Biomarkers of Host Response Predict Primary End-Point Radiological Pneumonia in Tanzanian Children with Clinical Pneumonia: A Prospective Cohort Study.

BACKGROUND: Diagnosing pediatric pneumonia is challenging in low-resource settings. The World Health Organization (WHO) has defined primary end-point radiological pneumonia for use in epidemiological and vaccine studies. However, radiography requires expertise and is often inaccessible. We hypothesized that plasma biomarkers of inflammation and endothelial activation may be useful surrogates for end-point pneumonia, and may provide insight into its biological significance. METHODS: We studied children with WHO-defined clinical pneumonia (n = 155) within a prospective cohort of 1,005 consecutive febrile children presenting to Tanzanian outpatient clinics. Based on x-ray findings, participants were categorized as primary end-point pneumonia (n = 30), other infiltrates (n = 31), or normal chest x-ray (n = 94). Plasma levels of 7 host response biomarkers at presentation were measured by ELISA. Associations between biomarker levels and radiological findings were assessed by Kruskal-Wallis test and multivariable logistic regression. Biomarker ability to predict radiological findings was evaluated using receiver operating characteristic curve analysis and Classification and Regression Tree analysis. RESULTS: Compared to children with normal x-ray, children with end-point pneumonia had significantly higher C-reactive protein, procalcitonin and Chitinase 3-like-1, while those with other infiltrates had elevated procalcitonin and von Willebrand Factor and decreased soluble Tie-2 and endoglin. Clinical variables were not predictive of radiological findings. Classification and Regression Tree analysis generated multi-marker models with improved performance over single markers for discriminating between groups. A model based on C-reactive protein and Chitinase 3-like-1 discriminated between end-point pneumonia and non-end-point pneumonia with 93.3% sensitivity (95% confidence interval 76.5-98.8), 80.8% specificity (72.6-87.1), positive likelihood ratio 4.9 (3.4-7.1), negative likelihood ratio 0.083 (0.022-0.32), and misclassification rate 0.20 (standard error 0.038). CONCLUSIONS: In Tanzanian children with WHO-defined clinical pneumonia, combinations of host biomarkers distinguished between end-point pneumonia, other infiltrates, and normal chest x-ray, whereas clinical variables did not. These findings generate pathophysiological hypotheses and may have potential research and clinical utility

Adaptation and validation of a self‐report measure of youth‐friendly primary healthcare services

AIM : To adapt the Youth‐Friendly Health Services‐World Health Organization+ questionnaire to suit the health needs of youth in the South African context, and estimate its psychometric properties. BACKGROUND : Youth‐friendly health services promote health‐seeking behaviour amongst young people. The perceptions of youth and adolescents are thus important whilst assessing the youth‐friendliness of health services. METHODS : We conducted six focus group interviews to evaluate the clarity and relevance of the questionnaire items and adapted the questionnaire which was was administered to 101 youth who visited primary healthcare clinics. We reduced the number of items through quantitative analysis of responses and item analysis. Cronbach's alpha was used to optimize internal consistency reliability. Experts established a baseline of youth‐friendliness. We ranked the responses from the youth against the baseline of youth‐friendliness and used independent two sample t‐test to test for construct validity of the final adapted version, titled Youth‐Friendly Health Services‐ South Africa. RESULTS OR FINDINGS : After the focus group interviews, we rephrased 27 items, removed four items and added eight items. We reduced the questionnaire to 57 items whilst optimizing internal consistency reliability. The statistical analysis supported construct validity. CONCLUSION : The Youth‐Friendly Health Services‐South Africa is the first English validated version and demonstrates good psychometric properties. IMPLICATION FOR NURSING PRACTICE AND HEALTH POLICY : The Youth‐Friendly Health Services‐South Africa can be useful to evaluate the youths' satisfaction with the health care and nursing service they receive. This study's findings indicate that the original questionnaire can be adapted for use in different contexts to shape local and global nursing practice and policies.A UNEDSA grant for Masters and PhD students in the Community‐Orientated Nursing Education Project for Women and Child Health (no. 0948), overseen by the University of Pretoria.https://onlinelibrary.wiley.com/journal/146676572020-06-01hj2019Nursing ScienceStatistic