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

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Assessment of Clinical Outcomes Among Children and Adolescents Hospitalized With COVID-19 in 6 Sub-Saharan African Countries.
JAMA Pediatrics ( IF 24.7 ) Pub Date : 2022-03-07 , DOI: 10.1001/jamapediatrics.2021.6436
Jean B Nachega _{1,

2,

3,

4} , Nadia A Sam-Agudu _{5,

6,

7,

8} , Rhoderick N Machekano ₉ , Helena Rabie ₁₀ , Marieke M van der Zalm ₁₁ , Andrew Redfern ₁₀ , Angela Dramowski ₁₀ , Natasha O'Connell ₁₀ , Michel Tshiasuma Pipo _{12,

13} , Marc B Tshilanda ₁₃ , Liliane Nsuli Byamungu ₁₄ , Refiloe Masekela ₁₄ , Prakash Mohan Jeena ₁₄ , Ashendri Pillay ₁₄ , Onesmus W Gachuno ₁₅ , John Kinuthia ₁₆ , Daniel Katuashi Ishoso ₁₇ , Emmanuella Amoako ₁₈ , Elizabeth Agyare ₁₉ , Evans K Agbeno ₂₀ , Charles Martyn-Dickens ₂₁ , Justice Sylverken _{21,

22} , Anthony Enimil _{21,

22} , Aishatu Mohammed Jibril ₂₃ , Asara M Abdullahi ₂₄ , Oma Amadi ₂₅ , Umar Mohammed Umar ₂₆ , Lovemore Nyasha Sigwadhi ₉ , Michel P Hermans ₂₇ , John Otshudiema Otokoye ₂₈ , Placide Mbala-Kingebeni ₂₉ , Jean-Jacques Muyembe-Tamfum ₂₉ , Alimuddin Zumla _{30,

31} , Nelson K Sewankambo ₃₂ , Hellen Tukamuhebwa Aanyu ₃₃ , Philippa Musoke ₃₄ , Fatima Suleman ₃₅ , Prisca Adejumo ₃₆ , Emilia V Noormahomed ₃₇ , Richard J Deckelbaum ₃₈ , Mary Glenn Fowler ₃₉ , Léon Tshilolo _{40,

41} , Gerald Smith ₄₂ , Edward J Mills _{42,

43} , Lawal W Umar ₂₃ , Mark J Siedner _{44,

45} , Mariana Kruger ₁₀ , Philip J Rosenthal ₄₆ , John W Mellors ₄₇ , Lynne M Mofenson ₄₈ ,

Affiliation

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.
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.
Division of Epidemiology and Biostatics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.
Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
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.
Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa.
Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
Community Health Department, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
Department of Pediatrics, Cape Coast Teaching Hospital, Cape Coast, Ghana.
Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana.
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana.
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.
Department of Pediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria.
Department of Internal Medicine, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria.
Department of Pediatrics, Asokoro District Hospital, Abuja, Nigeria.
Department of Internal Medicine, Asokoro District Hospital, Abuja, Nigeria.
Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium.
Health Emergencies Program, COVID-19 Response, World Health Organization, Kinshasa, Democratic Republic of the Congo.
National Institute of Biomedical Research, Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo.
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.
School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Pediatrics, Mulago Hospital, Kampala, Uganda.
Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa.
Department of Nursing, University of Ibadan, Ibadan, Nigeria.
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
Department of Pediatrics, Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York.
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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.
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.
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.
Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, San Francisco.
Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia.

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.

中文翻译：

评估 6 个撒哈拉以南非洲国家因 COVID-19 住院的儿童和青少年的临床结果。

重要性关于 COVID-19 在撒哈拉以南非洲地区儿童和青少年中的结果知之甚少，那里既往存在的合并症很普遍。目的评估撒哈拉以南非洲 6 个国家因 COVID-19 住院的儿童和青少年的临床结果和与结果相关的因素。设计、地点和参与者这项队列研究是对 2020 年 3 月 1 日至 12 月 31 日刚果民主共和国、加纳、肯尼亚、尼日利亚、南非和乌干达 25 家医院数据的回顾性记录审查，包括 469 0 至 19 岁的 SARS-CoV-2 感染住院患者。暴露年龄、性别、先前存在的合并症和居住地区。主要结果和测量使用了一个有序的主要结果量表，包括 5 个类别：(1)住院不补氧，(2)住院补氧，(3)入住ICU，(4)有创机械通气，(5)死亡。次要结果是住院时间。结果在 469 名住院儿童和青少年中，中位年龄为 5.9 岁（IQR，1.6-11.1 岁）；245 名患者 (52.4%) 为男性，115 名 (24.5%) 患者有合并症。中非共39例（8.3%），东非172例（36.7%），南部非洲208例（44.3%），西非50例（10.7%）。18 名患者疑似 (n = 6) 或确诊 (n = 12) 儿童多系统炎症综合征。39 名患者 (8.3%) 死亡，其中 69 名患者中有 22 名 (31.9%) 需要入住重症监护室，18 名患者中有 4 名 (22. 2%）患有疑似或确诊的儿童多系统炎症综合征。468 例患者中，出院 418 例（89.3%），住院 16 例（3.4%）。在 1 岁以下儿童中，以调整后的比值比 (aOR) 表示的严重程度较高或较低严重程度的可能性是 15 至 19 岁青少年的 4.89（95% CI，1.44-16.61）倍。存在高血压（aOR，5.91；95% CI，1.89-18.50）、慢性肺病（aOR，2.97；95% CI，1.65-5.37）或血液病（aOR，3.10；95% CI，1.04- 9.24) 与严重结果相关。年龄小于 1 岁（调整后的亚分布风险比 [asHR]，0.48；95% CI，0.27-0.87），存在 1 种合并症（asHR，0.54；95% CI，0.40-0.72），并且存在 2 种或更多合并症（asHR，0.26；95% CI，0.18-0。38) 与出院率降低有关。结该地区的年轻人口。

更新日期：2022-01-19

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