Which Clinical Signs Predict Severe Illness in Children Less than 2 Months of Age in Resource Poor Countries?

Coghill, Joanna; Simkiss, Douglas E.

doi:10.1093/tropej/fmr001

Cited by 10 publications

(5 citation statements)

References 13 publications

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“…Our findings are consistent with previous studies showing poor provider performance on the related IMCI guidelines contributed to misclassification of severe illness and lapses in treatment of infants and children [23][24][25][26]. Classification of severe infection depends on the providers' ability to recognize and interpret subtle presentation of signs of PSBI, while less severe classifications are based on the absence of these signs [26,53,54]. Since our study was limited to record review, we expect that 1.…”

Section: Plos Onesupporting

confidence: 89%

“…classification errors were underestimated, particularly for severe illness cases requiring referral and treatment with gentamicin. Given the low number of cases and subtle presentation of signs of severe infection in young infants, emphasis on recognizing and interpreting the signs of PSBI should be prioritized in training and supervision to improve classification and subsequent management [53,54]. A recent systematic review on effectiveness of strategies to improve healthcare provider practices in LMIC found packages of strategies-including training, group problem-solving and/or supervision, and providing job aides-were associated with larger improvements in provider performance than any of these strategies alone [55,56].…”

Section: Plos Onementioning

confidence: 99%

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Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh

Applegate

Ahmed²,

Harrison

et al. 2020

PLoS ONE

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Background Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0-59 days) using simplified antibiotic regimens when compliance with hospital referral is not feasible. Bangladesh was one of the first countries to adopt WHO's guidelines for implementation. We report results of an implementation research study that assessed facility readiness and provider performance in three rural sub-districts of Bangladesh during August 2015-August 2016. Methods This study took place in 19 primary health centers. Facility readiness was assessed using checklists completed by study staff at three time points. To assess provider performance, we extracted data for all infection cases from facility registers and compared providers' diagnosis and treatment against the guidelines. We plotted classification and dosage errors across the study period and superimposed a locally weighted smoothed (LOWESS) curve to analyze changes in performance over time. Focus group discussions (N = 2) and in-depth interviews (N = 28) with providers were conducted to identify barriers and facilitators for facility readiness and provider performance. Results At baseline, none of the facilities had adequate supply of antibiotics. During the 10-month period, 606 sick infants with signs of infection presented at the study facilities. Classification

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Section: Plos Onesupporting

confidence: 89%

Section: Plos Onementioning

confidence: 99%

Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh

Applegate

Ahmed²,

Harrison

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…One study was excluded because it included children over five years of age and the data could not be stratified, one study was conducted in adults, one study identified clinical predictors of pneumonia outcomes which were not used to develop a formal risk score, and five studies developed risk scores for predicting diagnosis or management rather than treatment failure or mortality. (13–20) Of the five articles that met inclusion criteria, three described development of pediatric pneumonia risk scores predicting mortality specifically (RISC, mRISC, and RISC-Malawi), and two described development of pediatric pneumonia risk scores predicting treatment failure, including mortality, after initiation of oral antibiotic treatment (APPIS and Malawi-CHW) in LRS (Table 1). (12, 21–24) All scores were developed using multivariable logistic regression.…”

Section: Resultsmentioning

confidence: 99%

Pneumonia Risk Stratification Scores for Children in Low-Resource Settings

Deardorff

McCollum

Ginsburg

2018

Pediatric Infectious Disease Journal

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“…Previous systematic reviews of clinical predictors of mortality from severe infections have included infants in developed countries, which may not applicable to areas of the world where the majority of the disease burden occurs ( 10 ). Furthermore, other systematic reviews have examined predictors of severe illness and/hospitalization rather than mortality ( 64 , 65 ), the latter which is a more objective, directly actionable outcome for use in intervention trials. Moreover, other previous work have focused on on all-cause mortality from sepsis as universally preventable disease, rather than more specific illness populations ( 7 ).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review

et al. 2018

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Background: Neonates and infants comprise the majority of the 6 million annual deaths under 5 years of age around the world. Most of these deaths occur in low/middle income countries (LMICs) and are preventable. However, the clinical identification of neonates and infants at imminent risk of death is challenging in developing countries.Objective: To systematically review the literature on clinical risk factors for mortality in infants under 12 months of age hospitalized for sepsis or serious infections in LMICs.Methods: MEDLINE and EMBASE were systematically searched using MeSH terms through April 2017. Abstracts were independently screened by two reviewers. Subsequently, full-text articles were selected by two independent reviewers based on PICOS criteria for inclusion in the final analysis. Study data were qualitatively synthesized without quantitative pooling of data due to heterogeneity in study populations and methodology.Results: A total of 1,139 abstracts were screened, and 169 full-text articles were selected for text review. Of these, 45 articles were included in the analysis, with 21 articles featuring neonatal populations (under 28 days of age) exclusively. Most studies were from Sub-Saharan Africa and South Asia. Risk factors for mortality varied significantly according to study populations. For neonatal deaths, prematurity, low birth-weight and young age at presentation were most frequently associated with mortality. For infant deaths, malnutrition, lack of breastfeeding and low oxygen saturation were associated with mortality in the highest number of studies.Conclusions: Risk factors for mortality differ between the neonatal and young infant age groups and were also dependant on the study population. These data can serve as a starting point for the development of individualized predictive models for in-hospital and post-discharge mortality and for the development of interventions to improve outcomes among these high-risk groups.

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Which Clinical Signs Predict Severe Illness in Children Less than 2 Months of Age in Resource Poor Countries?

Cited by 10 publications

References 13 publications

Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh

Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh

Pneumonia Risk Stratification Scores for Children in Low-Resource Settings

Predictors of Mortality in Neonates and Infants Hospitalized With Sepsis or Serious Infections in Developing Countries: A Systematic Review

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