Outcome Risk Factors during Respiratory Infections in a Paediatric Ward in Antananarivo, Madagascar 2010–2012

<div><p>Background</p><p>Acute respiratory infections are a leading cause of infectious disease-related morbidity, hospitalisation and mortality among children worldwide, and particularly in developing countries. In these low-income countries, most patients with acute respiratory infection (ARI), whether it is mild or severe, are still treated empirically.</p><p>The aim of the study was to evaluate the risk factors associated with the evolution and outcome of respiratory illnesses in patients aged under 5 years old.</p><p>Materials and Methods</p><p>We conducted a prospective study in a paediatric ward in Antananarivo from November 2010 to July 2012 including patients under 5 years old suffering from respiratory infections. We collected demographic, socio-economic, clinical and epidemiological data, and samples for laboratory analysis. Deaths, rapid progression to respiratory distress during hospitalisation, and hospitalisation for more than 10 days were considered as severe outcomes. We used multivariate analysis to study the effects of co-infections.</p><p>Results</p><p>From November 2010 to July 2012, a total of 290 patients were enrolled. Co-infection was found in 192 patients (70%). Co-infections were more frequent in children under 36 months, with a significant difference for the 19–24 month-old group (OR: 8.0).</p><p>Sixty-nine percent (230/290) of the patients recovered fully and without any severe outcome during hospitalisation; the outcome was scored as severe for 60 children and nine patients (3%) died.</p><p>Risk factors significantly associated with worsening evolution during hospitalisation (severe outcome) were admission at age under 6 months (OR = 5.3), comorbidity (OR = 4.6) and low household income (OR = 4.1).</p><p>Conclusion</p><p>Co-mordidity, low-income and age under 6 months increase the risk of severe outcome for children infected by numerous respiratory pathogens. These results highlight the need for implementation of targeted public health policy to reduce the contribution of respiratory diseases to childhood morbidity and mortality in low income countries.</p></div

Aetiological agents and co-infections among patients under 5 years old hospitalised for SARI, November 2010 to July 2012 in Antananarivo, Madagascar.

<p><i>RSV : Respiratory Syncitial Virus; IA : Influenza A; RhV : Rhinovirus; hMPV : human metapneumovirus;Co : coronavirus_co43/NL63/229E; BoV : Bocavirus; PiV : parainfluenza virus 1/2/3; Spn : Streptococcus pneumoniae; Hib : Haemophilus influenzae</i> de type b; <i>Sta : Staphylococcus aureus; Brc : Branhamella catharralis; S : Streptococcus mitis/sanguinis/G/D/equinis/Beta haemolitic; Aero.h : Aero hydromonas; Aeroc spp : Aerococcus spp; Pseu aer : Pseudomonas aeruginosa; List sp : Listeria sp; Ent.spp : Enterobacter spp; Kleb pn : Klebsiella pneumoniae; Ser Mar : Serritia marcescens; Mora sp : Moraxela species; Esch. c : Escherichia coli.</i></p

Patient characteristics and aetiologies according to outcome among patients under 5 years old hospitalized for SARI, November 2010 to July 2012, in Antananarivo, Madagascar.

*<p>Univarite analysis;</p>#<p>Multivariate analysis (variables with p<0.20 on univariate analysis).</p><p>–: reference variable.</p>**<p>Comorbitidy: congenital diseases, malnutrition, prematurity.</p>***<p>Atopic: including atopic food, drug, acaria pollen or asthma comorbidity.</p

Patient characteristics and main aetiologies according for mono- and co- infections among patients under 5 years old hospitalised for SARI between November 2010 and July 2012 in Antananarivo, Madagascar.

<p>P value: Fisher's exact test (univariate analysis), OR adjusted: multivariate analysis (variables with p<0.20 on univariate analysis).</p><p>–: reference variable.</p>*<p>♦Comorbitidy: congenital diseases, malnutrition, prematurity,</p>**<p>Atopic: including atopic food, drug, acaria pollen or asthma comorbidity.</p

Case-Control Study of the Etiology of Infant Diarrheal Disease in 14 Districts in Madagascar

<div><h3>Background</h3><p>Acute diarrhea is a major cause of childhood morbidity and mortality worldwide. Its microbiological causes and clinico-epidemiological aspects were examined during the rainy seasons from 2008 to 2009 in 14 districts in Madagascar.</p> <h3>Methods</h3><p>Stool specimens of 2196 children with acute diarrhea and 496 healthy children were collected in a community setting. Intestinal parasites were diagnosed by microscopy and bacteria by culturing methods. Rota-, astro and adenoviruses were identified using commercially available ELISA kits and rotaviruses were confirmed using reverse transcriptase polymerase chain reaction (RT-PCR).</p> <h3>Results</h3><p>Intestinal microorganisms were isolated from 54.6% of diarrheal patients and 45.9% of healthy subjects (p = <0.01). The most common pathogens in diarrheic patients were intestinal parasites (36.5%). Campylobacter spp. and Rotavirus were detected in 9.7% and 6.7% of diarrheic patients. The detection rates of <em>Entamoeba histolytica</em>, <em>Trichomonas intestinalis</em> and <em>Giardia lamblia</em> were much greater in diarrheal patients than in non diarrheal subjects (odds ratios of 5.1, 3.2, 1.7 respectively). The abundance of other enteropathogens among the non diarrheal group may indicate prolonged excretion or limited pathogenicity.</p> <h3>Conclusion</h3><p>In developing countries, where the lack of laboratory capacities is great, cross sectional studies of enteropathogens and their spatial distribution, including diarrheal and non diarrheal subjects, are interesting tools in order to advise regional policies on treatment and diarrheic patient management.</p> </div

Enteric pathogens isolated from diarrheal and non diarrheal stools.

*<p>Random effect mutivariate analysis controled for study sites.</p

Location of study sites in Madagascar.

<p>Location of study sites in Madagascar.</p

Clinical symptoms associated with the enteric pathogens isolated from diarrheic children in Madagascar 2008–2009.

<p>Clinical symptoms associated with the enteric pathogens isolated from diarrheic children in Madagascar 2008–2009.</p