Research Protocol - 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

Hdl Handle:
http://hdl.handle.net/10144/618753
Title:
Research Protocol - 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
Authors:
Shah, Tejshri; Greig, Jane; van der Plas, LM; Achar, J; Caleo, Grazia; Squire, James Sylvester; Turay, AS; Joshy, G; D’Este, C; Banks, E; Vogt, Florian; Lokuge, Kamalini
Abstract:
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.
Affiliation:
MSF UK; St Mary’s Hospital, Imperial College NHS; Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam; Ministry of Health and Sanitation of Sierra Leone; National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University; MSF Brussels
Issue Date:
Jul-2016
URI:
http://hdl.handle.net/10144/618753
Language:
en
Appears in Collections:
MSF Research Protocols

Full metadata record

DC FieldValue Language
dc.contributor.authorShah, Tejshrien
dc.contributor.authorGreig, Janeen
dc.contributor.authorvan der Plas, LMen
dc.contributor.authorAchar, Jen
dc.contributor.authorCaleo, Graziaen
dc.contributor.authorSquire, James Sylvesteren
dc.contributor.authorTuray, ASen
dc.contributor.authorJoshy, Gen
dc.contributor.authorD’Este, Cen
dc.contributor.authorBanks, Een
dc.contributor.authorVogt, Florianen
dc.contributor.authorLokuge, Kamalinien
dc.date.accessioned2017-01-13T11:38:48Z-
dc.date.available2017-01-13T11:38:48Z-
dc.date.issued2016-07-
dc.identifier.urihttp://hdl.handle.net/10144/618753-
dc.description.abstractBackground 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.en
dc.language.isoenen
dc.titleResearch Protocol - 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 studyen
dc.contributor.departmentMSF UK; St Mary’s Hospital, Imperial College NHS; Antoni van Leeuwenhoek Hospital, Netherlands Cancer Institute, Amsterdam; Ministry of Health and Sanitation of Sierra Leone; National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University; MSF Brusselsen
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