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06408nam a2201129Ia 4500 |
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10-1001-jamapediatrics-2021-6436 |
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220420s2022 CNT 000 0 und d |
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|a 21686203 (ISSN)
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|a Assessment of Clinical Outcomes among Children and Adolescents Hospitalized with COVID-19 in 6 Sub-Saharan African Countries
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|b American Medical Association
|c 2022
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|z View Fulltext in Publisher
|u https://doi.org/10.1001/jamapediatrics.2021.6436
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|a 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. © 2022 Nachega JB et al.
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|a adolescent
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|a Adolescent
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|a Africa south of the Sahara
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|a Africa South of the Sahara
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|a artificial ventilation
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|a child
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|a Child
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|a Child, Hospitalized
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|a Child, Preschool
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|a COVID-19
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|a female
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|a Female
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|a hospitalized child
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|a human
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|a Humans
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|a infant
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|a Infant
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|a length of stay
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|a Length of Stay
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|a male
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|a Male
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|a mortality
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|a Outcome Assessment, Health Care
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|a Oxygen Inhalation Therapy
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|a oxygen therapy
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|a pandemic
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|a Pandemics
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|a Pneumonia, Viral
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|a preschool child
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|a Respiration, Artificial
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|a SARS-CoV-2
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|a virology
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|a virus pneumonia
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|a Aanyu, H.T.
|e author
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|a Abdullahi, A.M.
|e author
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|a Adejumo, P.
|e author
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|a African Forum for Research and Education in Health (AFREhealth) COVID-19 Research Collaboration on Children and Adolescents
|e author
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|a Agbeno, E.K.
|e author
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|a Agyare, E.
|e author
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|a Amadi, O.
|e author
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|a Amoako, E.
|e author
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|a Byamungu, L.N.
|e author
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|a Deckelbaum, R.J.
|e author
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|a Dramowski, A.
|e author
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|a Enimil, A.
|e author
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|a Fowler, M.G.
|e author
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|a Gachuno, O.W.
|e author
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|a Hermans, M.P.
|e author
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|a Ishoso, D.K.
|e author
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|a Jeena, P.M.
|e author
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|a Jibril, A.M.
|e author
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|a Kinuthia, J.
|e author
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|a Kruger, M.
|e author
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|a MacHekano, R.N.
|e author
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|a Martyn-Dickens, C.
|e author
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|a Masekela, R.
|e author
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|a Mbala-Kingebeni, P.
|e author
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|a Mellors, J.W.
|e author
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|a Mills, E.J.
|e author
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|a Mofenson, L.M.
|e author
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|a Musoke, P.
|e author
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|a Muyembe-Tamfum, J.-J.
|e author
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|a Nachega, J.B.
|e author
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|a Noormahomed, E.V.
|e author
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|a O'Connell, N.
|e author
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|a Otokoye, J.O.
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|a Pillay, A.
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|a Pipo, M.T.
|e author
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|a Rabie, H.
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|a Redfern, A.
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|a Rosenthal, P.J.
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|a Sam-Agudu, N.A.
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|a Sewankambo, N.K.
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|a Siedner, M.J.
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|a Sigwadhi, L.N.
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|a Smith, G.
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|a Suleman, F.
|e author
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|a Sylverken, J.
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|a Tshilanda, M.B.
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|a Tshilolo, L.
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|a Umar, L.W.
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|a Umar, U.M.
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|a Van Der Zalm, M.M.
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|a Zumla, A.
|e author
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|t JAMA Pediatrics
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