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Seroprevalence of anti-Lassa Virus IgG antibodies in three districts of Sierra Leone: A cross-sectional, population-based study

Grant, Donald S. ; Engel, Emily J. ; Roberts Yerkes, Nicole ; [et al.]

Public Library of Science (PLoS) ; 2023

In: PLOS Neglected Tropical Diseases Vol. 17, No. 2 ( 2023-2-9), p. e0010938-

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In: PLOS Neglected Tropical Diseases, Public Library of Science (PLoS), Vol. 17, No. 2 ( 2023-2-9), p. e0010938-

Abstract: Lassa virus (LASV), the cause of the acute viral hemorrhagic illness Lassa fever (LF), is endemic in West Africa. Infections in humans occur mainly after exposure to infected excrement or urine of the rodent-host, Mastomys natalensis . The prevalence of exposure to LASV in Sierra Leone is crudely estimated and largely unknown. This cross-sectional study aimed to establish a baseline point seroprevalence of IgG antibodies to LASV in three administrative districts of Sierra Leone and identify potential risk factors for seropositivity and LASV exposure. Methodology and principal findings Between 2015 and 2018, over 10,642 participants from Kenema, Tonkolili, and Port Loko Districts were enrolled in this cross-sectional study. Previous LASV and LF epidemiological studies support classification of these districts as “endemic,” “emerging,” and “non-endemic”, respectively. Dried blood spot samples were tested for LASV antibodies by ELISA to determine the seropositivity of participants, indicating previous exposure to LASV. Surveys were administered to each participant to assess demographic and environmental factors associated with a higher risk of exposure to LASV. Overall seroprevalence for antibodies to LASV was 16.0%. In Kenema, Port Loko, and Tonkolili Districts, seroprevalences were 20.1%, 14.1%, and 10.6%, respectively. In a multivariate analysis, individuals were more likely to be LASV seropositive if they were living in Kenema District, regardless of sex, age, or occupation. Environmental factors contributed to an increased risk of LASV exposure, including poor housing construction and proximity to bushland, forested areas, and refuse. Conclusions and significance In this study we determine a baseline LASV seroprevalence in three districts which will inform future epidemiological, ecological, and clinical studies on LF and the LASV in Sierra Leone. The heterogeneity of the distribution of LASV and LF over both space, and time, can make the design of efficacy trials and intervention programs difficult. Having more studies on the prevalence of LASV and identifying potential hyper-endemic areas will greatly increase the awareness of LF and improve targeted control programs related to LASV.

Type of Medium: Online Resource

ISSN: 1935-2735

URL: Article

DOI: 10.1371/journal.pntd.0010938

DOI: 10.1371/journal.pntd.0010938.g001

DOI: 10.1371/journal.pntd.0010938.g002

DOI: 10.1371/journal.pntd.0010938.g003

DOI: 10.1371/journal.pntd.0010938.g004

DOI: 10.1371/journal.pntd.0010938.g005

DOI: 10.1371/journal.pntd.0010938.t001

DOI: 10.1371/journal.pntd.0010938.t002

DOI: 10.1371/journal.pntd.0010938.t003

DOI: 10.1371/journal.pntd.0010938.s001

DOI: 10.1371/journal.pntd.0010938.s002

DOI: 10.1371/journal.pntd.0010938.s003

DOI: 10.1371/journal.pntd.0010938.s004

DOI: 10.1371/journal.pntd.0010938.s005

DOI: 10.1371/journal.pntd.0010938.r001

DOI: 10.1371/journal.pntd.0010938.r002

DOI: 10.1371/journal.pntd.0010938.r003

DOI: 10.1371/journal.pntd.0010938.r004

DOI: 10.1371/journal.pntd.0010938.r005

DOI: 10.1371/journal.pntd.0010938.r006

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2023

detail.hit.zdb_id: 2429704-5

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Lassa Fever among Children in Eastern Province, Sierra Leone: A 7-year Retrospective Analysis (2012–2018)

Samuels, Robert J. ; Moon, Troy D. ; Starnes, Joseph R. ; [et al.]

American Society of Tropical Medicine and Hygiene ; 2021

In: The American Journal of Tropical Medicine and Hygiene Vol. 104, No. 2 ( 2021-02-03), p. 585-592

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In: The American Journal of Tropical Medicine and Hygiene, American Society of Tropical Medicine and Hygiene, Vol. 104, No. 2 ( 2021-02-03), p. 585-592

Abstract: Pediatric Lassa fever (LF) usually presents as a nonspecific febrile illness, similar to other endemic diseases in countries like Sierra Leone, where LF is considered to be hyperendemic. The nonspecificity of presentation and lack of research have made it difficult to fully understand best practices for pediatric management. We aim to describe clinical characteristics of hospitalized pediatric patients suspected or diagnosed with LF and assess factors associated with hospital outcomes among those with LF antigen–positive results. We conducted a 7-year retrospective cohort study using routine data for all children younger than 18 years admitted at the Kenema Government Hospital’s LF ward. A total of 292 children with suspected or confirmed LF were analyzed. Overall, mortality was high (21%). Children with antigen-positive results had a high case fatality rate of 63% ( P 〈 0.01). In univariate analyses, children who presented with unexplained bleeding (odds ratio [OR]: 3.58; 95% CI: 1.08–11.86; P = 0.040) and confusion (altered sensorium) (OR: 5.37; 95% CI: 1.34–21.48; P = 0.020) had increased odds of death. Abnormal serum levels of alanine aminotransferase ( P = 0.001), creatinine ( P = 0.004), and potassium ( P = 0.003) were associated with increased likelihood of death in these children. Treatment with ribavirin was not significantly associated with survival ( P = 0.916). Our findings provide insights into current pediatric LF clinical presentation and management. More evidence-based, high-quality research in creating predictive algorithms of antigen-positivity and hospital outcomes is needed in the management of pediatric LF.

Type of Medium: Online Resource

ISSN: 0002-9637 , 1476-1645

URL: Article

DOI: 10.4269/ajtmh.20-0773

Language: Unknown

Publisher: American Society of Tropical Medicine and Hygiene

Publication Date: 2021

detail.hit.zdb_id: 1491674-5

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Predicting the evolution of the Lassa virus endemic area and population at risk over the next decades

Klitting, Raphaëlle ; Kafetzopoulou, Liana E. ; Thiery, Wim ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Nature Communications Vol. 13, No. 1 ( 2022-09-27)

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In: Nature Communications, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2022-09-27)

Abstract: Lassa fever is a severe viral hemorrhagic fever caused by a zoonotic virus that repeatedly spills over to humans from its rodent reservoirs. It is currently not known how climate and land use changes could affect the endemic area of this virus, currently limited to parts of West Africa. By exploring the environmental data associated with virus occurrence using ecological niche modelling, we show how temperature, precipitation and the presence of pastures determine ecological suitability for virus circulation. Based on projections of climate, land use, and population changes, we find that regions in Central and East Africa will likely become suitable for Lassa virus over the next decades and estimate that the total population living in ecological conditions that are suitable for Lassa virus circulation may drastically increase by 2070. By analysing geotagged viral genomes using spatially-explicit phylogeography and simulating virus dispersal, we find that in the event of Lassa virus being introduced into a new suitable region, its spread might remain spatially limited over the first decades.

Type of Medium: Online Resource

ISSN: 2041-1723

URL: Article

DOI: 10.1038/s41467-022-33112-3

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2553671-0

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Respiratory virus surveillance in hospitalized children less than two-years of age in Kenema, Sierra Leone during the COVID-19 pandemic (October 2020- October 2021)

Samuels, Robert J. ; Sumah, Ibrahim ; Alhasan, Foday ; [et al.]

Public Library of Science (PLoS) ; 2023

In: PLOS ONE Vol. 18, No. 10 ( 2023-10-10), p. e0292652-

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In: PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 10 ( 2023-10-10), p. e0292652-

Abstract: Globally, viral pathogens are the leading cause of acute respiratory infection in children under-five years. We aim to describe the epidemiology of viral respiratory pathogens in hospitalized children under-two years of age in Eastern Province of Sierra Leone, during the second year of the SARS-CoV-2 pandemic. We conducted a prospective study of children hospitalized with respiratory symptoms between October 2020 and October 2021. We collected demographic and clinical characteristics and calculated each participant´s respiratory symptom severity. Nose and throat swabs were collected at enrollment. Total nucleic acid was purified and tested for multiple respiratory viruses. Statistical analysis was performed using R version 4.2.0 software. 502 children less than two-years of age were enrolled. 376 (74.9%) had at least one respiratory virus detected. The most common viruses isolated were HRV/EV (28.2%), RSV (19.5%) and PIV (13.1%). Influenza and SARS-CoV-2 were identified in only 9.2% and 3.9% of children, respectively. Viral co-detection was common. Human metapneumovirus and RSV had more than two-fold higher odds of requiring O2 therapy while hospitalized. Viral pathogen prevalence was high (74.9%) in our study population. Despite this, 100% of children received antibiotics, underscoring a need to expand laboratory diagnostic capacity and to revisit clinical guidelines implementation in these children. Continuous surveillance and serologic studies among more diverse age groups, with greater geographic breadth, are needed in Sierra Leone to better characterize the long-term impact of COVID-19 on respiratory virus prevalence and to better characterize the seasonality of respiratory viruses in Sierra Leone.

Type of Medium: Online Resource

ISSN: 1932-6203

URL: Article

DOI: 10.1371/journal.pone.0292652

DOI: 10.1371/journal.pone.0292652.g001

DOI: 10.1371/journal.pone.0292652.g002

DOI: 10.1371/journal.pone.0292652.t001

DOI: 10.1371/journal.pone.0292652.t002

DOI: 10.1371/journal.pone.0292652.t003

DOI: 10.1371/journal.pone.0292652.t004

DOI: 10.1371/journal.pone.0292652.s001

DOI: 10.1371/journal.pone.0292652.s002

DOI: 10.1371/journal.pone.0292652.r001

DOI: 10.1371/journal.pone.0292652.r002

DOI: 10.1371/journal.pone.0292652.r003

DOI: 10.1371/journal.pone.0292652.r004

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2023

detail.hit.zdb_id: 2267670-3

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Health seeking behavior after the 2013–16 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District, Sierra Leone

Koch, Mikaela R. ; Kanneh, Lansana ; Wise, Paul H. ; [et al.]

Public Library of Science (PLoS) ; 2021

In: PLOS Neglected Tropical Diseases Vol. 15, No. 7 ( 2021-7-14), p. e0009576-

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In: PLOS Neglected Tropical Diseases, Public Library of Science (PLoS), Vol. 15, No. 7 ( 2021-7-14), p. e0009576-

Abstract: The West African Ebola epidemic of 2013–2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone’s Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone. Methodology/Principal findings Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011–2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare. Conclusions/Significance Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.

Type of Medium: Online Resource

ISSN: 1935-2735

URL: Article

DOI: 10.1371/journal.pntd.0009576

DOI: 10.1371/journal.pntd.0009576.g001

DOI: 10.1371/journal.pntd.0009576.g002

DOI: 10.1371/journal.pntd.0009576.g003

DOI: 10.1371/journal.pntd.0009576.g004

DOI: 10.1371/journal.pntd.0009576.g005

DOI: 10.1371/journal.pntd.0009576.g006

DOI: 10.1371/journal.pntd.0009576.t001

DOI: 10.1371/journal.pntd.0009576.s001

DOI: 10.1371/journal.pntd.0009576.s002

DOI: 10.1371/journal.pntd.0009576.s003

DOI: 10.1371/journal.pntd.0009576.s004

DOI: 10.1371/journal.pntd.0009576.s005

DOI: 10.1371/journal.pntd.0009576.s006

DOI: 10.1371/journal.pntd.0009576.s007

DOI: 10.1371/journal.pntd.0009576.s008

DOI: 10.1371/journal.pntd.0009576.s009

DOI: 10.1371/journal.pntd.0009576.s010

DOI: 10.1371/journal.pntd.0009576.r001

DOI: 10.1371/journal.pntd.0009576.r002

DOI: 10.1371/journal.pntd.0009576.r003

DOI: 10.1371/journal.pntd.0009576.r004

DOI: 10.1371/journal.pntd.0009576.r005

DOI: 10.1371/journal.pntd.0009576.r006

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2021

detail.hit.zdb_id: 2429704-5

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Boosting understanding of Lassa Fever virus epidemiology: Field testing a novel assay to identify past Lassa Fever virus infection in blood and oral fluids of survivors and unexposed controls in Sierra Leone

Akpogheneta, Onome ; Dicks, Steve ; Grant, Donald ; [et al.]

Public Library of Science (PLoS) ; 2021

In: PLOS Neglected Tropical Diseases Vol. 15, No. 3 ( 2021-3-31), p. e0009255-

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In: PLOS Neglected Tropical Diseases, Public Library of Science (PLoS), Vol. 15, No. 3 ( 2021-3-31), p. e0009255-

Abstract: Despite identification 50 years ago, the true burden of Lassa Fever (LF) across Africa remains undefined for reasons including research focus on hospitalised patients, lack of validated field-feasible tools which reliably identify past infection, and the fact that all assays require blood samples making large-scale surveys difficult. Designated a priority pathogen of epidemic potential requiring urgent research by the World Health Organisation, a better understanding of LF sero-epidemiology is essential to developing and evaluating new interventions including vaccines. We describe the first field testing of a novel species-neutral Double Antigen Binding Assay (DABA) designed to detect antibodies to LF in plasma and oral fluid. Methodology/Principal findings Paired plasma and oral fluid were collected in Sierra Leone from survivors discharged from Kenema Government Hospital Lassa Fever Unit between 1980 and 2018, and from controls recruited in Freetown in 2019. Epidemiological sensitivity and specificity of the DABA measured against historical diagnosis in survivors and self-declared non-exposed controls was 81.7% (95% CI 70.7%– 89.9%) and 83.3% (72.7%- 91.1%) respectively in plasma, and 71.8% (60.0%– 81.9%) and 83.3% (72.7%– 91.1%) respectively in oral fluid. Antibodies were identified in people infected up to 15 years and, in one case, 40 years previously. Participants found oral fluid collection easy and painless with 80% happy to give an oral fluid sample regularly. Conclusions/Significance Given the difficulties of assay validation in a resource-limited setting, including unexpected exposures and diagnostics of varying accuracy, the new assay performed well in both plasma and oral fluid. Sensitivity and specificity are expected to be higher when case/control ascertainment is more definitive and further work is planned to investigate this. Even at the performance levels achieved, the species-neutral DABA has the potential to facilitate the large-scale seroprevalence surveys needed to underpin essential developments in LF control, as well as support zoonotic investigations.

Type of Medium: Online Resource

ISSN: 1935-2735

URL: Article

DOI: 10.1371/journal.pntd.0009255

DOI: 10.1371/journal.pntd.0009255.g001

DOI: 10.1371/journal.pntd.0009255.g002

DOI: 10.1371/journal.pntd.0009255.g003

DOI: 10.1371/journal.pntd.0009255.g004

DOI: 10.1371/journal.pntd.0009255.g005

DOI: 10.1371/journal.pntd.0009255.g006

DOI: 10.1371/journal.pntd.0009255.t001

DOI: 10.1371/journal.pntd.0009255.t002

DOI: 10.1371/journal.pntd.0009255.t003

DOI: 10.1371/journal.pntd.0009255.t004

DOI: 10.1371/journal.pntd.0009255.s001

DOI: 10.1371/journal.pntd.0009255.s002

DOI: 10.1371/journal.pntd.0009255.s003

DOI: 10.1371/journal.pntd.0009255.s004

Language: English

Publisher: Public Library of Science (PLoS)

Publication Date: 2021

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The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone

Ficenec, Samuel C. ; Grant, Donald S. ; Sumah, Ibrahim ; [et al.]

Springer Science and Business Media LLC ; 2022

In: BMC Infectious Diseases Vol. 22, No. 1 ( 2022-12)

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In: BMC Infectious Diseases, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)

Abstract: Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world’s population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors. Methodology and principal findings EVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p 〈 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p 〈 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss. Conclusions and significance This study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.

Type of Medium: Online Resource

ISSN: 1471-2334

URL: Article

DOI: 10.1186/s12879-022-07604-y

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2041550-3

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The Origins and Future of Sentinel: An Early-Warning System for Pandemic Preemption and Response

Botti-Lodovico, Yolanda ; Nair, Parvathy ; Nosamiefan, Dolo ; [et al.]

MDPI AG ; 2021

In: Viruses Vol. 13, No. 8 ( 2021-08-13), p. 1605-

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In: Viruses, MDPI AG, Vol. 13, No. 8 ( 2021-08-13), p. 1605-

Abstract: While investigating a signal of adaptive evolution in humans at the gene LARGE, we encountered an intriguing finding by Dr. Stefan Kunz that the gene plays a critical role in Lassa virus binding and entry. This led us to pursue field work to test our hypothesis that natural selection acting on LARGE—detected in the Yoruba population of Nigeria—conferred resistance to Lassa Fever in some West African populations. As we delved further, we conjectured that the “emerging” nature of recently discovered diseases like Lassa fever is related to a newfound capacity for detection, rather than a novel viral presence, and that humans have in fact been exposed to the viruses that cause such diseases for much longer than previously suspected. Dr. Stefan Kunz’s critical efforts not only laid the groundwork for this discovery, but also inspired and catalyzed a series of events that birthed Sentinel, an ambitious and large-scale pandemic prevention effort in West Africa. Sentinel aims to detect and characterize deadly pathogens before they spread across the globe, through implementation of its three fundamental pillars: Detect, Connect, and Empower. More specifically, Sentinel is designed to detect known and novel infections rapidly, connect and share information in real time to identify emerging threats, and empower the public health community to improve pandemic preparedness and response anywhere in the world. We are proud to dedicate this work to Stefan Kunz, and eagerly invite new collaborators, experts, and others to join us in our efforts.

Type of Medium: Online Resource

ISSN: 1999-4915

URL: Article

DOI: 10.3390/v13081605

Language: English

Publisher: MDPI AG

Publication Date: 2021

detail.hit.zdb_id: 2516098-9

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Space-Time Trends in Lassa Fever in Sierra Leone by ELISA Serostatus, 2012–2019

Shaffer, Jeffrey ; Schieffelin, John ; Momoh, Mambu ; [et al.]

MDPI AG ; 2021

In: Microorganisms Vol. 9, No. 3 ( 2021-03-12), p. 586-

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In: Microorganisms, MDPI AG, Vol. 9, No. 3 ( 2021-03-12), p. 586-

Abstract: Lassa fever (LF) is a viral hemorrhagic disease found in Sub-Saharan Africa and is responsible for up to 300,000 cases and 5000 deaths annually. LF is highly endemic in Sierra Leone, particularly in its Eastern Province. Kenema Government Hospital (KGH) maintains one of only a few LF isolation facilities in the world with year-round diagnostic testing. Here we focus on space-time trends for LF occurring in Sierra Leone between 2012 and 2019 to provide a current account of LF in the wake of the 2014–2016 Ebola epidemic. Data were analyzed for 3277 suspected LF cases and classified as acute, recent, and non-LF or prior LF exposure using enzyme-linked immunosorbent assays (ELISAs). Presentation rates for acute, recent, and non-LF or prior LF exposure were 6.0% (195/3277), 25.6% (838/3277), and 68.4% (2244/3277), respectively. Among 2051 non-LF or prior LF exposures, 33.2% (682/2051) tested positive for convalescent LF exposure. The overall LF case-fatality rate (CFR) was 78.5% (106/135). Both clinical presentations and confirmed LF cases declined following the Ebola epidemic. These declines coincided with an increased duration between illness onset and clinical presentation, perhaps suggesting more severe disease or presentation at later stages of illness. Acute LF cases and their corresponding CFRs peaked during the dry season (November to April). Subjects with recent (but not acute) LF exposure were more likely to present during the rainy season (May to October) than the dry season (p 〈 0.001). The findings here suggest that LF remains endemic in Sierra Leone and that caseloads are likely to resume at levels observed prior to the Ebola epidemic. The results provide insight on the current epidemiological profile of LF in Sierra Leone to facilitate LF vaccine studies and accentuate the need for LF cohort studies and continued advancements in LF diagnostics.

Type of Medium: Online Resource

ISSN: 2076-2607

URL: Article

DOI: 10.3390/microorganisms9030586

Language: English

Publisher: MDPI AG

Publication Date: 2021

detail.hit.zdb_id: 2720891-6

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Antibiotic prescribing practices for acute respiratory illness in children less than 24 months of age in Kenema, Sierra Leone: is it time to move beyond algorithm driven decision making?

Moon, Troy D. ; Sumah, Ibrahim ; Amorim, Gustavo ; [et al.]

Springer Science and Business Media LLC ; 2023

In: BMC Infectious Diseases Vol. 23, No. 1 ( 2023-09-25)

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In: BMC Infectious Diseases, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-09-25)

Abstract: Lower respiratory tract infections are the leading cause of mortality in young children globally. In many resource-limited settings clinicians rely on guidelines such as IMCI or ETAT + that promote empiric antibiotic utilization for management of acute respiratory illness (ARI). Numerous evaluations of both guidelines have shown an overall positive response however, several challenges have also been reported, including the potential for over-prescribing of unnecessary antibiotics. The aims of this study were to describe the antibiotic prescribing practices for children less than 24 months of age with symptoms of ARI, that were admitted to Kenema Government Hospital (KGH) in the Eastern Province of Sierra Leone, and to identify the number of children empirically prescribed antibiotics who were admitted to hospital with ARI, as well as their clinical signs, symptoms, and outcomes. Methods We conducted a prospective study of children 〈 24 months of age admitted to the KGH pediatric ward with respiratory symptoms between October 1, 2020 and May 31, 2022. Study nurses collected data on demographic information, medical and medication history, and information on clinical course while hospitalized. Results A total of 777 children were enrolled. Prior to arrival at the hospital, 224 children (28.8%) reported taking an antibiotic for this illness without improvement. Only 15 (1.9%) children received a chest radiograph to aid in diagnosis and 100% of patients were placed on antibiotics during their hospital stay. Conclusions Despite the lives saved, reliance on clinical decision-support tools such as IMCI and ETAT + for pediatric ARI, is resulting in the likely over-prescribing of antibiotics. Greater uptake of implementation research is needed to develop strategies and tools designed to optimize antibiotic use for ARI in LMIC settings. Additionally, much greater priority needs to be given to ensuring clinicians have the basic tools for clinical diagnosis, as well as greater investments in essential laboratory and radiographic diagnostics that help LMIC clinicians move beyond the sole reliance on algorithm based clinical decision making.

Type of Medium: Online Resource

ISSN: 1471-2334

URL: Article

DOI: 10.1186/s12879-023-08606-0

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

detail.hit.zdb_id: 2041550-3

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