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      Investigating the early-life determinants of illness in Africa: the Drakenstein Child Health Study

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      Author(s): 1 , 1 , 2 , 3 , 4
      Publication date (Electronic):
      Journal: Thorax
      Publisher: BMJ Publishing Group
      Keywords: Pneumonia

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          Abstract

          Respiratory disease is the predominant cause of illness in children globally. We describe a unique multidisciplinary South African birth cohort, the Drakenstein Child Health Study (DCHS), to investigate the incidence, risk factors, aetiology and long-term impact of early lower respiratory tract infection (LRTI) on child health. Pregnant women from a poor, peri-urban community with high exposure to infectious diseases and environmental risk factors are enrolled with 1000 mother–child pairs followed for at least 5 years. Biomedical, environmental, psychosocial and demographic risk factors are longitudinally measured. Environmental exposures are measured using monitors placed at home visits. Lung function is measured in children at 6 weeks, annually and during LRTI episodes. Microbiological investigations including microbiome and multiplex PCR measures are done longitudinally and at LRTI episodes. The DCHS is a unique African birth cohort study that uses sophisticated measures to comprehensively investigate the early-life determinants of child health in an impoverished area of the world.

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          Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries

          Igor Rudan, Katherine O’Brien, Harish Nair … (2013)
          Background The recent series of reviews conducted within the Global Action Plan for Pneumonia and Diarrhoea (GAPPD) addressed epidemiology of the two deadly diseases at the global and regional level; it also estimated the effectiveness of interventions, barriers to achieving high coverage and the main implications for health policy. The aim of this paper is to provide the estimates of childhood pneumonia at the country level. This should allow national policy–makers and stakeholders to implement proposed policies in the World Health Organization (WHO) and UNICEF member countries. Methods We conducted a series of systematic reviews to update previous estimates of the global, regional and national burden of childhood pneumonia incidence, severe morbidity, mortality, risk factors and specific contributions of the most common pathogens: Streptococcus pneumoniae (SP), Haemophilus influenzae type B (Hib), respiratory syncytial virus (RSV) and influenza virus (flu). We distributed the global and regional–level estimates of the number of cases, severe cases and deaths from childhood pneumonia in 2010–2011 by specific countries using an epidemiological model. The model was based on the prevalence of the five main risk factors for childhood pneumonia within countries (malnutrition, low birth weight, non–exclusive breastfeeding in the first four months, solid fuel use and crowding) and risk effect sizes estimated using meta–analysis. Findings The incidence of community–acquired childhood pneumonia in low– and middle–income countries (LMIC) in the year 2010, using World Health Organization's definition, was about 0.22 (interquartile range (IQR) 0.11–0.51) episodes per child–year (e/cy), with 11.5% (IQR 8.0–33.0%) of cases progressing to severe episodes. This is a reduction of nearly 25% over the past decade, which is consistent with observed reductions in the prevalence of risk factors for pneumonia throughout LMIC. At the level of pneumonia incidence, RSV is the most common pathogen, present in about 29% of all episodes, followed by influenza (17%). The contribution of different pathogens varies by pneumonia severity strata, with viral etiologies becoming relatively less important and most deaths in 2010 caused by the main bacterial agents – SP (33%) and Hib (16%), accounting for vaccine use against these two pathogens. Conclusions In comparison to 2000, the primary epidemiological evidence contributing to the models of childhood pneumonia burden has improved only slightly; all estimates have wide uncertainty bounds. Still, there is evidence of a decreasing trend for all measures of the burden over the period 2000–2010. The estimates of pneumonia incidence, severe morbidity, mortality and etiology, although each derived from different and independent data, are internally consistent – lending credibility to the new set of estimates. Pneumonia continues to be the leading cause of both morbidity and mortality for young children beyond the neonatal period and requires ongoing strategies and progress to reduce the burden further.
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            The global burden of respiratory disease-impact on child health.

            Heather J Zar, Thomas Ferkol (2014)
            Respiratory disease is the major cause of mortality and morbidity worldwide, with infants and young children especially susceptible. The spectrum of disease ranges from acute infections to chronic non-communicable diseases. Five respiratory conditions dominate-acute respiratory infections, chronic obstructive pulmonary disease, asthma, tuberculosis (TB), and lung cancer. Pneumonia remains the predominant cause of childhood mortality, causing nearly 1.3 million deaths each year, most of which are preventable. Asthma is the commonest non-communicable disease in children. Pediatric TB constitutes up to 20% of the TB caseload in high incidence countries. Environmental exposures such as tobacco smoke, indoor air pollution, and poor nutrition are common risk factors for acute and chronic respiratory diseases. Pediatric and adult respiratory disease is closely linked. Early childhood respiratory infection or environmental exposures may lead to chronic disease in adulthood. Childhood immunization can effectively reduce the incidence and severity of childhood pneumonia; childhood immunization is also effective for reducing pneumonia in the elderly. The Forum of International Respiratory Societies (FIRS), representing the major respiratory societies worldwide, has produced a global roadmap of respiratory diseases, Respiratory Disease in the World: Realities of Today-Opportunities for Tomorrow. This highlights the burden of respiratory diseases globally and contains specific recommendations for effective strategies. Greater availability and upscaled implementation of effective strategies for prevention and management of respiratory diseases is needed worldwide to improve global health and diminish the current inequities in health care worldwide.
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              Long Term Sequelae from Childhood Pneumonia; Systematic Review and Meta-Analysis

              Karen Edmond, Susana Scott, Viola Korczak … (2012)
              Background The risks of long term sequelae from childhood pneumonia have not been systematically assessed. The aims of this study were to: (i) estimate the risks of respiratory sequelae after pneumonia in children under five years; (ii) estimate the distribution of the different types of respiratory sequelae; and (iii) compare sequelae risk by hospitalisation status and pathogen. Methods We systematically reviewed published papers from 1970 to 2011. Standard global burden of disease categories (restrictive lung disease, obstructive lung disease, bronchiectasis) were labelled as major sequelae. ‘Minor’ sequelae (chronic bronchitis, asthma, other abnormal pulmonary function, other respiratory disease), and multiple impairments were also included. Thirteen papers were selected for inclusion. Synthesis was by random effects meta-analysis and meta-regression. Results Risk of at least one major sequelae was 5.5% (95% confidence interval [95% CI] 2.8–8.3%) in non hospitalised children and 13.6% [6.2–21.1%]) in hospitalised children. Adenovirus pneumonia was associated with the highest sequelae risk (54.8% [39.2–70.5%]) but children hospitalised with no pathogen isolated also had high risk (17.6% [10.9–24.3%]). The most common type of major sequela was restrictive lung disease (5.4% [2.5–10.2%]) . Potential confounders such as loss to follow up and median age at infection were not associated with sequelae risk in the final models. Conclusions All children with pneumonia diagnosed by a health professional should be considered at risk of long term sequelae. Evaluation of childhood pneumonia interventions should include potential impact on long term respiratory sequelae.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Thorax
                Journal ID (iso-abbrev): Thorax
                Journal ID (hwp): thoraxjnl
                Journal ID (publisher-id): thorax
                Title: Thorax
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 0040-6376
                ISSN (Electronic): 1468-3296
                Publication date (Print): June 2015
                Publication date (Electronic): 16 September 2014
                Volume: 70
                Issue: 6
                Pages: 592-594
                Affiliations
                [1 ]Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town , Cape Town, South Africa
                [2 ]Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town , Cape Town, South Africa
                [3 ]Department of Psychiatry and Mental Health and MRC Unit on Anxiety & Stress Disorders, University of Cape Town , Cape Town, South Africa
                [4 ]Department of Clinical Laboratory Sciences, University of Cape Town , Cape Town, South Africa
                Author notes
                [Correspondence to ] Professor Heather J Zar, Department of Paediatrics and Child Health, 5th Floor, ICH Building, Red Cross War Memorial Children's Hospital, Cape Town 7700, South Africa; heather.zar@ 123456uct.ac.za
                Article
                Publisher ID: thoraxjnl-2014-206242
                DOI: 10.1136/thoraxjnl-2014-206242
                PMC ID: 5107608
                PubMed ID: 25228292
                SO-VID: ea9e16d7-16cb-4efe-b8d1-4fbb4ac82862
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 29 August 2014
                Date accepted : 30 August 2014
                Categories
                Subject: 1506
                Subject: Chest Clinic
                Series title: Audit, research and guideline update
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                ScienceOpen disciplines: Surgery
                Keywords: pneumonia
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: pneumonia

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