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

dc.contributor.authorAyeni, Oluwatosin A.
dc.contributor.authorWalaza, Sibongile
dc.contributor.authorTempia, Stefano
dc.contributor.authorGroome, Michelle
dc.contributor.authorKahn, Kathleen
dc.contributor.authorMadhi, Shabir A.
dc.contributor.authorCohen, Adam L.
dc.contributor.authorMoyes, Jocelyn
dc.contributor.authorVenter, Marietjie
dc.contributor.authorPretorius, Marthi
dc.contributor.authorTreurnicht, Florette
dc.contributor.authorHellferscee, Orienka
dc.contributor.authorVon Gottberg, Anne
dc.contributor.authorWolter, Nicole
dc.contributor.authorCohen, Cheryl
dc.date.accessioned2022-05-17T05:47:15Z
dc.date.available2022-05-17T05:47:15Z
dc.date.issued2021-08
dc.description.abstractBACKGROUND: 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.departmentMedical Virologyen_US
dc.description.librarianpm2022en_US
dc.description.urihttp://www.plosone.orgen_US
dc.identifier.citationAyeni 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.issn1932-6203 (online)
dc.identifier.other10.1371/ journal.pone.0255941
dc.identifier.urihttps://repository.up.ac.za/handle/2263/85228
dc.language.isoenen_US
dc.publisherPublic Library of Scienceen_US
dc.rights© This is an open access article distributed under the Creative Commons CC0 public domain dedication.en_US
dc.subjectSevere acute respiratory illness (SARI)en_US
dc.subjectChildren living with HIV (CLWH)en_US
dc.subjectMortalityen_US
dc.subjectChildrenen_US
dc.subjectSouth Africa (SA)en_US
dc.titleMortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009–2013en_US
dc.typeArticleen_US

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