Constraints in the diagnosis and treatment of Lassa Fever and the effect on mortality in hospitalized children and women with obstetric conditions in a rural district hospital in Sierra Leone

Dahmane, A.; Griensven, Johan van; Herp, Michel Van; Bergh, Rafaël Van den; Nzomukunda, Yvonne; Prior, Jerilynn C.; Alders, Petra; Jambai, Amara; Zachariah, Rony

doi:10.1093/trstmh/tru009

Cited by 57 publications

(57 citation statements)

References 13 publications

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“…About 23% of the children with LVD and 3% with other illnesses died. A CFR of 23% in the era of availability of treatment with ribavirin is quite high and unacceptable but it is congruent with the evidence that LVD is a highly fatal illness [19,48,59,75]. The CFR in children with CAWF in this study was about 7% versus a CFR of only about 2% in febrile children without convulsions.…”

Section: Discussionsupporting

confidence: 84%

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

et al. 2017

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BackgroundConvulsions with fever in children are a common neurologic emergency in the tropics, and determining the contribution of endemic viral infections can be challenging. In particular, there is a dearth of data on the prevalence and clinical differentiation of Lassa virus disease (LVD) in febrile children in endemic areas of Nigeria, which has multiple lineages of the virus. The aim of this study was to determine the prevalence and presentation of LVD in febrile children with and without convulsions.Methodology/Principal findingsThis was a prospective study of consecutive febrile children aged ≥1 month– 15 years admitted to the Children’s Emergency Room of Irrua Specialist Teaching Hospital over a period of 1 year. Febrile children with convulsions (Cases) were compared with those without convulsions (Controls). LVD was defined by the presence of a positive Lassa virus RT-PCR test. Rates were compared between groups using χ2 or Fisher’s exact tests and p <0.05 taken as significant. 373 (40.9%) of 913 admissions had fever. Of these, 108/373 (29%) presented with convulsions. The overall prevalence of LVD was 13/373 (3.5%; 95% CI = 1.9%, 5.7%) in febrile admissions, 3/108 (2.8%) in Cases and 10/265 (3.8%) in Controls [(Odds Ratio (95% Confidence Interval) (OR (95% CI)) of LVD in Cases versus Controls = 0.73 (0.2, 2.7)]. Only vomiting (OR (95% CI) = 0.09 (0.01, 0.70)) and bleeding (OR (95% CI) = 39.56 (8.52, 183.7)) were significantly associated with an increased prevalence of LVD.Conclusions/SignificanceLVD is an important cause of fever, including undifferentiated fever in children in endemic areas, but it is not significantly associated with convulsions associated with fever. Its prevalence, and lack of clinical differentiation on presentation, underscores the importance of a high index of suspicion in diagnosis. Screening of febrile children with undifferentiated fever in endemic areas for LVD could be an important medical and public health control measure.

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Section: Discussionsupporting

confidence: 84%

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

et al. 2017

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“…Bo district has a population of about 600,000 and Bo Town is the district capital. Both the primary health center and hospital are located within a proximity of 500 m [15]. …”

Section: Methodsmentioning

confidence: 99%

“…It has 150 beds (but capacity could be increased to 200 according to need) and special wards for neonates, intensive care, malnutrition associated with complications and burns. It also had facilities to provide isolation for suspected Lassa Fever cases [15]. …”

Section: Methodsmentioning

confidence: 99%

“…The Gondama Health Centre is a primary health care facility providing dedicated out-patient consultations for under-five children. On the other hand, the Gondama Referral Hospital is an independent pediatric referral facility, run by Médecins Sans Frontières (MSF), providing emergency room services and admission facilities [15]. There are anecdotal observations that the Ebola outbreak hampered access to both of these facilities.…”

Section: Introductionmentioning

confidence: 99%

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Offering general pediatric care during the hard times of the 2014 Ebola outbreak: looking back at how many came and how well they fared at a Médecins Sans Frontières referral hospital in rural Sierra Leone

et al. 2017

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BackgroundIn Bo district, rural Sierra Leone, we assessed the burden of the 2014 Ebola outbreak on under-five consultations at a primary health center and the quality of care for under-15 children at a Médecins Sans Frontières (MSF) referral hospital.MethodsRetrospective cohort study, comparing a period before (May-October 2013) and during the same period of the Ebola outbreak (2014). Health worker infections occurred at the outbreak peak (October 2014), resulting in hospital closure due to fear of occupational-risk of contracting Ebola. Standardized hospital exit outcomes and case fatality were used to assess quality of care until closure.ResultsA total of 13,658 children under-five, were seen at the primary health center during 2013 compared to 8761 in 2014; a consultation decline of 36%. Of 6497 children seen in the hospital emergency room, during the outbreak, patients coming from within hospital catchment area declined with 38% and there were significantly more self-referrals (80% vs. 61%, P < 0.001). During Ebola, 23 children were dead on arrival and the proportion of children in severe clinical status (requiring urgent attention) was higher (74% during Ebola vs. 65% before, P < 0.001). Of 5,223 children with available hospital outcomes, unfavorable outcomes (combination of deaths and abandoned) were less than 15% during both periods, which is within the maximum acceptable in-house threshold set by MSF. Case fatality for severe malaria and lower respiratory tract infections (n = 3752) were similar (≤15%).ConclusionsValuable and good quality pediatric care was being provided in the pediatric hospital during the 2014 Ebola outbreak, but could not be sustained because of hospital closure. Health facility and health worker safety should be tackled as a universal requirement to try to avoid a déjà-vu.

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“…None of the studies investigated the aetiologies of fever in children under 5 years in sub-Saharan Africa by screening all relevant foci of infection, thus BSI, UTI, RTI and GII together. Patients included in the studies who were selected for our review were outpatients [23][24][25][26], inpatients [20,[27][28][29][30][31][32][33] or the both [18,[34][35][36][37][38]. The mortality rate in the studies that provided this specific information ranged from 1.4 to 22.5% and specifically concerned the inpatient studies [18,20,28,29,33,34].…”

Section: Aetiologies Of Fever In Children Under 5 Yearsmentioning

confidence: 99%

Aetiologies of non‐malaria febrile episodes in children under 5 years in sub‐Saharan Africa

Kiemdé

Spijker

Mens

et al. 2016

Tropical Med Int Health

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Abstractobjectives To provide an overview of the most frequent aetiologies found in febrile episodes of children under 5 years from sub-Saharan Africa.methods MEDLINE and EMBASE were searched for publications in English and French on nonmalaria fever episodes in African children under 5 years of age, which were published between January 1990 and July 2015. Case reports and conference abstracts were excluded.results In total, 3851 titles and abstracts were reviewed, and 153 were selected for full screening of which 18 were included in the present review. Bloodstream infection (BSI) was most commonly investigated (nine of 18) followed by urinary tract infection (UTI) (four of 18) and respiratory tract infection (RTI) (two of 18). Few studies investigated BSI and UTI in the same children (two of 18), or BSI and gastrointestinal infection (GII) (one of 18). As for BSI, the most frequently isolated bacteria were E. coli (four of 12), Streptococcus pneumonia (four of 12), Salmonella spp (three of 12) and Staphylococcus aureus (two of 12) with a positive identification rate of 19.7-33.3%, 5.2-27.6%, 11.7-65.4% and 23.5-42.0%, respectively. As for UTI, the main bacteria isolated were E. coli (six of six) and Klebsiella spp (six of six) with a positive rate of 20.0-72.3% and 10.0-28.5%, respectively. No bacterium was isolated in RTI group, but Human influenzae A and B were frequently found, with the highest positive identification rate in Tanzania (75.3%). Dengue virus (two of 12) was the most frequently reported viral infection with a positive identification rate of 16.7-30.8%. Finally, only rotavirus/adenovirus (69.2% positive identification rate) was found in GII and no bacterium was isolated in this group.conclusions The high prevalence of treatable causes of non-malaria fever episodes requires a proper diagnosis of the origin of fever followed by an appropriate treatment, thereby reducing the under-5 mortality in sub-Saharan Africa and preventing the overprescription of antibiotics and thus circumventing the rise of antibiotic resistance.

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Constraints in the diagnosis and treatment of Lassa Fever and the effect on mortality in hospitalized children and women with obstetric conditions in a rural district hospital in Sierra Leone

Abstract: These findings highlight shortcomings in LF management, including diagnostic and treatment delays. More research and development efforts should be devoted to this 'neglected disease'.

Cited by 57 publications

References 13 publications

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

Offering general pediatric care during the hard times of the 2014 Ebola outbreak: looking back at how many came and how well they fared at a Médecins Sans Frontières referral hospital in rural Sierra Leone

Aetiologies of non‐malaria febrile episodes in children under 5 years in sub‐Saharan Africa

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