A research report submitted to the Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, in partial
fulfillment of the requirements for the degree of Master of Science
in Epidemiology (Epidemiology and Biostatistics).
2016 / Background
Reducing severe acute respiratory illness (SARI)-associated mortality in African children
remains a public health priority and an immense challenge. The pneumococcal
conjugate vaccine (PCV) was introduced into the South African routine immunization
programme in 2009. The objectives of this study were:
I. To describe the demographic characteristics, clinical presentation, respiratory
pathogens of children aged <5 years hospitalized with SARI in an urban (Chris
Hani-Baragwanath Hospital, Soweto) and a rural (Matikwana and Mapuleng
Hospitals, Mpumalanga) setting in South Africa from 2009-2013 and
II. To compare the factors associated with mortality among children aged <5 years
hospitalized with SARI in these two sites separately.
Methods
Hospitalized children with SARI were enrolled into an active, prospective sentinel
surveillance program. Clinical and epidemiologic data were collected until discharge.
Nasopharyngeal aspirates were tested for influenza (A and B) and eight other
respiratory viruses. In-hospital case-fatality proportion (CFP) and risk factors for
mortality were determined for each hospital site separately using unconditional logistic
regression.
Results
The in-hospital CFP was significantly higher in the rural (6.9%, 103/1486) than the
urban (1.3%, 51/3811) site (p<0.001). This was observed among both HIV-infected
(urban: 6.6%, 17/257) vs. (rural: 12.9%, 30/233) (p=0.019) and HIV-uninfected children
(urban: 0.6%, 13/2236) vs. (rural: 4.2% 36/857) (p<0.001). In the urban site the only
factor that is independently associated with death on multivariate analysis was HIV
infection (odds ratio (OR) 12.1, 95% confidence interval (CI) 5.8-25.2). In the rural site
HIV infection (OR 3.5, 95% CI 1.7-6.9), age <1 year (OR 3.5, 95% CI 2.0-6.1) vs. 1-4
years, any respiratory virus detected (OR 0.4, 95% CI 0.2-0.6), pneumococcal infection(OR 4.5, 95% CI 1.8-10.8) and malnutrition (OR 12.8, 95%CI 1.2-134.6) were
independently associated with mortality.
Conclusion
SARI mortality was higher in the rural setting. Even in the era of PCV availability
pneumococcus is still associated with mortality in rural areas. Efforts to prevent and
treat HIV infections in children and reduce malnutrition may reduce SARI deaths. / MT2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/23238 |
| Date | January 2017 |
| Creators | Adetayo, Ayeni Oluwatosin |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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