Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models

Abstract

Abstractobjective To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs.methods We conducted a hospital-based survey in a district hospital from Southern Mozambique. results A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9%, and 19.8% of these children died (OR compared with nonhypoxaemic children 3.22, 95% CI 1.98-5.21, P < 0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate ≥70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling, with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios.conclusions Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.

A Systematic Review and Meta-analysis of Sex Differences in Morbidity and Mortality of Acute Lower Respiratory Tract Infections Among African Children

“…The publication dates for all the 14 studies ranged from 1990 to 2016. We found data on sex differences for case fatality in nine (26)(27)(28)(29)(30)(31)34), aetiology in three (23,34,35) and incidence of pneumonia in three (5,28,34) articles. There was no article on bronchiolitis with data on sex differences.…”

“…Other bacterial pathogens reported were Haemophilus influenzae type B in two studies (32,34) [male =37/247 (10.9%); female = 1/276 (0.4%)], and Staphylococcus aureus in one study (32) [male =7/55 (12.7%); female = 7/48 (14.6%)]. Sex disaggregated results on Rhinovirus and Pneumocystis jiroveci were presented by two (27,34) out the four studies while only a study (34) reported sex distribution for the Influenza virus, Parainfluenza, and Bocavirus as pathogens. Influenza virus, Parainfluenza, and Bocavirus were identified more frequently in male than female infants, male constitutes over 60% children from whom isolates were obtained.…”

“…We identified only 14 studies that reported on incidence, aetiology, and/or case fatality of LRTI among African children disaggregated by sex. These came from the Gambia (23), Kenya (5,24), Malawi (25), Mali (26), Mozambique (27,28), Nigeria (29-33) and South Africa (34,35) (Table IV). However, one Nigeria (33) study was excluded from narrative analysis for the incidence of LRTI, because the estimated incidence estimate was considered to be an outlier [ranged from 6.1 to 8.1 episodes per childyear an incidence ratio of 1.08 (male = 7.2; female = 6.7)].…”

“…The study population was children aged less than 5 years in all but two studies including a Nigerian study (30) which extended participants' age to 110 months and a Kenya study (5) which also included adults. Also, most of the studies were health facility-based (n=12/13) and data were prospectively collected in 11 studies (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), 9 studies were cross-sectional in design (5,24,25,(27)(28)(29)(30)(31)(32), 3 were case-control studies (26,34,36) and only two studies (33,35) involved follow up of participants for at least a year, respectively. Our assessment showed that none of the studies included in the review has a very high risk of bias; four studies (5,25,33,36) were classified as having a moderate risk of bias while the remaining 10 studies have a low risk of bias.…”

“…Four (28.6%) studies (23,27,32,34) out of the 14 studies reviewed investigated and presented sex-related data on aetiology of LRTI. In microbiology-based studies, the leading bacterial cause reported is Streptococcus pneumoniae, were identified in two studies (27,32). Streptococcus pneumoniae accounted for 4.5% of 557 and 6.1% of 380 pneumonia cases in males and females, respectively.…”