Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study
Background: Médecins Sans Frontières (MSF) opened Ebola management centres (EMCs) in Sierra Leone in Kailahun in June, 2014, and Bo in September, 2014. Case fatality in the west African Ebola virus disease epidemic has been highest in children younger than 5 years. Clinical data on outcomes can prov...
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Elsevier
2016-07-01
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Series: | The Lancet Global Health |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X16300973 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Tejshri Shah, MSc Jane Greig, PhD Linda Margaretha van der Plas, MD Jay Achar, MBBS Grazia Caleo, MD James Sylvester Squire, MD Alhaji Sayui Turay, MD Grace Joshy, PhD Catherine D'Este, PhD Emily Banks, PhD Florian Vogt, MSc Kamalini Lokuge, PhD |
spellingShingle |
Tejshri Shah, MSc Jane Greig, PhD Linda Margaretha van der Plas, MD Jay Achar, MBBS Grazia Caleo, MD James Sylvester Squire, MD Alhaji Sayui Turay, MD Grace Joshy, PhD Catherine D'Este, PhD Emily Banks, PhD Florian Vogt, MSc Kamalini Lokuge, PhD Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study The Lancet Global Health |
author_facet |
Tejshri Shah, MSc Jane Greig, PhD Linda Margaretha van der Plas, MD Jay Achar, MBBS Grazia Caleo, MD James Sylvester Squire, MD Alhaji Sayui Turay, MD Grace Joshy, PhD Catherine D'Este, PhD Emily Banks, PhD Florian Vogt, MSc Kamalini Lokuge, PhD |
author_sort |
Tejshri Shah, MSc |
title |
Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study |
title_short |
Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study |
title_full |
Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study |
title_fullStr |
Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study |
title_full_unstemmed |
Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort study |
title_sort |
inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two ebola management centres in sierra leone, 2014: a retrospective cohort study |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2016-07-01 |
description |
Background: Médecins Sans Frontières (MSF) opened Ebola management centres (EMCs) in Sierra Leone in Kailahun in June, 2014, and Bo in September, 2014. Case fatality in the west African Ebola virus disease epidemic has been highest in children younger than 5 years. Clinical data on outcomes can provide important evidence to guide future management. However, such data on children are scarce and disaggregated clinical data across all ages in this epidemic have focussed on symptoms reported on arrival at treatment facilities, rather than symptoms and signs observed during admission. We aimed to describe the clinical characteristics of children aged 5 years and younger admitted to the MSF EMCs in Bo and Kailahun, and any associations between these characteristics and mortality.
Methods: In a retrospective cohort study, we included data from children aged 5 years and younger with laboratory-confirmed Ebola virus disease admitted to EMCs between June and December, 2014. We described epidemiological, demographic, and clinical characteristics and viral load (measured using Ebola virus cycle thresholds [Ct]), and assessed their association with death using Cox regression modelling.
Findings: We included 91 children in analysis; 52 died (57·1%). Case fatality was higher in children aged less than 2 years (76·5% [26/34]) than those aged 2–5 years (45·6% [26/57]; adjusted HR 3·5 [95% CI 1·5–8·5]) and in those with high (Ct<25) versus low (Ct≥25) viral load (81·8% [18/22] vs 45·9% [28/61], respectively; adjusted HR 9·2 [95% CI 3·8–22·5]). Symptoms observed during admission included: weakness 74·7% (68); fever 70·8% (63/89); distress 63·7% (58); loss of appetite 60·4% (55); diarrhoea 59·3% (54); and cough 52·7% (48). At admission, 25% (19/76) of children were afebrile. Signs significantly associated with death were fever, vomiting, and diarrhoea. Hiccups, bleeding, and confusion were observed only in children who died.
Interpretation: This description of the clinical features of Ebola virus disease over the duration of illness in children aged 5 years and younger shows symptoms associated with death and a high prevalence of distress, with implications for clinical management. Collection and analysis of age-specific data on Ebola is very important to ensure that the specific vulnerabilities of children are addressed.
Funding: No specific funding was received for this study. EB is supported by the National Health and Medical Research Council of Australia. |
url |
http://www.sciencedirect.com/science/article/pii/S2214109X16300973 |
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doaj-dacfc854d0db4acbade8faf617dc67292020-11-25T02:29:30ZengElsevierThe Lancet Global Health2214-109X2016-07-0147e495e50110.1016/S2214-109X(16)30097-3Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: a retrospective cohort studyTejshri Shah, MSc0Jane Greig, PhD1Linda Margaretha van der Plas, MD2Jay Achar, MBBS3Grazia Caleo, MD4James Sylvester Squire, MD5Alhaji Sayui Turay, MD6Grace Joshy, PhD7Catherine D'Este, PhD8Emily Banks, PhD9Florian Vogt, MSc10Kamalini Lokuge, PhD11Manson Unit, Médecins Sans Frontières, London, UKManson Unit, Médecins Sans Frontières, London, UKDepartment of Medical Oncology, Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam, NetherlandsManson Unit, Médecins Sans Frontières, London, UKManson Unit, Médecins Sans Frontières, London, UKMinistry of Health and Sanitation of Sierra Leone, Kailahun, Sierra LeoneMinistry of Health and Sanitation of Sierra Leone, Bo, Sierra LeoneNational Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, AustraliaNational Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, AustraliaNational Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, AustraliaMédecins Sans Frontières, Brussels, BelgiumManson Unit, Médecins Sans Frontières, London, UKBackground: Médecins Sans Frontières (MSF) opened Ebola management centres (EMCs) in Sierra Leone in Kailahun in June, 2014, and Bo in September, 2014. Case fatality in the west African Ebola virus disease epidemic has been highest in children younger than 5 years. Clinical data on outcomes can provide important evidence to guide future management. However, such data on children are scarce and disaggregated clinical data across all ages in this epidemic have focussed on symptoms reported on arrival at treatment facilities, rather than symptoms and signs observed during admission. We aimed to describe the clinical characteristics of children aged 5 years and younger admitted to the MSF EMCs in Bo and Kailahun, and any associations between these characteristics and mortality. Methods: In a retrospective cohort study, we included data from children aged 5 years and younger with laboratory-confirmed Ebola virus disease admitted to EMCs between June and December, 2014. We described epidemiological, demographic, and clinical characteristics and viral load (measured using Ebola virus cycle thresholds [Ct]), and assessed their association with death using Cox regression modelling. Findings: We included 91 children in analysis; 52 died (57·1%). Case fatality was higher in children aged less than 2 years (76·5% [26/34]) than those aged 2–5 years (45·6% [26/57]; adjusted HR 3·5 [95% CI 1·5–8·5]) and in those with high (Ct<25) versus low (Ct≥25) viral load (81·8% [18/22] vs 45·9% [28/61], respectively; adjusted HR 9·2 [95% CI 3·8–22·5]). Symptoms observed during admission included: weakness 74·7% (68); fever 70·8% (63/89); distress 63·7% (58); loss of appetite 60·4% (55); diarrhoea 59·3% (54); and cough 52·7% (48). At admission, 25% (19/76) of children were afebrile. Signs significantly associated with death were fever, vomiting, and diarrhoea. Hiccups, bleeding, and confusion were observed only in children who died. Interpretation: This description of the clinical features of Ebola virus disease over the duration of illness in children aged 5 years and younger shows symptoms associated with death and a high prevalence of distress, with implications for clinical management. Collection and analysis of age-specific data on Ebola is very important to ensure that the specific vulnerabilities of children are addressed. Funding: No specific funding was received for this study. EB is supported by the National Health and Medical Research Council of Australia.http://www.sciencedirect.com/science/article/pii/S2214109X16300973 |