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Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study.
Lancet Glob Health. 2015 Feb; 3(2):e95-e103.LG

Abstract

BACKGROUND

Childhood pneumonia causes substantial mortality and morbidity. Accurate measurements of pneumonia incidence are scarce in low-income and middle-income countries, particularly after implementation of pneumococcal conjugate vaccine. We aimed to assess the incidence, severity, and risk factors for pneumonia in the first year of life in children enrolled in a South African birth cohort.

METHODS

This birth cohort study is being done at two sites in Paarl, a periurban area of South Africa. We enrolled pregnant women (>18 years) and followed up mother-infant pairs to 1 year of age. We obtained data for risk factors and respiratory symptoms. Children received 13-valent pneumococcal conjugate vaccine according to national immunisation schedules. We established pneumonia surveillance systems and documented episodes of ambulatory pneumonia and pneumonia warranting hospital admission. We calculated incidence rate ratios for pneumonia with mixed-effects Poisson regression.

FINDINGS

Between May 29, 2012 and May 31, 2014, we enrolled 697 infants who accrued 513 child-years of follow-up. We recorded 141 pneumonia episodes, with an incidence of 0·27 episodes per child-year (95% CI 0·23-0·32). 32 (23%) pneumonia cases were severe pneumonia, with an incidence of 0·06 episodes per child-year (95% CI 0·04-0·08). Two (1%) of 141 pneumonia episodes led to death from pneumonia. Maternal HIV, maternal smoking, male sex, and malnutrition were associated with an increased incidence of pneumonia.

INTERPRETATION

Pneumonia incidence was high in the first year of life, despite a strong immunisation programme including 13-valent pneumococcal conjugate vaccine. Incidence was associated with pneumonia risk factors that are amenable to interventions. Prevention of childhood pneumonia through public health interventions to address these risk factors should be strengthened.

FUNDING

Bill & Melinda Gates Foundation, South African Thoracic Society, Federation of Infectious Diseases Societies of South Africa, and University of Cape Town.

Authors+Show Affiliations

Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. Electronic address: dave.leroux@uct.ac.za.Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.Division of Medical Microbiology, University of Cape Town and National Health Laboratory Services, Cape Town, South Africa.Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25617203

Citation

le Roux, David M., et al. "Incidence and Severity of Childhood Pneumonia in the First Year of Life in a South African Birth Cohort: the Drakenstein Child Health Study." The Lancet. Global Health, vol. 3, no. 2, 2015, pp. e95-e103.
le Roux DM, Myer L, Nicol MP, et al. Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study. Lancet Glob Health. 2015;3(2):e95-e103.
le Roux, D. M., Myer, L., Nicol, M. P., & Zar, H. J. (2015). Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study. The Lancet. Global Health, 3(2), e95-e103. https://doi.org/10.1016/S2214-109X(14)70360-2
le Roux DM, et al. Incidence and Severity of Childhood Pneumonia in the First Year of Life in a South African Birth Cohort: the Drakenstein Child Health Study. Lancet Glob Health. 2015;3(2):e95-e103. PubMed PMID: 25617203.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study. AU - le Roux,David M, AU - Myer,Landon, AU - Nicol,Mark P, AU - Zar,Heather J, PY - 2015/1/25/entrez PY - 2015/1/27/pubmed PY - 2015/9/19/medline SP - e95 EP - e103 JF - The Lancet. Global health JO - Lancet Glob Health VL - 3 IS - 2 N2 - BACKGROUND: Childhood pneumonia causes substantial mortality and morbidity. Accurate measurements of pneumonia incidence are scarce in low-income and middle-income countries, particularly after implementation of pneumococcal conjugate vaccine. We aimed to assess the incidence, severity, and risk factors for pneumonia in the first year of life in children enrolled in a South African birth cohort. METHODS: This birth cohort study is being done at two sites in Paarl, a periurban area of South Africa. We enrolled pregnant women (>18 years) and followed up mother-infant pairs to 1 year of age. We obtained data for risk factors and respiratory symptoms. Children received 13-valent pneumococcal conjugate vaccine according to national immunisation schedules. We established pneumonia surveillance systems and documented episodes of ambulatory pneumonia and pneumonia warranting hospital admission. We calculated incidence rate ratios for pneumonia with mixed-effects Poisson regression. FINDINGS: Between May 29, 2012 and May 31, 2014, we enrolled 697 infants who accrued 513 child-years of follow-up. We recorded 141 pneumonia episodes, with an incidence of 0·27 episodes per child-year (95% CI 0·23-0·32). 32 (23%) pneumonia cases were severe pneumonia, with an incidence of 0·06 episodes per child-year (95% CI 0·04-0·08). Two (1%) of 141 pneumonia episodes led to death from pneumonia. Maternal HIV, maternal smoking, male sex, and malnutrition were associated with an increased incidence of pneumonia. INTERPRETATION: Pneumonia incidence was high in the first year of life, despite a strong immunisation programme including 13-valent pneumococcal conjugate vaccine. Incidence was associated with pneumonia risk factors that are amenable to interventions. Prevention of childhood pneumonia through public health interventions to address these risk factors should be strengthened. FUNDING: Bill & Melinda Gates Foundation, South African Thoracic Society, Federation of Infectious Diseases Societies of South Africa, and University of Cape Town. SN - 2214-109X UR - https://www.unboundmedicine.com/medline/citation/25617203/Incidence_and_severity_of_childhood_pneumonia_in_the_first_year_of_life_in_a_South_African_birth_cohort:_the_Drakenstein_Child_Health_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2214-109X(14)70360-2 DB - PRIME DP - Unbound Medicine ER -