Bronchiectasis in African children: disease burden, aetiology and clinical spectrum at a paediatric tertiary hospital in Cape Town, South Africa

Childhood bronchiectasis is a common cause of chronic lung disease globally, particularly in lower-middle-income countries (LMIC). Data from LMIC is lacking. We aimed to describe the disease burden, aetiology, and clinical spectrum of bronchiectasis in children attending a tertiary hospital in Cape Town, South Africa. Methods Data was collected by chart review of all patients 3 months to 15 years attending the respiratory clinic at red cross war memorial children's hospital between January – December 2019. We included children who had a diagnosis of bronchiectasis based on history of a recurrent (> 3 episodes/year) or persistent (> 4 weeks) wet cough, a clinical phenotype characterized by any of; exertion dyspnea, recurrent chest infections, growth failure, finger clubbing and chest deformity associated with radiographic features of bronchiectasis on plain chest radiography or HRCT reported by a paediatric radiologist. Patients with cystic fibrosis were excluded. Results Of 337 children seen during the study period, 58 (17.2%) had bronchiectasis that was diagnosed at a mean age of 34 months (SD 26). There were 32 (55.0%) female participants. The commonest causes of bronchiectasis were post-infectious (25, 43.1%), and underlying immunodeficiencies (19, 32.8%) including 16/58 (27.6%) who were HIV-infected and 3 (5.1 %) with primary immunodeficiency. Other causes included aspiration syndrome (8, 13.8 %) and anatomical abnormalities (4, 6.9%). Of the participants with post infectious bronchiectasis, tuberculosis was the commonest organism that was isolated (16, 64.0%) and commonest in children living with HIV (11/16, 68.8%). Cough was common (48, 82.8%) with wet cough being predominant (41, 85.4%), course crepitations accounted for 37 (63.8%), hyperinflation 24 (41.4%) finger clubbing 21 (36.2%), wheeze 16 (29.3%) and exertional dyspnea in 7 (12.0%). Conclusion: Bronchiectasis is a common cause of chronic lung disease in South African children mostly resulting from previous pneumonias, with tuberculosis being the commonest infective cause. The importance of identifying underlying treatable causes is highlighted

Duration of cART Before Delivery and Low Infant Birthweight Among HIV-Infected Women in Lusaka, Zambia

To estimate the association between duration of combination antiretroviral therapy (cART) during pregnancy and low infant birthweight (LBW), among women ≥37 weeks gestation

Bronchiectasis in African children : challenges and barriers to care

Bronchiectasis (BE) is a chronic condition aecting the bronchial tree. It is characterized by the dilatation of large and medium-sized airways, secondary to damage of the underlying bronchial wall structural elements and accompanied by the clinical picture of recurrent or persistent cough. Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where the prevalence is mostly unmeasured, and likely to be higher than high-income countries. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in high-income countries or from data in children with cystic fibrosis. Here we provide an overview of pediatric BE in Africa, highlighting risk factors, diagnostic and management challenges, need for a global approach to addressing key research gaps, and recommendations for practitioners working in Africa.http://www.frontiersin.org/Pediatricsdm2022Paediatrics and Child Healt

A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period

Access to lifelong combination antiretroviral therapy (cART) is expanding among HIV-infected pregnant and breastfeeding women throughout sub-Saharan Africa. For this strategy to meaningfully improve maternal HIV outcomes, retention in HIV care is essential. We developed a risk score to identify women with high likelihood of loss to follow-up (LTFU) at 6 months postpartum from HIV care, using data from public health facilities in Lusaka, Zambia. LTFU was defined as not presenting for HIV care within 60 days of the last scheduled appointment. We used logistic regression to assess demographic, obstetric, and HIV predictors of LTFU and to develop a simple risk score. Sensitivity and specificity were assessed at each risk score cut-point. Among 2,029 pregnant women initiating cART between 2009 and 2011, 507 (25%) were LTFU by 6 months postpartum. Parity, education, employment status, WHO clinical stage, duration of cART during pregnancy, and number of antenatal care visits were associated with LTFU (p-value<0.10). A risk score cut-point of 11 (42nd percentile) had 85% sensitivity (95% CI 82%, 88%) and 22% specificity (95% CI 20%, 24%) to detect women LTFU and would exclude 20% of women from a retention intervention. A risk score cut-point of 18 (69th percentile) identified the 23% of women with the highest probability of LTFU and had sensitivity 32% (95% CI 28%, 36%) and specificity 80% (95% CI 78%, 82%). A risk score approach may be useful to triage a subset of women most likely to be LTFU for targeted retention interventions

Bronchiectasis in African children: Challenges and barriers to care.

Bronchiectasis (BE) is a chronic condition affecting the bronchial tree. It is characterized by the dilatation of large and medium-sized airways, secondary to damage of the underlying bronchial wall structural elements and accompanied by the clinical picture of recurrent or persistent cough. Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where the prevalence is mostly unmeasured, and likely to be higher than high-income countries. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in high-income countries or from data in children with cystic fibrosis. Here we provide an overview of pediatric BE in Africa, highlighting risk factors, diagnostic and management challenges, need for a global approach to addressing key research gaps, and recommendations for practitioners working in Africa