Wedderburn Catherine J, Bondar Julia, Lake Marilyn T, Nhapi Raymond, Barnett Whitney, Nicol Mark P, Goddard Liz, Zar Heather J
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, South Africa.
Department of Clinical Research, London School of Hygiene & Tropical Medicine, UK.
medRxiv. 2023 Jun 12:2023.06.08.23289961. doi: 10.1101/2023.06.08.23289961.
Children in sub-Saharan Africa (SSA) are disproportionately affected by morbidity and mortality; there is also a growing vulnerable population of children who are HIV-exposed uninfected (HEU). Understanding reasons and risk factors for early-life child hospitalisation will help optimise interventions to improve health outcomes. We investigated hospitalisations from birth to two years in a South African birth cohort.
Mother-child pairs in the Drakenstein Child Health Study were followed from birth to two years with active surveillance for hospital admission and investigation of aetiology and outcome. Incidence, duration, cause, and factors associated with child hospitalisation were investigated, and compared between HEU and HIV-unexposed uninfected (HUU) children.
Of 1136 children (247 HEU; 889 HUU), 314 (28%) children were hospitalised in 430 episodes despite >98% childhood vaccination coverage. The highest hospitalisation rate was from 0-6 months, decreasing thereafter; 20% (84/430) of hospitalisations occurred in neonates at birth. Amongst hospitalisations subsequent to discharge after birth, 83% (288/346) had an infectious cause; lower respiratory tract infection (LRTI) was the most common cause (49%;169/346) with respiratory syncytial virus (RSV) responsible for 31% of LRTIs; from 0-6 months, RSV-LRTI accounted for 22% (36/164) of all-cause hospitalisations. HIV exposure was a risk factor for hospitalisation in infants (IRR 1.63 [95% CI 1.29-2.05]) and longer hospital admission (p=0.004). Prematurity (HR 2.82 [95% CI 2.28-3.49]), delayed infant vaccinations (1.43 [1.12-1.82]), or raised maternal HIV viral load in HEU infants were risk factors; breastfeeding was protective (0.69 [0.53-0.90]).
Children in SSA continue to experience high rates of hospitalisation in early life. Infectious causes, especially RSV-LRTI, underly most hospital admissions. HEU children are at particular risk in infancy. Available strategies such as promoting breastfeeding, timely vaccination, and optimising antenatal maternal HIV care should be strengthened. New interventions to prevent RSV may have a large additional impact in reducing hospitalisation.
撒哈拉以南非洲地区（SSA）的儿童在发病率和死亡率方面受到的影响尤为严重；此外，越来越多的儿童处于暴露于HIV但未感染（HEU）的脆弱群体中。了解早期儿童住院的原因和风险因素将有助于优化干预措施，以改善健康结果。我们对南非一个出生队列中从出生到两岁的儿童住院情况进行了调查。
在德拉肯斯堡儿童健康研究中，对母婴对从出生到两岁进行了积极监测，以了解住院情况，并对病因和结果进行调查。对儿童住院的发病率、持续时间、原因及相关因素进行了调查，并在HEU儿童和未暴露于HIV且未感染（HUU）的儿童之间进行了比较。
在1136名儿童（247名HEU；889名HUU）中，尽管儿童疫苗接种覆盖率超过98%，仍有314名（28%）儿童发生了430次住院。住院率最高的是0至6个月的儿童，此后逐渐下降；20%（84/430）的住院发生在出生时的新生儿期。在出生后出院后的住院病例中，83%（288/346）有感染性病因；下呼吸道感染（LRTI）是最常见的病因（49%；169/346），呼吸道合胞病毒（RSV）导致了31%的LRTI；在0至6个月的儿童中，RSV-LRTI占所有病因住院的22%（36/164）。HIV暴露是婴儿住院的一个风险因素（发病率比值比1.63 [95%置信区间1.29 - 2.05]），且住院时间更长（p = 0.004）。早产（风险比2.82 [95%置信区间2.28 - 3.49]）、婴儿疫苗接种延迟（1.43 [1.12 - 1.82]）或HEU婴儿中母亲HIV病毒载量升高是风险因素；母乳喂养具有保护作用（0.69 [0.53 - 0.90]）。
SSA地区的儿童在生命早期仍有较高的住院率。感染性病因，尤其是RSV-LRTI，是大多数住院病例的基础病因。HEU儿童在婴儿期面临特别的风险。应加强现有的策略，如促进母乳喂养、及时接种疫苗以及优化产前母亲的HIV护理。预防RSV的新干预措施可能对减少住院有很大的额外影响。
