Predictors associated with critical care need and in-hospital mortality among children with laboratory-confirmed COVID-19 infection in a high HIV infection burden region

IntroductionDespite the extra mortality associated with COVID-19 death globally, there is scant data on COVID-19-related paediatric mortality in Sub-Saharan Africa. We assessed predictors of critical care needs and hospital mortality in South African children with laboratory-confirmed SARS-CoV-2 infection in region with high HIV infection burden.MethodsWe conducted a secondary multicentre analysis of the AFREhealth cohort (a multinational, multicentre cohort of paediatric COVID-19 clinical outcomes across six African countries) of children admitted to the Inkosi Albert Luthuli, a quaternary hospital in KwaZulu-Natal, South Africa, with confirmed RT-PCR between March 2020 and December 2020. We constructed multivariable logistic regression to explore factors associated with the need for critical care (high care/ intensive care hospitalisation or oxygen requirement) and cox-proportional hazards models to further assess factors independently associated with in-hospital death.ResultsOf the 82 children with PCR-confirmed SARS-CoV-2 infection (mean ± SD age: 4.2 ± 4.4 years), 35(42.7%) were younger than one year, 52(63%) were female and 59(71%) had a pre-existing medical condition. Thirty-seven (45.2%) children required critical care (median (IQR) duration: 7.5 (0.5–13.5) days) and 14(17%) died. Independent factors associated with need for critical care were being younger than 1 year (aPR: 3.02, 95%CI: 1.05–8.66; p = 0.04), having more than one comorbidity (aPR: 2.47, 95%CI: 1.32–4.61; p = 0.004), seizure (aPR: 2.39, 95%CI: 1.56–3.68; p < 0.001) and impaired renal function. Additionally, independent predictors of in-hospital mortality were exposure to HIV infection (aHR: 6.8, 95%CI:1.54–31.71; p = 0.01), requiring invasive ventilation (aHR: 3.59, 95%CI: 1.01–12.16, p = 0.048) and increase blood urea nitrogen (aHR: 1.06, 95%CI: 1.01–1.11; p = 0.017). However, children were less likely to die from COVID-19 if they were primarily admitted to quaternary unit (aHR: 0.23, 95%CI: 0.1–0.86, p = 0.029).ConclusionWe found a relatively high hospital death rate among children with confirmed COVID-19. During COVID-19 waves, a timely referral system and rapid identification of children at risk for critical care needs and death, such as those less than one year and those with comorbidities, could minimize excess mortality, particularly in high HIV-infection burden countries

Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries

Importance: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. / Objective: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. / Design, Setting, and Participants: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. / Exposures: Age, sex, preexisting comorbidities, and region of residence. / Main Outcomes and Measures: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. / Results: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. / Conclusions and Relevance: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region

The Critical Need for Pooled Data on Coronavirus Disease 2019 in African Children: An AFREhealth Call for Action Through Multicountry Research Collaboration

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries

The critical need for pooled data on coronavirus disease 2019 in African children : an AFREhealth call for action through multicountry research collaboration

Globally, there are prevailing knowledge gaps in the epidemiology, clinical manifestations, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among children and adolescents; and these gaps are especially wide in African countries. The availability of robust age-disaggregated data is a critical first step in improving knowledge on disease burden and manifestations of coronavirus disease 2019 (COVID-19) among children. Furthermore, it is essential to improve understanding of SARS-CoV-2 interactions with comorbidities and coinfections such as human immunodeficiency virus (HIV), tuberculosis, malaria, sickle cell disease, and malnutrition, which are highly prevalent among children in sub-Saharan Africa. The African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents is conducting studies across Western, Central, Eastern, and Southern Africa to address existing knowledge gaps. This consortium is expected to generate key evidence to inform clinical practice and public health policy-making for COVID-19 while concurrently addressing other major diseases affecting children in African countries.The US National Institutes of Health (NIH)/ Fogarty International Centre (FIC) to the African Forum for Research and Education in Health (AFREhealth).https://academic.oup.com/cidam2022Paediatrics and Child Healt

Assessing the effect of insecticide-treated cattle on tsetse abundance and trypanosome transmission at the wildlife-livestock interface in Serengeti, Tanzania

In the absence of national control programmes against Rhodesian human African trypanosomiasis, farmer-led treatment of cattle with pyrethroid-based insecticides may be an effective strategy for foci at the edges of wildlife areas, but there is limited evidence to support this. We combined data on insecticide use by farmers, tsetse abundance and trypanosome prevalence, with mathematical models, to quantify the likely impact of insecticide-treated cattle. Sixteen percent of farmers reported treating cattle with a pyrethroid, and chemical analysis indicated 18% of individual cattle had been treated, in the previous week. Treatment of cattle was estimated to increase daily mortality of tsetse by 5–14%. Trypanosome prevalence in tsetse, predominantly from wildlife areas, was 1.25% for T. brucei s.l. and 0.03% for T. b. rhodesiense. For 750 cattle sampled from 48 herds, 2.3% were PCR positive for T. brucei s.l. and none for T. b. rhodesiense. Using mathematical models, we estimated there was 8–29% increase in mortality of tsetse in farming areas and this increase can explain the relatively low prevalence of T. brucei s.l. in cattle. Farmer-led treatment of cattle with pyrethroids is likely, in part, to be limiting the spill-over of human-infective trypanosomes from wildlife areas

Conservation leadership programme: Project Reporting

Conservation Leadership Programme: Project Reporting FINAL REPORTOur study focused on endangered bird species, Sokoke pipit, which has a very small range, and its habitat is declining owing to clearance for cultivation, intensive charcoal production and logging. Our aim was to generate information relevant for conservation of Sokoke pipit in Zaraninge forest. We collected data for density estimation using distance sampling techniques, alongside recording habitat data. We also collected data regarding familiarity of species among surrounding local communities, which was followed by awareness-rising on missing knowledge. Result showed that S. pipit preferred least disturbed habitats with tall trees that are less influenced by human activities. Analysis using DISTANCE program revealed that the pipit population is very low in Zaraninge forest (1.6 individuals/km2). Furthermore, in this forest, the species is only restricted in the forest core habitats. Although some members of the local community claimed to know the species, results showed that there were confusion of our species with other birds especially House sparrow and other species of pipit. We concluded that S. pipit in Zaraninge forest avoided areas that experienced frequent human interference including places next to pineapple and maize fields. Overall, the findings appeared to suggest that local communities in the study area had little knowledge about the study species

Storage time effect on blood diet for tsetse mass production in sterile insect technique

Background & objectives: Different methods have been developed for tsetse and trypanosomiasis control oreradication but all these have their specific advantages and limitations. However, a combination of methodscould be used as part of an Area-wide Integrated Pest Management (AWPM). The sterile insect technique(SIT) as a technique of choice for eradication of tsetse flies requires mass production of flies in the laboratories.Since tsetses are exclusively haemotophogous insects, a quality blood diet is needed for maintenance of flieswith optimum production. The aim of this study was to establish the optimum storage time of blood diet fortsetse colonies.Methods: A total of 450 flies Glossina austeni were fed on different batches of blood (collected in 2004, 2005,2006, 2007 and 2008) three times a week. Pupae were collected daily and mortality checks were done onweekly basis. The quality of the blood diet was measured by observation of tsetse production parametersincluding survival, pupae production and size.Results: The survival of flies fed on 2004 and 2006 batches had lower survival compared to the rest of thebatches. Also the 2005 batch had a significant higher number of pupae compared to the production in othertreatments. The 2004 and 2005 batches had more of small pupae (class A & B) compared to the other batches.Interpretation & conclusion: There was a significant difference between the blood batches and the productionparameters were better in the last three years, i.e. 2008, 2007 and 2006. Therefore, this study recommendsthree years to be an optimum storage time for blood diet under regional conditions. Also the storage temperatureconditions should remain stable at –20ºC

A tsetse Glossina pallidipes harbors the pathogenic trypanosomes circulating in Liwale district, Tanzania

Veterinary Parasitology: Regional studies and reports 9 (2017) 93-97African Animal Trypanosomiasis (AAT) is among several constraints hindering development of the livestock sector in Tanzania. A survey was conducted in Liwale district located in southern Tanzania in 2013 to determine the population density of Glossina species, distribution pattern and Trypanosome species infection rate in tsetse flies. A total of 200 flies were collected from the study area and three Glossina species were identified. The proportional abundance of all trapped flies was 90% (180) for Glossina pallidipes, 6% (12) for G. brevipalpis and 4% (8) for G. m. morsitans with apparent densities (fly/trap/day - FTD) of 0.44. Higher density of Glossina pallidipes was observed in villages closer to than those far from the Selous game reserve. Trypanosomes were detected and identified by microscopy and ITS1 polymerase chain reaction (PCR) assay on DNA purified from 200 flies. Glossina pallidipes was the only fly found infected by three Trypanosoma species, namely T. vivax (60%), T. simiae (10%) and T. brucei (30%) with an overall infection rate of 10% (20/200). A higher proportion of trypanosome infections were observed in female tsetse flies than in males. Results of this study show that G pallidipes is the major Glossina species harboring pathogenic trypanosomes in Liwale district and that the Selous game reserve is a potential reservoir of trypanosomes in terms of parasite abundance and species diversity.COSTEC

A tsetse Glossina pallidipes harbors the pathogenic trypanosomes circulating in Liwale district, Tanzania

Veterinary Parasitology: Regional studies and reports 9 (2017) 93-97African Animal Trypanosomiasis (AAT) is among several constraints hindering development of the livestock sector in Tanzania. A survey was conducted in Liwale district located in southern Tanzania in 2013 to determine the population density of Glossina species, distribution pattern and Trypanosome species infection rate in tsetse flies. A total of 200 flies were collected from the study area and three Glossina species were identified. The proportional abundance of all trapped flies was 90% (180) for Glossina pallidipes, 6% (12) for G. brevipalpis and 4% (8) for G. m. morsitans with apparent densities (fly/trap/day - FTD) of 0.44. Higher density of Glossina pallidipes was observed in villages closer to than those far from the Selous game reserve. Trypanosomes were detected and identified by microscopy and ITS1 polymerase chain reaction (PCR) assay on DNA purified from 200 flies. Glossina pallidipes was the only fly found infected by three Trypanosoma species, namely T. vivax (60%), T. simiae (10%) and T. brucei (30%) with an overall infection rate of 10% (20/200). A higher proportion of trypanosome infections were observed in female tsetse flies than in males. Results of this study show that G pallidipes is the major Glossina species harboring pathogenic trypanosomes in Liwale district and that the Selous game reserve is a potential reservoir of trypanosomes in terms of parasite abundance and species diversity.COSTEC

Detecting Wahlund effects together with amplification problems : cryptic species, null alleles and short allele dominance in Glossina pallidipes populations from Tanzania

Population genetics is a convenient tool to study the population biology of non-model and hard to sample species. This is particularly true for parasites and vectors. Heterozygote deficits and/or linkage disequilibrium often occur in such studies and detecting the origin of those (Wahlund effect, reproductive system or amplification problems) is uneasy. We used new tools (correlation between the number of times a locus is found in significant linkage disequilibrium and its genetic diversity, correlations between Wright's F-IS and F-ST, F-IS and number of missing data, F-IT and allele size and standard errors comparisons) for the first time on a real data set of tsetse flies, a vector of dangerous diseases to humans and domestic animals in sub-Saharan Africa. With these new tools, and cleaning data from null allele, temporal heterogeneity and short allele dominance effects, we unveiled the coexistence of two highly divergent cryptic clades in the same sites. These results are in line with other studies suggesting that the biodiversity of many taxa still largely remain undescribed, in particular pathogenic agents and their vectors. Our results also advocate that including individuals from different cohorts tends to bias subdivision measures and that keeping loci with short allele dominance and/or too frequent missing data seriously jeopardize parameter's estimations. Finally, separated analyses of the two clades suggest very small tsetse densities and relatively large dispersal