Management of Multisystem Inflammatory Syndrome in Children (MIS-C) in resource limited settings: The Kenyan Experience

Abstract

Background Since the onset of the recent COVID-19 pandemic, there have been growing concerns regarding multisystem inflammatory syndrome in children (MIS-C). This study aims to describe the clinico-epidemiological profile and challenges in management of MIS-C in low-middle income countries by highlighting the Kenyan experience. Methods A retrospective study at the Aga Khan University Hospital Nairobi, Avenue Hospital Kisumu and Kapsabet County Referral Hospital was undertaken to identify cases of MIS-C. A detailed chart review using the World Health Organization (WHO) data collection tool was adapted to incorporate information on socio-demographic details and treatment regimens. Findings Twenty children with MIS-C were identified across the three facilities between August 1st 2020 and August 31st 2021. Seventy percent of the children were male (14 of 20). COVID-19 PCR testing was done for five children and only one was positive. The commonest clinical symptoms were fever (90%), tachycardia (80%), prolonged capillary refill (80%), oral mucosal changes (65%) and peripheral cutaneous inflammation (50%). Four children required admission into the critical care unit for ventilation support and inotropic support. Cardiac evaluation was available for six patients four of whom had myocardial dysfunction, three had valvulitis and one had pericarditis. Immunoglobulin therapy was availed to two children and systemic steroids provided for three children. There were no documented mortalities. Interpretation We describe the first case series of MIS-C in East and Central Africa. Majority of suspected cases of MIS-C did not have access to timely COVID-19 testing and other appropriate evaluations which highlights the iniquity in access to diagnostics and treatment.

Short-term outcomes of South African children with multisystem inflammatory syndrome in children: a prospective cohort study

“…This study adds to expanding data on the outcomes of African children with MIS-C. As in the cohort from Nigeria 10 and Kenya, 28 overall outcomes were good, and no children required a biologic agent. It is, however, in contrast with data recently published from KwaZulu Natal, South Africa, 13 Pakistan 14 and Egypt, 29 where the mortality was reported to be very high (20.6%, 20% and 33.3%, respectively).…”

Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review

“…In rural areas, a lack of resources might result in many undiagnosed cases among children, explaining the low or nonexistent detection rate. However, compared with HICs, studies from the developing world have reported higher rates of hospitalization and deaths from MIS-C [44]. Involvement of coronary artery and the overall infectivity rate in Pakistan in children younger than 20 years was higher (>10%) compared with the rest of the world [45].…”

Pediatric coronavirus disease 2019 in Africa

“…In addition, IVIG is expensive, and availability is limited in many African regions. Therapy in African studies did not always include IVIGs, with remarkably low use in the report from Kenya [26 ▪▪ ]. The best available treatment study did not show the superiority of IVIGs alone compared to glucocorticoids alone [31].…”

“…Five cohort studies describe 251 children with MIS-C from four countries, South Africa, Nigeria, Kenya and Egypt, with most data coming from South Africa (Table 2) [21 ▪▪ ,24 ▪▪ –27 ▪▪ ]. The median age of children across the studies was 4.0–7.5 years as opposed to 9 years in the USA [28].…”