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, Cape Town, South Africa.
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLOS Glob Public Health. 2024 Jan 17;4(1):e0002754. doi: 10.1371/journal.pgph.0002754. eCollection 2024.
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 study. 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 associated with increased incidence rates of 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 (HR 1.43 [95% CI 1.12-1.82]), or raised maternal HIV viral load in HEU infants were risk factors for hospitalisation; breastfeeding was protective (HR 0.69 [95% CI 0.53-0.90]). In conclusion, children in SSA experience high rates of hospitalisation in early life. Infectious causes, especially RSV-LRTI, underly most hospital admissions. HEU children are at greater risk of hospitalisation in infancy compared to HUU children. Available strategies such as promoting breastfeeding, timely vaccination, and optimising antenatal maternal HIV care should be strengthened. New interventions to prevent RSV may have 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，受艾滋病毒暴露但未感染（HEU）影响的儿童弱势群体也在不断增加。了解儿童早期住院的原因和风险因素将有助于优化干预措施，以改善健康状况。我们在一项南非出生队列研究中调查了从出生到两岁的住院情况。德拉肯斯泰因儿童健康研究中的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。对与儿童住院相关的发病率、持续时间、原因和因素进行了调查，并在HEU儿童和未暴露于艾滋病毒且未感染（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%，但仍有314名（28%）儿童因430次住院。最高住院率出现在0至6个月，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/
