Health itinerary-related survival of children under-five with severe malaria or bloodstream infection, DR Congo.
Creators: name: Tack, Bieke
name: Vita, Daniel
name: Nketo, José
name: Wasolua, Naomie
name: Ndengila, Nathalie
name: Herssens, Natacha
name: Ntangu, Emmanuel
name: Kasidiko, Grace
name: Nkoji-Tunda, Gaëlle
name: Phoba, Marie-France
name: Im, Justin
name: Jeon, Hyon Jin
name: Marks, Florian
name: Toelen, Jaan
name: Lunguya, Octavie
name: Jacobs, Jan
Publisher: name: Apollo - University of Cambridge Repository
Year: 2023
Subjects: Humans
Child
Infant
Democratic Republic of the Congo
Cohort Studies
Hospital Mortality
Malaria
Salmonella
Malaria, Falciparum
Bacterial Infections
Sepsis

description: Acknowledgements: The authors are very grateful to the HIT BSI research team for their dedicated patient enrolment, data collection and patient follow-up. The authors also thank all clinical, laboratory and research staff from Kisantu hospital, INRB and IVI for their collaboration during their routine clinical care and microbiological surveillance activities. We would also like to thank the hospital management and local health authorities; their involvement, support and insights have been crucial for this study. Finally, the authors thank the unit of Tropical Bacteriology, the Clinical Trial Unit at ITM and the ITM office in Kinshasa for their support in writing procedures, clinical study management and support in logistics and accountancy. We thank Inge Van Cauwenberg for her support to the project administration and management.
description: Funder: European Society of Clinical Microbiology and Infectious Diseases; funder-id: http://dx.doi.org/10.13039/501100001704; Grant(s): Research Grant for the follow-up study ‘Treating Non-typhoidal Salmonella Bloodstream Infections in Children Under-five in DR Congo: a Cohort Study (TreNTS)’
description: BACKGROUND: Prompt appropriate treatment reduces mortality of severe febrile illness in sub-Saharan Africa. We studied the health itinerary of children under-five admitted to the hospital with severe febrile illness in a setting endemic for Plasmodium falciparum (Pf) malaria and invasive non-typhoidal Salmonella infections, identified delaying factors and assessed their associations with in-hospital death. METHODOLOGY: Health itinerary data of this cohort study were collected during 6 months by interviewing caretakers of children (&gt;28 days - &lt;5 years) admitted with suspected bloodstream infection to Kisantu district hospital, DR Congo. The cohort was followed until discharge to assess in-hospital death. PRINCIPAL FINDINGS: From 784 enrolled children, 36.1% were admitted &gt;3 days after fever onset. This long health itinerary was more frequent in children with bacterial bloodstream infection (52.9% (63/119)) than in children with severe Pf malaria (31.0% (97/313)). Long health itinerary was associated with in-hospital death (OR = 2.1, p = 0.007) and two thirds of deaths occurred during the first 3 days of admission. Case fatality was higher in bloodstream infection (22.8% (26/114)) compared to severe Pf malaria (2.6%, 8/309). Bloodstream infections were mainly (74.8% (89/119)) caused by non-typhoidal Salmonella. Bloodstream infections occurred in 20/43 children who died in-hospital before possible enrolment and non-typhoidal Salmonella caused 16 out of these 20 bloodstream infections. Delaying factors associated with in-hospital death were consulting traditional, private and/or multiple providers, rural residence, prehospital intravenous therapy, and prehospital overnight stays. Use of antibiotics reserved for hospital use, intravenous therapy and prehospital overnight stays were most frequent in the private sector. CONCLUSIONS: Long health itineraries delayed appropriate treatment of bloodstream infections in children under-five and were associated with increased in-hospital mortality. Non-typhoidal Salmonella were the main cause of bloodstream infection and had high case fatality. TRIAL REGISTRATION: NCT04289688.