Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study

Abstract

No specific funding was received for this study. EB is supported by the National Health and Medical Research Council of Australia.

Characteristics and Outcomes of Pediatric Patients With Ebola Virus Disease Admitted to Treatment Units in Liberia and Sierra Leone: A Retrospective Cohort Study

“…This observation is in line with other reports that bleeding was not a prominent finding among all EVD patients during this epidemic [19, 21, 22, 29]. It is also noteworthy that 1 in 5 children presented without fever and, of these, 27% never developed fever, which is similar to findings from one study [28] but not another [30]. Our findings support the mounting evidence that fever is not a sensitive screening tool for EVD [17, 28].…”

“…The odds of death were 20-fold higher in EVD patients aged <5 years compared with older children. This finding is consistent with other data reported from the West African EVD epidemic [4, 21, 27, 28]. Days of hospitalization before death for half of those aged <2 years ranged from 6 to 12 days.…”

“…Days of hospitalization before death for half of those aged <2 years ranged from 6 to 12 days. This range is comparable to that reported by Shah et al [21, 28]. Hemorrhagic features developed in fewer than half of pediatric patients; when present, they were associated with a 5-fold higher odds of mortality.…”

Development of a Pediatric Ebola Predictive Score, Sierra Leone1

“…Ideally, the model should be tested against other datasets from West Africa and prospectively in future outbreaks, because different EVD strains are likely to result in different disease manifestations. Indeed, in another pediatric cohort from Kailahun and Bo, Sierra Leone, containing 91 children <5 years of age, fever was absent in 25% (compared with 4% in our study) whereas bleeding was seen in 15% ( 15 ). In a large international cohort of 1,371 children <16 years of age with EVD, fever prevalence was 90% and bleeding 10% ( 24 ).…”

“…The WHO indicators, including fever, breathing difficulties, and gastrointestinal symptoms, are common features in many pediatric pathologies. In this outbreak, gastrointestinal symptoms dominated, whereas bleeding, characteristic of previous outbreaks, was rare ( 3 , 15 – 19 ). This difference meant clinical diagnosis of EVD in the West African outbreak was difficult, which motivated this study.…”