Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries.

Autor:	Nachega JB; Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland., Sam-Agudu NA; International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.; Institute of Human Virology, University of Maryland School of Medicine, Baltimore.; Department of Pediatrics, University of Maryland School of Medicine, Baltimore.; Department of Pediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana., Machekano RN; Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa., Rabie H; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa., van der Zalm MM; Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa., Redfern A; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa., Dramowski A; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa., O'Connell N; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa., Pipo MT; Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo.; Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo., Tshilanda MB; Unit of Sickle Cell Disease and Clinical Research, Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo., Byamungu LN; Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa., Masekela R; Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa., Jeena PM; Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa., Pillay A; Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa., Gachuno OW; Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya., Kinuthia J; Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya., Ishoso DK; Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo., Amoako E; Department of Pediatrics, Cape Coast Teaching Hospital, Cape Coast, Ghana., Agyare E; Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana., Agbeno EK; Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana., Martyn-Dickens C; Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana., Sylverken J; Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.; Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana., Enimil A; Pediatrics Infectious Diseases Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.; Department of Child Health, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana., Jibril AM; Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria., Abdullahi AM; Department of Internal Medicine, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria., Amadi O; Department of Pediatrics, Asokoro District Hospital, Abuja, Nigeria., Umar UM; Department of Internal Medicine, Asokoro District Hospital, Abuja, Nigeria., Sigwadhi LN; Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa., Hermans MP; Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium., Otokoye JO; Health Emergencies Program, COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo., Mbala-Kingebeni P; National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo., Muyembe-Tamfum JJ; National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo., Zumla A; Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, London, United Kingdom.; National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Services Foundation Trust, London, United Kingdom., Sewankambo NK; School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda., Aanyu HT; Department of Pediatrics, Mulago Hospital, Kampala, Uganda., Musoke P; Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda., Suleman F; Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa., Adejumo P; Department of Nursing, University of Ibadan, Ibadan, Nigeria., Noormahomed EV; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique., Deckelbaum RJ; Department of Pediatrics, Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York., Fowler MG; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland., Tshilolo L; Department of Pediatrics, Official University of Mbuji-Mayi, Kinshasa, Democratic Republic of the Congo.; Le Centre de Formation et d'Appui Sanitaire, Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo., Smith G; Department of Real World and Advanced Analytics, Cytel, Vancouver, British Columbia, Canada., Mills EJ; Department of Real World and Advanced Analytics, Cytel, Vancouver, British Columbia, Canada.; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada., Umar LW; Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria., Siedner MJ; Department of Medicine, Division of Infectious Diseases, Harvard Medical School, Massachusetts General Hospital, Boston.; Department of Medicine, School of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda., Kruger M; Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa., Rosenthal PJ; Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco., Mellors JW; Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Mofenson LM; Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia.
Jazyk:	angličtina
Zdroj:	JAMA pediatrics [JAMA Pediatr] 2022 Mar 01; Vol. 176 (3), pp. e216436. Date of Electronic Publication: 2022 Mar 07.
DOI:	10.1001/jamapediatrics.2021.6436
Abstrakt:	Importance: Little is known about COVID-19 outcomes among children and adolescents in sub-Saharan Africa, where preexisting comorbidities are prevalent. Objective: To assess the clinical outcomes and factors associated with outcomes among children and adolescents hospitalized with COVID-19 in 6 countries in sub-Saharan Africa. Design, Setting, and Participants: This cohort study was a retrospective record review of data from 25 hospitals in the Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda from March 1 to December 31, 2020, and included 469 hospitalized patients aged 0 to 19 years with SARS-CoV-2 infection. Exposures: Age, sex, preexisting comorbidities, and region of residence. Main Outcomes and Measures: An ordinal primary outcome scale was used comprising 5 categories: (1) hospitalization without oxygen supplementation, (2) hospitalization with oxygen supplementation, (3) ICU admission, (4) invasive mechanical ventilation, and (5) death. The secondary outcome was length of hospital stay. Results: Among 469 hospitalized children and adolescents, the median age was 5.9 years (IQR, 1.6-11.1 years); 245 patients (52.4%) were male, and 115 (24.5%) had comorbidities. A total of 39 patients (8.3%) were from central Africa, 172 (36.7%) from eastern Africa, 208 (44.3%) from southern Africa, and 50 (10.7%) from western Africa. Eighteen patients had suspected (n = 6) or confirmed (n = 12) multisystem inflammatory syndrome in children. Thirty-nine patients (8.3%) died, including 22 of 69 patients (31.9%) who required intensive care unit admission and 4 of 18 patients (22.2%) with suspected or confirmed multisystem inflammatory syndrome in children. Among 468 patients, 418 (89.3%) were discharged, and 16 (3.4%) remained hospitalized. The likelihood of outcomes with higher vs lower severity among children younger than 1 year expressed as adjusted odds ratio (aOR) was 4.89 (95% CI, 1.44-16.61) times higher than that of adolescents aged 15 to 19 years. The presence of hypertension (aOR, 5.91; 95% CI, 1.89-18.50), chronic lung disease (aOR, 2.97; 95% CI, 1.65-5.37), or a hematological disorder (aOR, 3.10; 95% CI, 1.04-9.24) was associated with severe outcomes. Age younger than 1 year (adjusted subdistribution hazard ratio [asHR], 0.48; 95% CI, 0.27-0.87), the presence of 1 comorbidity (asHR, 0.54; 95% CI, 0.40-0.72), and the presence of 2 or more comorbidities (asHR, 0.26; 95% CI, 0.18-0.38) were associated with reduced rates of hospital discharge. Conclusions and Relevance: In this cohort study of children and adolescents hospitalized with COVID-19 in sub-Saharan Africa, high rates of morbidity and mortality were observed among infants and patients with noncommunicable disease comorbidities, suggesting that COVID-19 vaccination and therapeutic interventions are needed for young populations in this region.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu