, we found that compared with S. Typhi bacteremia, cases of NTS bacteremia had more severe acute malnutrition (SAM) in children under five years of age, less often presented with a duration of fever ≥ 5 days, and were more likely to have co-morbidities on admission such as pneumonia and clinical signs of sepsis (p<0.05 in all cases). In multivariable logistic regression, SAM, clinical sepsis, and pneumonia were independent risk factors for NTS bacteremia compared with S. Typhi bacteremia (p<0.05 in all cases). Notably, we found marked differences in antibiotic susceptibilities, including NTS strains resistant to antibiotics commonly used for empiric therapy of patients suspected to have typhoid fever. CONCLUSIONS/SIGNIFICANCE Diarrheal patients with NTS bacteremia more often presented with co-morbidities and had a higher case fatality rate compared to those with typhoidal bacteremia. Clinicians in regions where both typhoid and NTS bacteremia are prevalent need to be vigilant about the possibility of both entities, especially given notable differences in antibiotic susceptibility patterns.
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Affiliation(s)
- K. M. Shahunja
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Daniel T. Leung
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Dilruba Ahmed
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Firdausi Qadri
- Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Edward T. Ryan
- Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mohammod Jobayer Chisti
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
- * E-mail:
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18
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Chisti MJ, Ahmed T, Shahid ASMSB, Shahunja KM, Bardhan PK, Faruque ASG, Das SK, Salam MA. Sociodemographic, Epidemiological, and Clinical Risk Factors for Childhood Pulmonary Tuberculosis in Severely Malnourished Children Presenting With Pneumonia: Observation in an Urban Hospital in Bangladesh. Glob Pediatr Health 2015; 2:2333794X15594183. [PMID: 27335971 PMCID: PMC4784598 DOI: 10.1177/2333794x15594183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We aimed to evaluate sociodemographic, epidemiological, and clinical risk factors for pulmonary tuberculosis (PTB) in children presenting with severe acute malnutrition (SAM) and pneumonia. Children aged 0 to 59 months with SAM and radiologic pneumonia from April 2011 to July 2012 were studied in Bangladesh. Children with confirmed PTB (by culture and/or X-pert MTB/RIF) (cases = 27) and without PTB (controls = 81; randomly selected from 378 children) were compared. The cases more often had the history of contact with active PTB patient (P < .01) and exposure to cigarette smoke (P = .04) compared with the controls. In logistic regression analysis, after adjusting for potential confounders, the cases were independently associated with working mother (P = .05) and positive tuberculin skin test (TST; P = .02). Thus, pneumonia in SAM children is a common presentation of PTB and further highlights the importance of the use of simple TST and/or history of contact with active TB patients in diagnosing PTB in such children, especially in resource-limited settings.
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Affiliation(s)
| | - Tahmeed Ahmed
- International Centre for Diarhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abu S M S B Shahid
- International Centre for Diarhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - K M Shahunja
- International Centre for Diarhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- International Centre for Diarhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Sumon Kumar Das
- International Centre for Diarhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammed Abdus Salam
- International Centre for Diarhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Leung DT, Das SK, Malek MA, Qadri F, Faruque ASG, Chisti MJ, Ryan ET. Concurrent Pneumonia in Children Under 5 Years of Age Presenting to a Diarrheal Hospital in Dhaka, Bangladesh. Am J Trop Med Hyg 2015; 93:831-5. [PMID: 26149863 DOI: 10.4269/ajtmh.15-0074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/12/2015] [Indexed: 11/07/2022] Open
Abstract
Respiratory and gastrointestinal infections are the top killers of children worldwide, and their co-occurrence is reported but not well understood. Our aim was to determine the risk factors for concurrent presentation of diarrhea and pneumonia (DP) in a resource-limited setting in Bangladesh. We used data from the Diarrheal Disease Surveillance System of the icddr,b Dhaka Hospital to identify children < 60 months of age with diarrhea and concurrent pneumonia, defined as a history of cough, an abnormal lung examination, and tachypnea. For the years 1996-2007, out of total 14,628 diarrheal patients surveyed, there were 607 (4%) patients who satisfied criteria for pneumonia. Those with DP had a higher mortality rate (4% versus 0.05%, odds ratio [OR] = 86, 95% confidence interval [CI] = 26-286) and a longer hospital stay (mean 84 versus 26 hours, difference 58 hours, 95% CI = 52-64 hours) than those with diarrhea (D) only. In multivariable logistic regression comparing cases (N = 607) with controls matched for month and year of admission at a ratio of 1:3 (N = 1,808), we found that DP was associated with younger age, male gender, severe acute malnutrition (SAM), less maternal education, lower family income, and lack of current breast-feeding history.
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Affiliation(s)
- Daniel T Leung
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Sumon K Das
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - M A Malek
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Firdausi Qadri
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - A S G Faruque
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Mohammod J Chisti
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
| | - Edward T Ryan
- Division of Infectious Diseases, Department of Medicine, and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah; Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; School of Public Health, The University of Queensland, Brisbane, Australia; Division of Infectious Disease, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts
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Jroundi I, Mahraoui C, Benmessaoud R, Moraleda C, Tligui H, Seffar M, Kettani SECE, Benjelloun BS, Chaacho S, Muñoz-Almagro C, Ruiz J, Alonso PL, Bassat Q. Risk factors for a poor outcome among children admitted with clinically severe pneumonia to a university hospital in Rabat, Morocco. Int J Infect Dis 2014; 28:164-70. [PMID: 25305555 PMCID: PMC7129557 DOI: 10.1016/j.ijid.2014.07.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/11/2014] [Accepted: 07/30/2014] [Indexed: 02/04/2023] Open
Abstract
Pneumonia remains one of the major killers of children in a middle-income country such as Morocco. A history of prematurity, a history of fever, leaving in a house with smokers, impaired consciousness, cyanosis, pallor, having ronchi on auscultation and human metapneumovirus infection are all independent risk factors for an adverse outcome. A history of asthma is independently associated with a positive outcome. Early identification of risk factors for an adverse outcome could improve overall prognosis.
Objectives Data on prognostic factors among children with severe pneumonia are scarce in middle-income countries. We investigated prognostic factors for an adverse outcome among children admitted to the Hôpital d’Enfants de Rabat, Morocco with World Health Organization-defined clinically severe pneumonia (CSP). Methods Children aged 2–59 months admitted to the hospital and fulfilling the CSP definition were recruited into this 13-month prospective study. A poor prognosis was defined as death, a need for intensive care, or a Respiratory Index of Severity in Children (RISC) score ≥3. Multivariate logistic regression was performed to ascertain independent predictive factors for a poor prognosis. Results Of the 689 children included in this analysis, 55 (8.0%) required intensive care and 28 died (4.0%). Five hundred and two (72.8%) children were classified as having a good prognosis and 187 (27.2%) as having a poor prognosis. A history of prematurity (odds ratio (OR) 2.50, 95% confidence interval (CI) 1.24–5.04), of fever (OR 2.25, 95% CI 1.32–3.83), living in a house with smokers (OR 1.79, 95% CI 1.18–2.72), impaired consciousness (OR 10.96, 95% CI 2.88–41.73), cyanosis (OR 2.09, 95% CI 1.05–4.15), pallor (OR 2.27, 95% CI 1.34–3.84), having rhonchi on auscultation (OR 2.45, 95% CI 1.58–3.79), and human metapneumovirus infection (OR 2.13, 95% CI 1.13–4.02) were all independent risk factors for an adverse outcome, whereas a history of asthma (OR 0.46, 95% CI 0.25–0.84) was the only independent risk factor for a positive outcome. Conclusions The early identification of factors associated with a poor prognosis could improve management strategies and the likelihood of survival of Moroccan children with severe pneumonia.
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Affiliation(s)
- Imane Jroundi
- Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain; Ecole Nationale de Santé Publique (ENSP), Ministère de la Santé, Rabat, Morocco
| | - Chafiq Mahraoui
- Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco; Faculté de Médecine et de Pharmacie de Rabat, Rabat, Morocco
| | - Rachid Benmessaoud
- Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain
| | - Cinta Moraleda
- Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain
| | - Houssain Tligui
- Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco; Faculté de Médecine et de Pharmacie de Rabat, Rabat, Morocco
| | - Myriam Seffar
- Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco
| | - Salma Ech-Cherif El Kettani
- Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco; Faculté de Médecine et de Pharmacie de Rabat, Rabat, Morocco
| | - Badr Sououd Benjelloun
- Hôpital d'Enfants de Rabat (HER), Centre Hospitalier Universitaire Ibn Sina, Rabat, Morocco; Faculté de Médecine et de Pharmacie de Rabat, Rabat, Morocco
| | - Saad Chaacho
- Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain; Centre Hôpitalier Universitaire (CHU) Ibn Sina, Rabat, Morocco
| | | | - Joaquim Ruiz
- Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain
| | - Pedro L Alonso
- Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain
| | - Quique Bassat
- Barcelona Centre for International Health Research, CRESIB, Hospital Clinic-Universitat de Barcelona, Carrer Rosselló 132, 5è 2ª E-08036 Barcelona, Spain.
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Sarmin M, Ahmed T, Bardhan PK, Chisti MJ. Specialist hospital study shows that septic shock and drowsiness predict mortality in children under five with diarrhoea. Acta Paediatr 2014; 103:e306-11. [PMID: 24661049 DOI: 10.1111/apa.12640] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/13/2014] [Accepted: 03/19/2014] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the clinical characteristics and outcome in children hospitalised with diarrhoea, comparing those developed septic shock with those who did not. METHODS We carried out a retrospective chart review on children aged 0-59 months admitted to the Dhaka Hospital, International Centre for Diarrhoeal Diseases Research, Bangladesh, with diarrhoea between October 2010 and September 2011. They were included if they had severe sepsis defined as tachycardia plus hyperthermia or hypothermia or an abnormal white blood cell count plus poor peripheral perfusion in absence of dehydration. Patients unresponsive to fluid and boluses, who required inotropes, were categorised as having septic shock (n = 88). The controls were those without septic shock (n = 116). RESULTS Death was significantly higher among the children with septic shock (67%) than the controls (14%) (p < 0.001). A logistic regression analysis, adjusted for potential confounders, found that children with septic shock were more likely to be drowsy on admission and received blood transfusions and mechanical ventilation (all p < 0.05). CONCLUSION Children hospitalised for diarrhoea with septic shock were more likely to die, be drowsy on admission and receive blood transfusions and mechanical ventilation. A randomised clinical trial on inotropes in children with diarrhoea, severe sepsis and drowsiness may expedite their use and prevent mechanical ventilation and deaths.
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Affiliation(s)
- Monira Sarmin
- Clinical Service (CS); International Centre for Diarrhoeal Disease Research; Bangladesh (icddr,b); Dhaka Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security; International Centre for Diarrhoeal Disease Research; Bangladesh (icddr,b); Dhaka Bangladesh
| | - Pradip K. Bardhan
- Clinical Service (CS); International Centre for Diarrhoeal Disease Research; Bangladesh (icddr,b); Dhaka Bangladesh
- Centre for Nutrition & Food Security; International Centre for Diarrhoeal Disease Research; Bangladesh (icddr,b); Dhaka Bangladesh
| | - Mohammod J. Chisti
- Clinical Service (CS); International Centre for Diarrhoeal Disease Research; Bangladesh (icddr,b); Dhaka Bangladesh
- Centre for Nutrition & Food Security; International Centre for Diarrhoeal Disease Research; Bangladesh (icddr,b); Dhaka Bangladesh
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Mothers' perception and healthcare seeking behavior of pneumonia children in rural bangladesh. ISRN FAMILY MEDICINE 2014; 2014:690315. [PMID: 24967328 PMCID: PMC4041267 DOI: 10.1155/2014/690315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/24/2013] [Indexed: 11/15/2022]
Abstract
We describe mothers' perception about signs and symptoms, causes of the illness, and healthcare seeking behaviors related to pneumonia and express the major modifiable barriers to seeking timely treatment when their under-5 children had pneumonia in rural Bangladesh. Using focus group discussion, we understood mothers' perception and healthcare seeking behavior of childhood pneumonia. Although mothers described pneumonia as a serious life threatening disease in young children but most of the mothers (n = 24) could not diagnose whether their child had pneumonia or not. Environmental factors such as dust particles, spread from coughing mother, and drinking cold water or playing with water were perceived as the causes for pneumonia. Three common barriers noted were as follows: illness was not perceived as serious enough or distance from healthcare facility or lack of money at household for seeking treatment outside. Most of the rural mothers did not have knowledge about severity of childhood pneumonia.
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Chisti MJ, Salam MA, Ashraf H, Faruque ASG, Bardhan PK, Hossain MI, Shahid ASMSB, Shahunja KM, Das SK, Imran G, Ahmed T. Clinical risk factors of death from pneumonia in children with severe acute malnutrition in an urban critical care ward of Bangladesh. PLoS One 2013; 8:e73728. [PMID: 24040043 PMCID: PMC3767805 DOI: 10.1371/journal.pone.0073728] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/22/2013] [Indexed: 01/08/2023] Open
Abstract
Background Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM. Methods For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105). Results The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38–122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42–37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12–16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21–24.99) for the management of crystalloid resistant systolic hypotension. Conclusion and Significance We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and prompt management of these simple clinically recognizable predictors of death and discourage the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce deaths in such population.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | | | - Hasan Ashraf
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. G. Faruque
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. M. S. B. Shahid
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K. M. Shahunja
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Gazi Imran
- Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Chisti MJ, Salam MA, Ashraf H, Faruque ASG, Bardhan PK, Das SK, Shahunja KM, Shahid ASMSB, Ahmed T. Clinical signs of radiologic pneumonia in under-five hypokalemic diarrheal children admitted to an urban hospital in bangladesh. PLoS One 2013; 8:e71911. [PMID: 23951267 PMCID: PMC3741193 DOI: 10.1371/journal.pone.0071911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 07/04/2013] [Indexed: 11/25/2022] Open
Abstract
Background Clinical signs of pneumonia are often veiled in under-five diarrheal children presenting with hypokalemia, making clinical diagnosis of pneumonia very difficult in such population. However, there is no published report that describes the influences of hypokalemia on the clinical signs of pneumonia in diarrheal children. Our objective was to assess the influences of hypokalemia, and their outcome in such children. Methods We prospectively enrolled all under-five diarrheal children (n = 180) admitted to the Special Care Ward of the Dhaka Hospital of icddr,b from September-December 2007 with radiological pneumonia who also had their serum potassium estimated. We compared the clinical features and outcome of the diarrheal children having pneumonia with (cases = 55) and without hypokalemia (controls = 125). Results The case-fatality among the cases was 2 times higher compared to the controls, but the difference was not statistically significant (p = 0.202). In logistic regression analysis, after adjusting for potential confounders such as age of the patient, clinical dehydration, severe wasting, abnormally sleepy, lower chest wall in-drawing, nasal flaring and inability to drink on admission, under-five diarrheal children with pneumonia who presented with nutritional edema had 3 times more risk to have hypokalemia compared to those without nutritional edema (OR = 2.76, 95% CI = 1.01–7.51) and these hypokalemic children were 64% less likely to present with fast breathing (OR = 0.36, 95% CI = 0.17–0.74). Conclusion and significance The results of our analysis are simple but may have great public health implications and underscore the importance of diligent assessment for pneumonia in under-five diarrheal children having risk of hypokalemia as in children with nutritional edema even in absence of fast breathing, a useful sign of pneumonia. This may help for early initiation of first dose of parental antibiotics along with potassium supplementation before referral to tertiary hospitals by health workers to combat probability of deaths in such population especially in resource limited settings.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
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Bhutta ZA, Das JK. Global burden of childhood diarrhea and pneumonia: what can and should be done? Pediatrics 2013; 131:634-6. [PMID: 23509166 DOI: 10.1542/peds.2012-3737] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Zulfiqar A Bhutta
- Division of Women & Child Health, The Aga Khan University, Karachi 74800, Pakistan.
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Das SK, Chisti MJ, Huq S, Malek MA, Salam MA, Ahmed T, Faruque ASG. Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/fns.2013.43031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chisti MJ, Ahmed T, Ashraf H, Faruque ASG, Bardhan PK, Dey SK, Huq S, Das SK, Salam MA. Clinical predictors and outcome of metabolic acidosis in under-five children admitted to an urban hospital in Bangladesh with diarrhea and pneumonia. PLoS One 2012; 7:e39164. [PMID: 22720060 PMCID: PMC3376101 DOI: 10.1371/journal.pone.0039164] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/17/2012] [Indexed: 12/01/2022] Open
Abstract
Background Clinical features of metabolic acidosis and pneumonia frequently overlap in young diarrheal children, resulting in differentiation from each other very difficult. However, there is no published data on the predictors of metabolic acidosis in diarrheal children also having pneumonia. Our objective was to evaluate clinical predictors of metabolic acidosis in under-five diarrheal children with radiological pneumonia, and their outcome. Methods We prospectively enrolled all under-five children (n = 164) admitted to the Special Care Ward (SCW) of the Dhaka Hospital of icddr, b between September and December 2007 with diarrhea and radiological pneumonia who also had their total serum carbon-dioxide estimated. We compared the clinical features and outcome of children with radiological pneumonia and diarrhea with (n = 98) and without metabolic acidosis (n = 66). Results Children with metabolic acidosis more often had higher case-fatality (16% vs. 5%, p = 0.039) compared to those without metabolic acidosis on admission. In logistic regression analysis, after adjusting for potential confounders such as age of the patient, fever on admission, and severe wasting, the independent predictors of metabolic acidosis in under-five diarrheal children having pneumonia were clinical dehydration (OR 3.57, 95% CI 1.62–7.89, p = 0.002), and low systolic blood pressure even after full rehydration (OR 1.02, 95% CI 1.01–1.04, p = 0.005). Proportions of children with cough, respiratory rate/minute, lower chest wall indrawing, nasal flaring, head nodding, grunting respiration, and cyanosis were comparable (p>0.05) among the groups. Conclusion and Significance Under-five diarrheal children with radiological pneumonia having metabolic acidosis had frequent fatal outcome than those without acidosis. Clinical dehydration and persistent systolic hypotension even after adequate rehydration were independent clinical predictors of metabolic acidosis among the children. However, metabolic acidosis in young diarrheal children had no impact on the diagnostic clinical features of radiological pneumonia which underscores the importance of early initiation of appropriate antibiotics to combat morbidity and deaths in such population.
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Affiliation(s)
- Mohammod J Chisti
- Clinical Services, International Centre for Diarhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
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Ashraf H, Alam NH, Chisti MJ, Salam MA, Ahmed T, Gyr N. Observational follow-up study following two cohorts of children with severe pneumonia after discharge from day care clinic/hospital in Dhaka, Bangladesh. BMJ Open 2012; 2:bmjopen-2012-000961. [PMID: 22842561 PMCID: PMC4400608 DOI: 10.1136/bmjopen-2012-000961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To compare the features of relapse, morbidity, mortality and re-hospitalisation following successful discharge after severe pneumonia in children between a day care group and a hospital group and to explore the predictors of failures during 3 months of follow-up. DESIGN An observational study following two cohorts of children with severe pneumonia for 3 months after discharge from hospital/clinic. SETTING Day care was provided at the Radda Clinic and hospital care at a hospital in Dhaka, Bangladesh. PARTICIPANTS Children aged 2-59 months with severe pneumonia attending the clinic/hospital who survived to discharge. INTERVENTION No intervention was done except providing some medications for minor illnesses, if indicated. PRIMARY OUTCOME MEASURES The primary outcome measures were the proportion of successes and failures of day care at follow-up visits as determined by estimating the OR with 95% CI in comparison to hospital care. RESULTS The authors enrolled 360 children with a mean (SD) age of 8 (7) months, 81% were infants and 61% were men. The follow-up compliance dropped from 95% at first to 85% at sixth visit. The common morbidities during the follow-up period included cough (28%), fever (17%), diarrhoea (9%) and rapid breathing (7%). During the follow-up period, significantly more day care children (n=22 (OR 12.2 (95% CI 8.2-17.8))) required re-hospitalisation after completion of initial day care compared with initial hospital care group (n=11 (OR 6.1 (95% CI 3.4-10.6))). The predictors for failure were associated with tachycardia, tachypnoea and hypoxaemia on admission and prolonged duration of stay. CONCLUSIONS There are considerable morbidities in children discharged following treatment of severe pneumonia like cough, fever, rapid breathing and diarrhoea during 3-month period. The findings indicate the importance of follow-up for early detection of medical problems and their management to reduce the risk of death. Establishment of an effective community follow-up would be ideal to address the problem of 'non-compliance with follow-up'. TRIAL REGISTRATION The original randomised control trial comparing day care with hospital care was registered at http://www.clinicaltrials.gov (identifier NCT00455468).
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Affiliation(s)
- Hasan Ashraf
- Centre for Nutrition and Food Security (CNFS), International Centre for
Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Nur H Alam
- Centre for Nutrition and Food Security (CNFS), International Centre for
Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mohammod Jobayer Chisti
- Centre for Nutrition and Food Security (CNFS), International Centre for
Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Mohammed Abdus Salam
- Centre for Nutrition and Food Security (CNFS), International Centre for
Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security (CNFS), International Centre for
Diarrhoeal Disease Research, Bangladesh (icddr,b)
| | - Niklaus Gyr
- Department of Internal Medicine, University of Basel, Basel,
Switzerland
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