Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009–2013

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dc.contributor.author Ayeni, Oluwatosin A.
dc.contributor.author Walaza, Sibongile
dc.contributor.author Tempia, Stefano
dc.contributor.author Groome, Michelle
dc.contributor.author Kahn, Kathleen
dc.contributor.author Madhi, Shabir A.
dc.contributor.author Cohen, Adam L.
dc.contributor.author Moyes, Jocelyn
dc.contributor.author Venter, Marietjie
dc.contributor.author Pretorius, Marthi
dc.contributor.author Treurnicht, Florette
dc.contributor.author Hellferscee, Orienka
dc.contributor.author Von Gottberg, Anne
dc.contributor.author Wolter, Nicole
dc.contributor.author Cohen, Cheryl
dc.date.accessioned 2022-05-17T05:47:15Z
dc.date.available 2022-05-17T05:47:15Z
dc.date.issued 2021-08
dc.description.abstract BACKGROUND: Severe acute respiratory illness (SARI) is an important cause of mortality in young children, especially in children living with HIV infection. Disparities in SARI death in children aged <5 years exist in urban and rural areas. OBJECTIVE: To compare the factors associated with in-hospital death among children aged <5 years hospitalized with SARI in an urban vs. a rural setting in South Africa from 2009–2013. METHODS: Data were collected from hospitalized children with SARI in one urban and two rural sentinel surveillance hospitals. Nasopharyngeal aspirates were tested for ten respiratory viruses and blood for pneumococcal DNA using polymerase chain reaction. We used multivariable logistic regression to identify patient and clinical characteristics associated with in-hospital death. RESULTS: From 2009 through 2013, 5,297 children aged <5 years with SARI-associated hospital admission were enrolled; 3,811 (72%) in the urban and 1,486 (28%) in the rural hospitals. In-hospital case-fatality proportion (CFP) was higher in the rural hospitals (6.9%) than the urban hospital (1.3%, p<0.001), and among HIV-infected than the HIV-uninfected children (9.6% vs. 1.6%, p<0.001). In the urban hospital, HIV infection (odds ratio (OR):11.4, 95% confidence interval (CI):5.4–24.1) and presence of any other underlying illness (OR: 3.0, 95% CI: 1.0–9.2) were the only factors independently associated with death. In the rural hospitals, HIV infection (OR: 4.1, 95% CI: 2.3–7.1) and age <1 year (OR: 3.7, 95% CI: 1.9– 7.2) were independently associated with death, whereas duration of hospitalization ≥ 5 days (OR: 0.5, 95% CI: 0.3–0.8) and any respiratory virus detection (OR: 0.4, 95% CI: 0.3–0.8) were negatively associated with death. CONCLUSION: We found that the case-fatality proportion was substantially higher among children admitted to rural hospitals and HIV infected children with SARI in South Africa. While efforts to prevent and treat HIV infections in children may reduce SARI deaths, further efforts to address health care inequality in rural populations are needed. en_US
dc.description.department Medical Virology en_US
dc.description.librarian pm2022 en_US
dc.description.uri http://www.plosone.org en_US
dc.identifier.citation Ayeni OA, Walaza S, Tempia S, Groome M, Kahn K, Madhi SA, et al. (2021) Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009–2013. PLoS ONE 16(8): e0255941. https://doi.org/10.1371/journal.pone.0255941. en_US
dc.identifier.issn 1932-6203 (online)
dc.identifier.other 10.1371/ journal.pone.0255941
dc.identifier.uri https://repository.up.ac.za/handle/2263/85228
dc.language.iso en en_US
dc.publisher Public Library of Science en_US
dc.rights © This is an open access article distributed under the Creative Commons CC0 public domain dedication. en_US
dc.subject Severe acute respiratory illness (SARI) en_US
dc.subject Children living with HIV (CLWH) en_US
dc.subject Mortality en_US
dc.subject Children en_US
dc.subject South Africa (SA) en_US
dc.title Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009–2013 en_US
dc.type Article en_US


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