OBJECTIVE: As the proportion of children living low malaria transmission areas in sub-Saharan Africa increases, approaches for identifying non-malarial severe illness need to be evaluated to improve child outcomes. DESIGN: As a prospective cohort study, we identified febrile paediatric inpatients, recorded data using Integrated Management of Childhood Illness (IMCI) criteria, and collected diagnostic specimens. SETTING: Tertiary referral centre, northern Tanzania. RESULTS: Of 466 participants with known outcome, median age was 1.4 years (range 2 months-13.0 years), 200 (42.9%) were female, 11 (2.4%) had malaria and 34 (7.3%) died. Inpatient death was associated with: Capillary refill >3 s (OR 9.0, 95% CI 3.0 to 26.7), inability to breastfeed or drink (OR 8.9, 95% CI 4.0 to 19.6), stiff neck (OR 7.0, 95% CI 2.8 to 17.6), lethargy (OR 5.2, 95% CI 2.5 to 10.6), skin pinch >2 s (OR 4.8, 95% CI 1.9 to 12.3), respiratory difficulty (OR 4.0, 95% CI 1.9 to 8.2), generalised lymphadenopathy (OR 3.6, 95% CI 1.6 to 8.3) and oral candidiasis (OR 3.4, 95% CI 1.4 to 8.3). BCS <5 (OR 27.2, p<0.001) and severe wasting (OR 6.9, p<0.001) were independently associated with inpatient death. CONCLUSIONS: In a low malaria transmission setting, IMCI criteria performed well for predicting inpatient death from non-malarial illness. Laboratory results were not as useful in predicting death, underscoring the importance of clinical examination in assessing prognosis. Healthcare workers should consider local malaria epidemiology as malaria over-diagnosis in children may delay potentially life-saving interventions in areas where malaria is uncommon.
OBJECTIVE: As the proportion of children living low malaria transmission areas in sub-Saharan Africa increases, approaches for identifying non-malarial severe illness need to be evaluated to improve child outcomes. DESIGN: As a prospective cohort study, we identified febrile paediatric inpatients, recorded data using Integrated Management of Childhood Illness (IMCI) criteria, and collected diagnostic specimens. SETTING: Tertiary referral centre, northern Tanzania. RESULTS: Of 466 participants with known outcome, median age was 1.4 years (range 2 months-13.0 years), 200 (42.9%) were female, 11 (2.4%) had malaria and 34 (7.3%) died. Inpatient death was associated with: Capillary refill >3 s (OR 9.0, 95% CI 3.0 to 26.7), inability to breastfeed or drink (OR 8.9, 95% CI 4.0 to 19.6), stiff neck (OR 7.0, 95% CI 2.8 to 17.6), lethargy (OR 5.2, 95% CI 2.5 to 10.6), skin pinch >2 s (OR 4.8, 95% CI 1.9 to 12.3), respiratory difficulty (OR 4.0, 95% CI 1.9 to 8.2), generalised lymphadenopathy (OR 3.6, 95% CI 1.6 to 8.3) and oral candidiasis (OR 3.4, 95% CI 1.4 to 8.3). BCS <5 (OR 27.2, p<0.001) and severe wasting (OR 6.9, p<0.001) were independently associated with inpatient death. CONCLUSIONS: In a low malaria transmission setting, IMCI criteria performed well for predicting inpatient death from non-malarial illness. Laboratory results were not as useful in predicting death, underscoring the importance of clinical examination in assessing prognosis. Healthcare workers should consider local malaria epidemiology as malaria over-diagnosis in children may delay potentially life-saving interventions in areas where malaria is uncommon.
Authors: Joanna R M Armstrong Schellenberg; Rose Nathan; Salim Abdulla; Oscar Mukasa; Tanya J Marchant; Marcel Tanner; Christian Lengeler Journal: Trop Med Int Health Date: 2002-06 Impact factor: 2.622
Authors: John A Crump; Habib O Ramadhani; Anne B Morrissey; Levina J Msuya; Lan-Yan Yang; Shein-Chung Chow; Susan C Morpeth; Hugh Reyburn; Boniface N Njau; Andrea V Shaw; Helmut C Diefenthal; John A Bartlett; John F Shao; Werner Schimana; Coleen K Cunningham; Grace D Kinabo Journal: Trop Med Int Health Date: 2011-04-07 Impact factor: 2.622
Authors: Heiko Becher; Olaf Müller; Albrecht Jahn; Adjima Gbangou; Gisela Kynast-Wolf; Bocar Kouyaté Journal: Bull World Health Organ Date: 2004-04 Impact factor: 9.408
Authors: Paluku Bahwere; Patrick De Mol; Philippe Donnen; Michèle Dramaix-Wilmet; Jean Paul Butzler; Philippe Hennart; Jack Levy Journal: Pediatr Infect Dis J Date: 2004-08 Impact factor: 2.129
Authors: Elizabeth M Obimbo; Dorothy A Mbori-Ngacha; James O Ochieng; Barbra A Richardson; Phelgona A Otieno; Rose Bosire; Carey Farquhar; Julie Overbaugh; Grace C John-Stewart Journal: Pediatr Infect Dis J Date: 2004-06 Impact factor: 2.129
Authors: Joanna Armstrong Schellenberg; Jennifer Bryce; Don de Savigny; Thierry Lambrechts; Conrad Mbuya; Leslie Mgalula; Katarzyna Wilczynska Journal: Health Policy Plan Date: 2004-01 Impact factor: 3.344
Authors: Holly M Biggs; Rebecca Lester; Behzad Nadjm; George Mtove; Jim E Todd; Grace D Kinabo; Rune Philemon; Ben Amos; Anne B Morrissey; Hugh Reyburn; John A Crump Journal: Clin Infect Dis Date: 2013-12-13 Impact factor: 9.079
Authors: Matthew O Wiens; Charles P Larson; Elias Kumbakumba; Niranjan Kissoon; J Mark Ansermino; Joel Singer; Hubert Wong; Andrew Ndamira; Jerome Kabakyenga; Peter Moschovis; Julius Kiwanuka Journal: Pediatr Crit Care Med Date: 2016-05 Impact factor: 3.624
Authors: Nasim Lowlaavar; Charles P Larson; Elias Kumbakumba; Guohai Zhou; J Mark Ansermino; Joel Singer; Niranjan Kissoon; Hubert Wong; Andrew Ndamira; Jerome Kabakyenga; Julius Kiwanuka; Matthew O Wiens Journal: PLoS One Date: 2016-03-10 Impact factor: 3.240
Authors: David Gathara; Lucas Malla; Philip Ayieko; Stella Karuri; Rachel Nyamai; Grace Irimu; Michael Boele van Hensbroek; Elizabeth Allen; Mike English Journal: BMC Pediatr Date: 2017-04-05 Impact factor: 2.125
Authors: Manuela Carugati; Helen L Zhang; Kajiru G Kilonzo; Michael J Maze; Venance P Maro; Matthew P Rubach; John A Crump Journal: Am J Trop Med Hyg Date: 2018-11 Impact factor: 2.345
Authors: John A Crump; Anne B Morrissey; William L Nicholson; Robert F Massung; Robyn A Stoddard; Renee L Galloway; Eng Eong Ooi; Venance P Maro; Wilbrod Saganda; Grace D Kinabo; Charles Muiruri; John A Bartlett Journal: PLoS Negl Trop Dis Date: 2013-07-18