Journal Article > ResearchFull Text
Front Epidemiol. 2024 March 21; Volume 4; 1309149.; DOI:10.3389/fepid.2024.1309149
Gutierrez R, Landa M, Sambou M, Bassane H, Dia N, et al.
Front Epidemiol. 2024 March 21; Volume 4; 1309149.; DOI:10.3389/fepid.2024.1309149
BACKGROUND
With growing use of parasitological tests to detect malaria and decreasing incidence of the disease in Africa; it becomes necessary to increase the understanding of causes of non-malaria acute febrile illness (NMAFI) towards providing appropriate case management. This research investigates causes of NMAFI in pediatric out-patients in rural Guinea-Bissau.
METHODS
Children 0–5 years presenting acute fever (≥38°) or history of fever, negative malaria rapid diagnostic test (mRDT) and no signs of specific disease were recruited at the out-patient clinic of 3 health facilities in Bafatá province during 54 consecutive weeks (dry and rainy season). Medical history was recorded and blood, nasopharyngeal, stool and urine samples were collected and tested for the presence of 38 different potential aetiological causes of fever.
RESULTS
Samples from 741 children were analysed, the protocol was successful in determining a probable aetiological cause of acute fever in 544 (73.61%) cases. Respiratory viruses were the most frequently identified pathogens, present in the nasopharynx samples of 435 (58.86%) cases, followed by bacteria detected in 167 (22.60%) samples. Despite presenting negative mRDTs, P. falciparum was identified in samples of 24 (3.25%) patients.
CONCLUSIONS
This research provides a description of the aetiological causes of NMAFI in West African context. Evidence of viral infections were more commonly found than bacteria or parasites.
With growing use of parasitological tests to detect malaria and decreasing incidence of the disease in Africa; it becomes necessary to increase the understanding of causes of non-malaria acute febrile illness (NMAFI) towards providing appropriate case management. This research investigates causes of NMAFI in pediatric out-patients in rural Guinea-Bissau.
METHODS
Children 0–5 years presenting acute fever (≥38°) or history of fever, negative malaria rapid diagnostic test (mRDT) and no signs of specific disease were recruited at the out-patient clinic of 3 health facilities in Bafatá province during 54 consecutive weeks (dry and rainy season). Medical history was recorded and blood, nasopharyngeal, stool and urine samples were collected and tested for the presence of 38 different potential aetiological causes of fever.
RESULTS
Samples from 741 children were analysed, the protocol was successful in determining a probable aetiological cause of acute fever in 544 (73.61%) cases. Respiratory viruses were the most frequently identified pathogens, present in the nasopharynx samples of 435 (58.86%) cases, followed by bacteria detected in 167 (22.60%) samples. Despite presenting negative mRDTs, P. falciparum was identified in samples of 24 (3.25%) patients.
CONCLUSIONS
This research provides a description of the aetiological causes of NMAFI in West African context. Evidence of viral infections were more commonly found than bacteria or parasites.
Journal Article > ResearchFull Text
AIDS Res Hum Retroviruses. 2023 April 11; Volume 10 (Issue 1); 1-6.; DOI:10.24966/CMPH-1978/1000125
Temessadouno FW, Hiffler L, Gallo J, Gignoux EM, Domenichini C, et al.
AIDS Res Hum Retroviruses. 2023 April 11; Volume 10 (Issue 1); 1-6.; DOI:10.24966/CMPH-1978/1000125
CONTEXT
The Paediatric Early Warning System (PEWS) is a clinical monitoring tool used routinely in emergency and observation rooms to detect rapid deterioration in paediatric patients, allowing timely action. MSF has been using an adapted version of PEWS in all paediatric projects since 2013 and started using it in the Simao Mendes National Hospital (HNSM) in 2017. The PEWS has not been previously considered as a predictive tool for mortality risk. In this study, we evaluate whether the PEWS could be validated as a paediatric mortality risk score in our Paediatric Intensive Care Unit (PICU) setting.
METHODS
This is an observational study with prospective data collection among children admitted to the HNSM PICU, assessing an adapted version of PEWS on admission, 24 hours after admission, and notification of the outcome of the hospitalization. Data analysis, using State 15.0, was conducted in three stages: description of participants, univariate analysis, and multivariate analysis.
RESULTS
The main analysis showed that the greater the PEWS score, the higher the risk of death. However, only a PEWS score >7 was significantly associated with an increased risk of death, OR =5.9; 95% CI: 2.3 - 12.9, p < 0.001. In addition, having an underlying pathology increased the risk of death, OR=4.2; 95% CI: 1.3 - 13.2, p=0.015. Age was not significantly associated with increased risk of death, which may be due to the small sample size of patients less than one year old. A PEWS score greater than five, 24 hours after admission, indicated a significantly higher risk of death, OR=6.2; 95% CI: 2.8 - 13.6, p < 0.001.
CONCLUSION
Our evaluation of PEWS among children on admission to the PICU found that it could be a simple and useful predictive tool of mortality risk in low resource settings. It may allow better organization of the human resources, and improve the analysis of the mortality ratio, in a PICU. However, adequate follow-up and management of those classified as orange, yellow, or even green by the PEWS should be maintained as the PEWS would fail to identify a significant proportion of patients at risk of death.
The Paediatric Early Warning System (PEWS) is a clinical monitoring tool used routinely in emergency and observation rooms to detect rapid deterioration in paediatric patients, allowing timely action. MSF has been using an adapted version of PEWS in all paediatric projects since 2013 and started using it in the Simao Mendes National Hospital (HNSM) in 2017. The PEWS has not been previously considered as a predictive tool for mortality risk. In this study, we evaluate whether the PEWS could be validated as a paediatric mortality risk score in our Paediatric Intensive Care Unit (PICU) setting.
METHODS
This is an observational study with prospective data collection among children admitted to the HNSM PICU, assessing an adapted version of PEWS on admission, 24 hours after admission, and notification of the outcome of the hospitalization. Data analysis, using State 15.0, was conducted in three stages: description of participants, univariate analysis, and multivariate analysis.
RESULTS
The main analysis showed that the greater the PEWS score, the higher the risk of death. However, only a PEWS score >7 was significantly associated with an increased risk of death, OR =5.9; 95% CI: 2.3 - 12.9, p < 0.001. In addition, having an underlying pathology increased the risk of death, OR=4.2; 95% CI: 1.3 - 13.2, p=0.015. Age was not significantly associated with increased risk of death, which may be due to the small sample size of patients less than one year old. A PEWS score greater than five, 24 hours after admission, indicated a significantly higher risk of death, OR=6.2; 95% CI: 2.8 - 13.6, p < 0.001.
CONCLUSION
Our evaluation of PEWS among children on admission to the PICU found that it could be a simple and useful predictive tool of mortality risk in low resource settings. It may allow better organization of the human resources, and improve the analysis of the mortality ratio, in a PICU. However, adequate follow-up and management of those classified as orange, yellow, or even green by the PEWS should be maintained as the PEWS would fail to identify a significant proportion of patients at risk of death.