8 research outputs found
Aetiology of acute febrile episodes in children attending Korogwe District Hospital in north-eastern Tanzania
No full textIntroduction: Although the burden of malaria in many parts of Tanzania has declined, the proportion of children with fever has not changed. This situation underscores the need to explore the possible causes of febrile episodes in patients presenting with symptoms at the Korogwe District Hospital (KDH).
Methods: A hospital based cross-sectional study was conducted at KDH, north-eastern Tanzania. Patients aged 2 to 59 months presenting at the outpatient department with an acute medical condition and fever (measured axillary temperature ≥37.5°C) were enrolled. Blood samples were examined for malaria parasites, human immunodeficiency virus (HIV) and bacterial infections. A urine culture was performed in selected cases to test for bacterial infection and a chest radiograph was requested if pneumonia was suspected. Diagnosis was based on both clinical and laboratory investigations.
Results: A total of 867 patients with a median age of 15.1 months (Interquartile range 8.6-29.9) were enrolled from January 2013 to October 2013. Respiratory tract infections were the leading clinical diagnosis with 406/867 (46.8%) of patients diagnosed with upper respiratory tract infection and 130/867 (15.0%) with pneumonia. Gastroenteritis was diagnosed in 184/867 (21.2%) of patients. Malaria infection was confirmed in 72/867 (8.3%) of patients. Bacterial infection in blood and urine accounted for 26/808 (3.2%) infections in the former, and 66/373 (17.7%) infections in the latter. HIV infection was confirmed in 10/824 (1.2%) of patients. Respiratory tract infections and gastroenteritis were frequent in patients under 36 months of age (87.3% and 91.3% respectively). Co-infections were seen in 221/867 (25.5%) of patients. The cause of fever was not identified in 65/867 (7.5%) of these patients.
Conclusions: The different proportions of infections found among febrile children reflect the causes of fever in the study area. These findings indicate the need to optimise patient management by developing malaria and non-malaria febrile illnesses management protocols. © 2014 Mahende et al
Bloodstream bacterial infection among outpatient children with acute febrile illness in north‑eastern Tanzania
No full textBackground: Fever is a common clinical symptom in children attending hospital outpatient clinics in rural Tanzania,
yet there is still a paucity of data on the burden of bloodstream bacterial infection among these patients.
Methods: The present study was conducted at Korogwe District Hospital in north-eastern Tanzania. Patients aged
between 2 and 59 months with a history of fever or measured axillary temperature ≥37.5°C attending the outpatient
clinic were screened for enrolment into the study. Blood culturing was performed using the BACTEC 9050® system.
A biochemical analytical profile index and serological tests were used for identification and confirmation of bacterial
isolates. In-vitro antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method. The
identification of Plasmodium falciparum malaria was performed by microscopy with Giemsa stained blood films.
Results: A total of 808 blood cultures were collected between January and October 2013. Bacterial growth was
observed in 62/808 (7.7%) of the cultured samples. Pathogenic bacteria were identified in 26/808 (3.2%) cultures and
the remaining 36/62 (58.1%) were classified as contaminants. Salmonella typhi was the predominant bacterial isolate
detected in 17/26 (65.4%) patients of which 16/17 (94.1%) were from patients above 12 months of age. Streptococcus
pneumoniae was the second leading bacterial isolate detected in 4/26 (15.4%) patients. A high proportion of S.
typhi 11/17 (64.7%) was isolated during the rainy season. S. typhi isolates were susceptible to ciprofloxacin (n = 17/17,
100%) and ceftriaxone (n = 13/17, 76.5%) but resistant to chloramphenicol (n = 15/17, 88.2%). P. falciparum malaria
was identified in 69/808 (8.5%) patients, none of whom had bacterial infection.
Conclusion: Bloodstream bacterial infection was not found to be a common cause of fever in outpatient children;
and S. typhi was the predominant isolate. This study highlights the need for rational use of antimicrobial prescription
in febrile paediatric outpatients presenting at healthcare facilities in rural Tanzania
Demographic characteristics, clinical diagnosis and laboratory findings of patients enrolled at KDH.
No full text†<p><i>Escherichia coli</i> (1), <i>Enterobacter cloacae</i> (1), <i>Staphylococcus</i> aureus (1).</p>‡<p><i>Acinetobacter baumanii</i> (1), <i>Citrobacter koseri</i> (1), <i>Pseudomonas aeruginosa</i> (2), <i>Staphylococcus aureus</i> (6) <i>Staphylococcus saprophyticus</i> (3), <i>Streptococcus faecalis</i> (1), <i>Streptococcus mitis</i> (1), <i>Streptococcus viridans</i> (2).</p
Study flow diagram of patient enrollment at KDH and the investigations performed.
No full text<p>Study flow diagram of patient enrollment at KDH and the investigations performed.</p
Distribution of illnesses among hospitalised patients at KDH (n = 141).
No full text<p>Distribution of illnesses among hospitalised patients at KDH (n = 141).</p
Distribution of common diagnosis according to age group.
No full text<p>Distribution of common diagnosis according to age group.</p
Efficacy and safety of the RTS,S/AS01 malaria vaccine during 18 months after vaccination : a phase 3 randomized, controlled trial in children and young infants at 11 African sites
No full textA malaria vaccine could be an important addition to current control strategies. We report the safety and vaccine efficacy (VE) of the RTS,S/AS01 vaccine during 18 mo following vaccination at 11 African sites with varying malaria transmission.; 6,537 infants aged 6-12 wk and 8,923 children aged 5-17 mo were randomized to receive three doses of RTS,S/AS01 or comparator vaccine. VE against clinical malaria in children during the 18 mo after vaccine dose 3 (per protocol) was 46% (95% CI 42% to 50%) (range 40% to 77%; VE, p>0.01 across all sites). VE during the 20 mo after vaccine dose 1 (intention to treat [ITT]) was 45% (95% CI 41% to 49%). VE against severe malaria, malaria hospitalization, and all-cause hospitalization was 34% (95% CI 15% to 48%), 41% (95% CI 30% to 50%), and 19% (95% CI 11% to 27%), respectively (ITT). VE against clinical malaria in infants was 27% (95% CI 20% to 32%, per protocol; 27% [95% CI 21% to 33%], ITT), with no significant protection against severe malaria, malaria hospitalization, or all-cause hospitalization. Post-vaccination anti-circumsporozoite antibody geometric mean titer varied from 348 to 787 EU/ml across sites in children and from 117 to 335 EU/ml in infants (per protocol). VE waned over time in both age categories (Schoenfeld residuals p>0.001). The number of clinical and severe malaria cases averted per 1,000 children vaccinated ranged across sites from 37 to 2,365 and from -1 to 49, respectively; corresponding ranges among infants were -10 to 1,402 and -13 to 37, respectively (ITT). Meningitis was reported as a serious adverse event in 16/5,949 and 1/2,974 children and in 9/4,358 and 3/2,179 infants in the RTS,S/AS01 and control groups, respectively.; RTS,S/AS01 prevented many cases of clinical and severe malaria over the 18 mo after vaccine dose 3, with the highest impact in areas with the greatest malaria incidence. VE was higher in children than in infants, but even at modest levels of VE, the number of malaria cases averted was substantial. RTS,S/AS01 could be an important addition to current malaria control in Africa
