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

Abstract

BackgroundAcute 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.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.Materials and MethodsWe 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.ResultsFrom 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).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.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).ConclusionCo-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.

Respiratory viral coinfection and disease severity in children: A systematic review and meta-analysis

“…They found no association between viral coinfection and length of stay, oxygen requirements, admission to PICU and need of mechanical ventilation [59]. They found a higher mortality risk in preschool children, which was not consistent with our results and previous studies [41,46]. The second systematic review with mixed adult-children population included 19 studies, and reported an overall increase in risk of hospitalization in patients with two or more viruses detected, but there was not a subgroup analysis only with children for this outcome [60].…”

Influenza-Like Illnesses in Senegal: Not Only Focus on Influenza Viruses

“…However, influenza viruses seem to be only one of several frequent etiological agents of ILI: we found numerous other respiratory viruses, some in mono-infections and some in coinfections indicating that the circulation of these viruses in the community is substantial. As in Madagascar [16,17], pathogenic respiratory viruses were present in more than 70% of the samples collected from cases of ILI, and the involvement of non-influenza viruses was substantial: adenoviruses (22%), rhinoviruses (19%) (1) TAMBACOUNDA…”

Health Inequalities and Infectious Disease Epidemics: A Challenge for Global Health Security

“…Malnutrition-either hunger or obesity-is a risk factor for severe disease. In a study of outcomes among children hospitalized due to acute respiratory infection in Madagascar, 35 2 out of 3 malnourished children died. Disparities in vaccine uptake rates could also cause differential susceptibility once exposed to the virus.…”