Mortality in Children Aged <5 Years with Severe Acute Respiratory Illness in a High HIV-prevalence Urban and Rural Areas of South Africa, 2009-2013

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Aug 12

PMID 34383824

Citations 3

Authors

Oluwatosin A Ayeni

Sibongile Walaza

Stefano Tempia

Michelle Groome

Kathleen Kahn

Shabir A Madhi

Adam L Cohen

Jocelyn Moyes

Marietjie Venter

Marthi Pretorius

Florette Treurnicht

Orienka Hellferscee

Anne von Gottberg

Nicole Wolter

Cheryl Cohen

Affiliations

Soon will be listed here.

Abstract

Background: Severe acute respiratory illness (SARI) is an important cause of mortality in young children, especially in children living with HIV infection. Disparities in SARI death in children aged <5 years exist in urban and rural areas.

Objective: To compare the factors associated with in-hospital death among children aged <5 years hospitalized with SARI in an urban vs. a rural setting in South Africa from 2009-2013.

Methods: Data were collected from hospitalized children with SARI in one urban and two rural sentinel surveillance hospitals. Nasopharyngeal aspirates were tested for ten respiratory viruses and blood for pneumococcal DNA using polymerase chain reaction. We used multivariable logistic regression to identify patient and clinical characteristics associated with in-hospital death.

Results: From 2009 through 2013, 5,297 children aged <5 years with SARI-associated hospital admission were enrolled; 3,811 (72%) in the urban and 1,486 (28%) in the rural hospitals. In-hospital case-fatality proportion (CFP) was higher in the rural hospitals (6.9%) than the urban hospital (1.3%, p<0.001), and among HIV-infected than the HIV-uninfected children (9.6% vs. 1.6%, p<0.001). In the urban hospital, HIV infection (odds ratio (OR):11.4, 95% confidence interval (CI):5.4-24.1) and presence of any other underlying illness (OR: 3.0, 95% CI: 1.0-9.2) were the only factors independently associated with death. In the rural hospitals, HIV infection (OR: 4.1, 95% CI: 2.3-7.1) and age <1 year (OR: 3.7, 95% CI: 1.9-7.2) were independently associated with death, whereas duration of hospitalization ≥5 days (OR: 0.5, 95% CI: 0.3-0.8) and any respiratory virus detection (OR: 0.4, 95% CI: 0.3-0.8) were negatively associated with death.

Conclusion: We found that the case-fatality proportion was substantially higher among children admitted to rural hospitals and HIV infected children with SARI in South Africa. While efforts to prevent and treat HIV infections in children may reduce SARI deaths, further efforts to address health care inequality in rural populations are needed.

Citing Articles

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Pathogen Profile of Children Hospitalised with Severe Acute Respiratory Infections during COVID-19 Pandemic in the Free State Province, South Africa.

Ogunbayo A, Mogotsi M, Sondlane H, Nkwadipo K, Sabiu S, Nyaga M Int J Environ Res Public Health. 2022; 19(16).

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