Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa

Nichols, Chelsea; Espinoza, Ligia María Cruz; Kalckreuth, Vera von; Aaby, Péter; Ali, Mohammad; Aseffa, Abraham; Bjerregaard-Andersen, Morten; Breiman, Robert F.; Cosmas, Leonard; Crump, John A.; Dekker, Denise; Sow, Amy Gassama; Gasmelseed, Nagla; Hertz, Julian T.; Im, Justin; Kabore, Leon Parfait; Keddy, Karen H.; Konings, Frank; Løfberg, Sandra Valborg; Meyer, Christian G.; Niang, A; Njariharinjakamampionona, Andriamampionona; Olack, Beatrice; Pak, Gi Deok; Panzner, Ursula; Park, Jin Kyung; Park, Se Eun; Rabezanahary, Henintsoa; Rakotozandrindrainy, Raphäel; Raminosoa, Tiana Mirana; Rubach, Matthew P.; Teferi, Mekonnen; Seo, Hye Jin; Sooka, Arvinda; Soura, Abdramane; Tall, Adama; Toy, Trevor; Yeshitela, Biruk; Clemens, John D.; Wierzba, Thomas F.; Baker, Stephen; Marks, Florian

doi:10.1093/cid/civ730

Cited by 18 publications

(21 citation statements)

References 27 publications

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“…The primary finding of this study is that there is a considerable and widespread burden of pediatric typhoid fever in rural Cambodia, thus questioning the dogma that typhoid fever is predominantly geographically restricted to urban populations with poor sanitation systems [ 9 , 7 ]. Our data are consistent with findings from a recent study conducted across sub-Saharan Africa [ 30 ]. The Typhoid Surveillance in Africa Programme (TSAP) found a large burden of typhoid fever in younger children and almost equivalent population incidences between urban and rural settings.…”

Section: Discussionsupporting

confidence: 93%

The Molecular and Spatial Epidemiology of Typhoid Fever in Rural Cambodia

et al. 2016

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Typhoid fever, caused by the bacterium Salmonella Typhi, is an endemic cause of febrile disease in Cambodia. The aim of this study was to better understand the epidemiology of pediatric typhoid fever in Cambodia. We accessed routine blood culture data from Angkor Hospital for Children (AHC) in Siem Reap province between 2007 and 2014, and performed whole genome sequencing (WGS) on the isolated bacteria to characterize the S. Typhi population. The resulting phylogenetic information was combined with conventional epidemiological approaches to investigate the spatiotemporal distribution of S. Typhi and population-level risk factors for reported disease. During the study period, there were 262 cases of typhoid within a 100 km radius of AHC, with a median patient age of 8.2 years (IQR: 5.1–11.5 years). The majority of infections occurred during the rainy season, and commune incidences as high as 11.36/1,000 in children aged <15 years were observed over the study period. A population-based risk factor analysis found that access to water within households and increasing distance from Tonle Sap Lake were protective. Spatial mapping and WGS provided additional resolution for these findings, and confirmed that proximity to the lake was associated with discrete spatiotemporal disease clusters. We confirmed the dominance of MDR H58 S. Typhi in this population, and found substantial evidence of diversification (at least seven sublineages) within this single lineage. We conclude that there is a substantial burden of pediatric typhoid fever in rural communes in Cambodia. Our data provide a platform for additional population-based typhoid fever studies in this location, and suggest that this would be a suitable setting in which to introduce a school-based vaccination programme with Vi conjugate vaccines.

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Section: Discussionsupporting

confidence: 93%

The Molecular and Spatial Epidemiology of Typhoid Fever in Rural Cambodia

et al. 2016

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“…Antibiotic self-treatment was reported for 15% of pediatric admissions throughout Uganda during this 18-month period, a frequency similar to that from other reports from Africa. 27,30 Antibiotic pretreatment may have decreased sensitivity of blood cultures. Additionally, challenges obtaining adequate blood volumes, particularly from malnourished children, decreases the ability to subject clinical specimens to a wide array of diagnostic tests, potentially limiting diagnostic success.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these challenges, the overall proportion of pediatric blood cultures with evidence of bacterial pathogens was similar to that of other reports from Africa. 3,5,28,30,31 Antimicrobial susceptibility results presented here must also be interpreted with care. Reproducible AST results depend on the reagents used.…”

Section: Discussionmentioning

confidence: 99%

A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

et al. 2018

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Global health security depends on effective surveillance for infectious diseases. In Uganda, resources are inadequate to support collection and reporting of data necessary for an effective and responsive surveillance system. We used a cross-cutting approach to improve surveillance and laboratory capacity in Uganda by leveraging an existing pediatric inpatient malaria sentinel surveillance system to collect data on expanded causes of illness, facilitate development of real-time surveillance, and provide data on antimicrobial resistance. Capacity for blood culture collection was established, along with options for serologic testing for select zoonotic conditions, including arboviral infection, brucellosis, and leptospirosis. Detailed demographic, clinical, and laboratory data for all admissions were captured through a web-based system accessible at participating hospitals, laboratories, and the Uganda Public Health Emergency Operations Center. Between July 2016 and December 2017, the expanded system was activated in pediatric wards of 6 regional government hospitals. During that time, patient data were collected from 30,500 pediatric admissions, half of whom were febrile but lacked evidence of malaria. More than 5,000 blood cultures were performed; 4% yielded bacterial pathogens, and another 4% yielded likely contaminants. Several WHO antimicrobial resistance priority pathogens were identified, some with multidrug-resistant phenotypes, including Acinetobacter spp., Citrobacter spp., Escherichia coli, Staphylococcus aureus, and typhoidal and nontyphoidal Salmonella spp. Leptospirosis and arboviral infections (alphaviruses and flaviviruses) were documented. The lessons learned and early results from the development of this multisectoral surveillance system provide the knowledge, infrastructure, and workforce capacity to serve as a foundation to enhance the capacity to detect, report, and rapidly respond to wide-ranging public health concerns in Uganda.

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“…This has implications on resources for patient, family members and health system since some drug combinations are relatively expensive [ 19 – 21 ]. Non-compliance to malaria negative results by prescribing AMDs neglects underlying cause of fever and expose patients unnecessarily to adverse effects; underlying infections, such as sepsis, pneumonia and meningitis [ 22 – 25 ], present as malaria clinically but are not routinely investigated [ 26 ] and may not be treated [ 10 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Health workers’ compliance to rapid diagnostic tests (RDTs) to guide malaria treatment: a systematic review and meta-analysis

Kabaghe

Visser

Spijker

et al. 2016

Malar J

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BackgroundThe World Health Organization recommends malaria to be confirmed by either microscopy or a rapid diagnostic test (RDT) before treatment. The correct use of RDTs in resource-limited settings facilitates basing treatment onto a confirmed diagnosis; contributes to speeding up considering a correct alternative diagnosis, and prevents overprescription of anti-malarial drugs, reduces costs and avoids unnecessary exposure to adverse drug effects. This review aims to evaluate health workers’ compliance to RDT results and factors contributing to compliance.MethodsA PROSPERO-registered systematic review was conducted to evaluate health workers’ compliance to RDTs in sub-Saharan Africa, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published up to November 2015 were searched without language restrictions in Medline/Ovid, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, Biosis Previews and the African Index Medicus. The primary outcome was health workers treating patients according to the RDT results obtained.ResultsThe literature search identified 474 reports; 14 studies were eligible and included in the quantitative analysis. From the meta-analysis, health workers’ overall compliance in terms of initiating treatment or not in accordance with the respective RDT results was 83 % (95 % CI 80–86 %). Compliance to positive and negative results was 97 % (95 % CI 94–99 %) and 78 % (95 % CI 66–89 %), respectively. Community health workers had higher compliance rates to negative test results than clinicians. Patient expectations, work experience, scepticism of results, health workers’ cadres and perceived effectiveness of the test, influenced compliance.ConclusionsWith regard to published data, compliance to RDT appears to be generally fair in sub-Saharan Africa; compliance to negative results will need to improve to prevent mismanagement of patients and overprescribing of anti-malarial drugs. Improving diagnostic capacity for other febrile illnesses and developing local evidence-based guidelines may help improve compliance and management of negative RDT results.Trial registration: CRD42015016151 (PROSPERO)Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1218-5) contains supplementary material, which is available to authorized users.

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Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa

Cited by 18 publications

References 27 publications

The Molecular and Spatial Epidemiology of Typhoid Fever in Rural Cambodia

The Molecular and Spatial Epidemiology of Typhoid Fever in Rural Cambodia

A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda

Health workers’ compliance to rapid diagnostic tests (RDTs) to guide malaria treatment: a systematic review and meta-analysis

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