Predicting sequelae and death after bacterial meningitis in childhood: A systematic review of prognostic studies

Background: Bacterial meningitis (BM) is a severe infection responsible for high mortality and disabling sequelae. Early identification of patients at high risk of these outcomes is necessary to prevent their occurrence by adequate treatment as much as possible. For this reason, several prognostic models have been developed. The objective of this study is to summarize the evidence regarding prognostic factors predicting death or sequelae due to BM in children 0-18 years of age. Methods: A search in MEDLINE and EMBASE was conducted to identify prognostic studies on risk factors for mortality and sequelae after BM in children. Selection of abstracts, full-text articles and assessment of methodological quality using the QUIPS checklist was performed by two reviewers independently. Data on prognostic factors per outcome were summarized. Results: Of the 31 studies identified, 15 were of moderate to high quality. Due to substantial heterogeneity in study characteristics and evaluated prognostic factors, no quantitative analysis was performed. Prognostic factors found to be statistically significant in more than one study of moderate or high quality are: complaints > 48 hours before admission, coma/impaired consciousness, (prolonged duration of) seizures, (prolonged) fever, shock, peripheral circulatory failure, respiratory distress, absence of petechiae, causative pathogen Streptococcus pneumoniae, young age, male gender, several cerebrospinal fluid (CSF) parameters and white blood cell (WBC) count. Conclusions: Although several important prognostic factors for the prediction of mortality or sequelae after BM were identified, the inability to perform a pooled analysis makes the exact (independent) predictive value of these factors uncertain. This emphasizes the need for additional well-conducted prognostic studie

Influence of Classroom Control Practices on The Development of Holistic Learners in Public Secondary Schools in Kenya

Effective curriculum implementation in schools should be geared towards nurturing and promoting development of holistic learners which is the desire of every education system worldwide. The same is able to instill practical skills, knowledge, desired values, beliefs and attitudes in learners who in turn become useful members in the society. There little or no information at all in regard to the influence of curriculum implementation dynamics on the development of holistic learners in public secondary schools in Kiambu County, Kenya. The purpose of the study was therefore to establish the influence of classroom control practices on the development of holistic learners in public secondary schools in Kiambu County, Kenya. The objectives of the study was to establish the influence of classroom control practices on the development of holistic learners in public secondary schools in Kiambu County, Kenya. The study was informed by the holistic development theory and instructional design theory. The study employed mixed methodology and concurrent triangulation design that enabled the researcher to triangulate the findings. The target population comprised 1200 respondents: 100 principals, 300 teachers and 800 form three students. Stratified, purposive and simple random sampling techniques were used to select the required sample size which was 360 respondents comprising 30 principals, 90 teachers and 240 students. Questionnaires were administered to teachers and students while interview guides were used for the principals. Piloting of research instruments was conducted in schools not included in the actual study during data collection. Reliability was tested by use of test-retest method where Cronbach`s Alpha coefficient determined the reliability coefficient value r=0.7 an indication of high internal reliability hence the instruments were suitable to collect data. Validity of the research instruments was determined by considering the judgment of experts and supervisors. To ensure dependability of the instruments, comparable data was collected via a follow up study carried out in the same context using same process on the same respondents. To guarantee the gathered data were credible, concurrent research design was used.nbsp Qualitative data was analyzed thematically while quantitative data was analyzed using descriptive and inferential statistics (Correlation Coefficient with the help of SPSS version 23). Quantitative results collected through questionnaires from teachers and students were presented in figures and frequency tables generated through Microsoft excel version 2010. Pearson product moments correlation coefficient (r) was used to test for strength of association at 95% confidence level. The findings revealed that there was a correlation between curriculum implementation dynamics and the development of holistic learners in secondary schools of Kiambu county Kenya. Assessment practices, classroom control practices and co-curricular activities were found to have negative correlation with the development of learner`s spirituality, cognitive, personality, self-efficacy, inter-personal values among other aspects of a holistic learner. However, there was a strong and positive correlation between teaching methods, remedial teaching and engagement in co-curricular activities and the development of holistic learners in Kiambu County. The study concluded that in public secondary schools in Kiambu County, curriculum implementation dynamics employed are correlated with the development of holistic learners. The study therefore recommended that teachers` in-service training programmes must be adjusted to reinforce classroom control practices that contribute positively to the development of holistic learners and eliminate school related practices that affect the development of holistic learners negatively

Defining episodes of diarrhoea: results from a three-country study in sub-Saharan Africa

The study was conducted to assess the effect of definition of episode on diarrhoeal morbidity and to develop a means of adjusting estimates of morbidity for the definition of episode used. This paper reports on a cohort study of 374 children, aged 9-32 months, in three African countries, which recorded frequency and consistency of stool over a seven-month period. Different definitions of episode were applied to these data to assess their effect on annualized diarrhoeal morbidity. Adjustment factors were then derived that corrected morbidity for non-standard definitions of episode. Applying non-standard definitions of episode gave estimates of an annualized number of episodes between 38% and 137% of the internationally-accepted definition. Researchers should be encouraged to use the standard definition of episode of diarrhoea and to use appropriate field protocols. Where this is not possible, correction factors should be applied, particularly where estimates of diarrhoeal morbidity are pooled in systematic reviews

Respiratory syncytial virus epidemiology in Turkey

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections in infants and young children worldwide. This study was conducted to determine the prevalence of RSV among high-risk children admitted with respiratory symptoms in a developing country. This is a multicenter study conducted among children less than 24 months of age and admitted to the hospital with respiratory symptoms. The inclusion criteria included: lower respiratory tract symptoms on admission, gestational age less than 35 weeks, and admission age less than six months, or children less than 24 months of age with a diagnosis of bronchopulmonary dysplasia requiring medical treatment or intervention during the last six months or with an uncorrected congenital heart disease (other than patent ductus arteriosus). Nasopharyngeal samples were obtained with one of the three standard methods: nasopharyngeal aspirate, nasopharyngeal wash or nasopharyngeal swab. RSV antigen was determined by enzyme immunoassay using Abbott TESTPACK RSV (No. 8100/2027-16). Statistical analysis was performed using Student's t-test and chi-square test. In this study, 332 children (135 females, 40.7%; 197 males, 59.3%) were included, and the nasopharyngeal specimens of 98 (29.5%) children were determined to be RSV-positive. There were no differences in sex, age of gestation, age of admission, family education, number of siblings and smoking at home for RSV-positive and -negative cases. Furthermore, underlying disease and duration of hospital and intensive care unit stay were similar among groups. Only otitis media was more common among RSV-positive cases. No fatality at hospital was recorded. Frozen samples revealed more negative results. Most cases presented during winter and the number of RSV-positive cases was higher in cold and economically poor areas. Premature children and children with underlying medical con dition acquire RSV irrespective of other sociodemographic risk factors, and most of them are hospitalized. Thus, an RSV vaccine seems the most effective mode of protection to decrease morbidity and mortality