Lassa Fever among Children in Eastern Province, Sierra Leone: A 7-year Retrospective Analysis (2012–2018)

Abstract

Pediatric Lassa fever (LF) usually presents as a nonspecific febrile illness, similar to other endemic diseases in countries like Sierra Leone, where LF is considered to be hyperendemic. The nonspecificity of presentation and lack of research have made it difficult to fully understand best practices for pediatric management. We aim to describe clinical characteristics of hospitalized pediatric patients suspected or diagnosed with LF and assess factors associated with hospital outcomes among those with LF antigen-positive results. We conducted a 7-year retrospective cohort study using routine data for all children younger than 18 years admitted at the Kenema Government Hospital's LF ward. A total of 292 children with suspected or confirmed LF were analyzed. Overall, mortality was high (21%). Children with antigenpositive results had a high case fatality rate of 63% (P < 0.01). In univariate analyses, children who presented with unexplained bleeding (odds ratio [OR]: 3.58; 95% CI: 1.08-11.86; P = 0.040) and confusion (altered sensorium) (OR: 5.37; 95% CI: 1.34-21.48; P = 0.020) had increased odds of death. Abnormal serum levels of alanine aminotransferase (P = 0.001), creatinine (P = 0.004), and potassium (P = 0.003) were associated with increased likelihood of death in these children. Treatment with ribavirin was not significantly associated with survival (P = 0.916). Our findings provide insights into current pediatric LF clinical presentation and management. More evidence-based, high-quality research in creating predictive algorithms of antigen-positivity and hospital outcomes is needed in the management of pediatric LF.

Space-Time Trends in Lassa Fever in Sierra Leone by ELISA Serostatus, 2012–2019

“…More recently, CFRs for LF have reached 69% in Sierra Leone and may exceed 80% in third-trimester pregnancies [18,20,21]. Other recent studies in Sierra Leone revealed LF CFRs of 67% in hospitalized patients and 63% in hospitalized children [22,23]. Countries reporting LF outside of Sierra Leone have historically reported lower CFRs.…”

Respiratory virus surveillance in hospitalized children less than two-years of age in Kenema, Sierra Leone during the COVID-19 pandemic (October 2020- October 2021)

“…This study was conducted at KGH, in Kenema District of Eastern Province, Sierra Leone. KGH has a catchment area endemic for illnesses such as malaria and Lassa fever (LF) and is a hospital that was at the epicenter of Sierra Leone´s efforts during the 2014–2016 West African Ebola outbreak [ 19 , 23 , 24 ]. The pediatric ward of KGH provides free health care for children under five years of age and admits approximately 400 children per month.…”

Antibiotic prescribing practices for acute respiratory illness in children less than 24 months of age in Kenema, Sierra Leone: is it time to move beyond algorithm driven decision making?

“…KGH, located in Kenema District of Eastern Province, has a catchment area of roughly 600,000 persons and was at the epicenter of Sierra Leone’s efforts during the 2014–2016 West African Ebola outbreak [ 31 , 33 ]. The pediatric ward admits ~ 400 children per month.…”

“…Nevertheless, Sierra Leone is still one of the countries with the highest under-five mortality rates. In order to address this, the “Free Health Care Initiative” was implemented in 2010, establishing free health services to pregnant women, lactating mothers, and children under-five throughout the country [ 20 , 31 ].…”