Journal of Tropical Pediatrics最新文献

Malaria remains a leading cause of morbidity and mortality among children under five years in Nigeria, a country accounting for over a quarter of global malaria cases. Despite the availability of interventions, Nigeria continues to face persistent challenges in controlling malaria, especially in the under-five population, thus, the need for this review. This narrative review synthesizes peer-reviewed literature, national reports, and policy documents published since 2010. A structured search was conducted across PubMed, Google Scholar, Scopus, and relevant grey literature from the WHO, UNICEF, and the Nigerian Ministry of Health. The review adhered to SANRA guidelines to ensure methodological rigour and focused on studies reporting malaria epidemiology, interventions, and control efforts targeting children under five in Nigeria. Findings revealed a high malaria burden among children in Nigeria, with notable regional disparities. Northern states report the highest prevalence, with rural areas disproportionately affected. Contributing factors include socioeconomic deprivation, climate variability, and suboptimal coverage of interventions. Key challenges include diagnostic limitations, drug resistance, and inconsistent use of preventive measures. While interventions such as long-lasting insecticidal nets (LLINs), intermittent preventive therapy, and indoor residual spraying have shown effectiveness, gaps remain in coverage and implementation. Innovations in diagnostics, vaccines, and surveillance systems are promising but underutilized. Despite progress, Nigeria faces multifaceted challenges in malaria control among under-fives. A coordinated, multisectoral response involving innovative strategies, stronger health systems, and policy reforms is essential. Attention must also be directed to enhancing the acceptability, fidelity, and longevity of these interventions.

Diagnosing tuberculosis (TB) in children is challenging due to non-specific symptoms, paucibacillary disease, and difficulty producing sputum. Chest X-rays (CXRs), though widely used, are often inaccessible in low-resource settings and involve radiation. Ultrasound (US) is a radiation-free, portable, and potentially low-cost alternative that can detect pulmonary and extrapulmonary TB features. However, its diagnostic accuracy in paediatric TB remains unclear. This systematic review and meta-analysis assessed US diagnostic performance for paediatric TB across anatomical sites. Following PRISMA-DTA guidelines, we searched five databases through May 2025. Studies were included if they involved children under 15 with presumptive TB and reported US diagnostic accuracy data. Data extraction, quality assessment (QUADAS-2), and meta-analyses using a bivariate random-effects model were conducted. Graham's TB classification served as the reference standard. CXR was used as a comparator where available, with agreement assessed via Cohen's kappa. Of 17 019 records, 7 studies involving 945 children met inclusion criteria. Pooled US sensitivity was 52% (95% CI: 46-58%), and specificity was 76% (95% CI: 67-83%). US showed high specificity but low sensitivity across most features, including abdominal lymphadenopathy and pericardial effusion; pleural effusion had slightly higher sensitivity (18%). Agreement with CXR was moderate (kappa 0.24-0.42). Variability in US protocols, operator skills, and reference standards limited generalizability. Only one study had low risk of bias across all QUADAS-2 domains. US is a promising adjunct for paediatric TB diagnosis in resource-limited settings, but standardization and validation are needed to improve its standalone utility.

Acute febrile encephalopathy (AFE) is a common neurological emergency in all age groups. In tropical regions, long-standing infections such as Japanese encephalitis and bacterial meningitis continue to be major causes of AFE, while changing presentations of familiar infections and newly emerged diseases like COVID-19 are also becoming increasingly notable. To describe various clinical presentations, etiology and mortality of AFE in pediatric age group. This prospective observational study was undertaken in a tertiary care institute of Northern India from April 2022 to April 2023. Children aged 1 month to 18 years presenting to the pediatric emergency department with fever of <2 weeks duration and altered sensorium lasting >24 hours were eligible for inclusion. A total of 100 patients (49% males) with AFE were enrolled. The mean (SD) duration of encephalopathy was 1.39 (0.69) days. The most frequent etiologies were viral encephalitis (17%), dengue encephalopathy (12%), and hepatic encephalopathy (9%). The peak incidence occurred between August and November. The overall case fatality rate was 33%. Under-5 children with severe acute malnutrition (SAM) had the highest fatality rate (56%, 9/16). Among survivors, 16% (11/67) had poor functional outcomes. Higher odds of mortality were observed in patients with a Glasgow coma scale score <8, hypoglycemia at admission, requirement for mechanical ventilation or inotropic support, and presence of multiorgan dysfunction. AFE demonstrates a predictable seasonal pattern and is associated with high mortality and morbidity, particularly in under-5 children with SAM, who represent the most vulnerable group.

Staphylococcus aureus is a common cause of serious infections in children, with the incidence of methicillin-resistant Staphylococcus aureus (MRSA) rising in recent decades. To identify the factors associated with disease severity in pediatric patients hospitalized with S. aureus infection in high-complexity institutions in Santander, Colombia. A cross-sectional study was conducted among children under 18 years of age with S. aureus infection who were hospitalized (2018-21). Clinical characteristics and outcomes were compared between MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) infections. Factors associated with severity were identified through multivariate analysis with logistic and binomial regression. One hundred fifty-four cases of S. aureus infection were included, with 75 (48.7%) being MRSA. Among community-acquired infections, 55.7% (44/79) were caused by MRSA. Pediatric intensive care unit (PICU) admission was required in 55.8% of cases, and the infection-attributable case-fatality rate (CFR) was 1.9%. MRSA infections were associated with a greater need for vasopressor/inotropic support (prevalence ratio [PR], 2.06; 95% confidence interval [CI], 1.05-4.04; P = .036). Persistent bacteremia was associated with an increased PICU admission (PR 1.72; 95%CI: 1.19-2.46), mechanical ventilation (PR 8.63; 95%CI: 3.16-23.54), and vasopressor/inotropic support (PR 11.06; 95%CI: 4.59-26.58). S. aureus infections showed a high prevalence of MRSA, with a notable proportion of community-acquired cases. More than half required admission to PICU, but the infection-attributable CFR was low. MRSA infections and persistent bacteremia were associated with disease severity. These findings support the use of timely antibiotic therapy and reinforce the need for infection prevention and control strategies.

This study aimed to evaluate the demographic, clinical, laboratory, microbiological, and radiological characteristics of pediatric brucellosis patients with and without osteoarticular involvement, and to identify associated risk factors and outcomes. A retrospective analysis was conducted on 101 children diagnosed with brucellosis between 2008 and 2022. Data were extracted from patient files and electronic records. Patients were grouped based on the presence or absence of osteoarticular involvement. Of the 101 patients, 52 (51.5%) had osteoarticular involvement. Myalgia (P = .027), low back pain (P < .001), and higher serum standard tube agglutination titers (P = .004) were significantly more common in this group, while abdominal pain was more frequent in patients without joint involvement (P = .007). The time from symptom onset to hospital admission was significantly longer in the osteoarticular group (P = .033). Magnetic resonance imaging confirmed sacroiliitis and hip involvement in 69.2% of relevant cases. In tropical and endemic regions where brucellosis remains a significant public health problem, children presenting with myalgia, back pain, high standard tube agglutination titers, and prolonged symptom duration should be carefully evaluated for osteoarticular brucellosis. Early identification is essential for preventing complications and optimizing treatment.

Scrub typhus is an important cause of acute febrile illness in children that may progress to acute respiratory failure (ARF). However, evidence for noninvasive respiratory support (NIRS) in this setting is limited. The main objective of this study is to compare outcomes of NIRS versus invasive mechanical ventilation (IMV) in pediatric scrub typhus-related ARF and identify predictors of NIV failure. This study included children aged 28 days-15 years with confirmed scrub typhus and ARF who were admitted to the pediatric critical care unit of a tertiary center in South India. Patients were classified according to the type of respiratory support in the first 4 h (NIRS: heated humidified high-flow nasal cannula [HHHFNC] and/or noninvasive ventilation [NIV]; or IMV). Clinical and laboratory data and outcomes were analyzed. The predictors of NIV failure were evaluated in a subgroup of NIV recipients. Of the 160 children, 46 (28.8%) received HHHFNC, 52 (32.5%) NIV, and 62 (38.7%) IMV as initial support. Eighteen NIV patients (34.6%) required intubation and were analysed with the IMV group (IMV n=80, NIRS n=80). The overall survival was 67.5%, higher with NIRS than IMV (96.3% vs 38.7%, P<.001). NIV failure occurred in 22.5% of patients and was associated with a mortality rate of 66.7%. Younger age, male sex, facial puffiness, hepatomegaly, thrombocytopenia, elevated lactate levels, and higher SOFA, PIM2, and VIS scores predicted NIV failure (P<.05). The duration of respiratory support, ICU stay, and inotrope use were greater with IMV. NIRS is effective and is associated with better survival in children with scrub typhus ARDS. Vigilant monitoring and early escalation in high-risk patients may improve outcomes.

Home-Based Newborn Care (HBNC) is a Government of India initiative to reduce neonatal mortality. This study assessed coverage of appropriate HBNC services in a community development block in West Bengal, identified subcentres with acceptable coverage, and explored perceptions of beneficiaries and challenges of Accredited Social Health Activists (ASHAs). A mixed-methods, cross-sectional study employing Lot Quality Assurance Sampling (LQAS) was conducted in Barrackpore-II block, North 24 Parganas, West Bengal. A total of 434 mother-child dyads with infants aged 43-60 days were surveyed. Each of the 31 subcentres constituted a lot, with a sample size of 14 and a decision value of 4, based on threshold values of 50% and 85%. HBNC services were deemed 'appropriate' if all home visits adhered to the prescribed schedule (±1 day), i.e., 'complete' and were 'effective'. Essential components of an effective visit included promotion of exclusive breastfeeding, eye and cord care, temperature and weight measurement, and proper hand hygiene. Qualitative data were obtained through 19 in-depth interviews and eight focus group discussions. Nearly half of the lots (48.4%) had unacceptable HBNC coverage, and estimated overall coverage was 67.6%. Key challenges for ASHAs included socio-economic disparities, low perceived credibility, irregular payments, and inadequate co-ordination. Beneficiary perception regarding HBNC was influenced by the fulfilment of expected support from ASHA. Strengthening both demand-factors (community awareness and perceived credibility of services) and supply-factors (capacity building, timely remuneration, and robust inter-sectoral co-ordination) are crucial to improving effectiveness of Home-Based Newborn Care.

Human milk is the optimal source of nutrition for preterm infants, significantly reducing neonatal morbidities and enhancing neurodevelopmental outcomes. However, preterm neonates face challenges in direct breastfeeding due to immaturity, maternal-infant separation, and inadequate milk production. The aim of this study is to compare the impact of a structured early intervention package on exclusive breastfeeding rate and compare that to a control group that had no structured early intervention package regarding exclusive breastfeeding at 6 months of chronological age in neonates born at less than 34 weeks. Eligible mother-infant dyads were divided into the control and intervention groups. While both the groups received breastfeeding counseling, the control group received routine counseling as per WHO guidelines during antenatal visits, hospital stay, and follow-up immunization visits. In contrast, the intervention group received structured, frequent counseling using specially developed education materials, including intrapartum counseling in the pre-labor area, early initiation of expression facilitated by designated personnel, and scheduled postnatal sessions. Breast milk output was measured at days 3, 7, and 14 or discharge. Exclusive breastfeeding rates were assessed at 6 months. Among 90 enrolled dyads, the exclusive breastfeeding rate at 6 months was significantly higher in the intervention group (75.0%) compared to the control group (47.3%) (P value = .015). Breast milk output on day 3 was also significantly higher in the intervention group (P value = .008). The findings indicate that integrating structured lactation support into neonatal care can improve breastfeeding outcomes, and larger studies are needed to validate these results.

Acute hepatitis (AH) is a common cause of pediatric hospitalization, with infectious and non-infectious etiologies. This study aims to assess the clinical profile, etiologies, and predictors of adverse outcomes in hospitalized children with AH. Medical case records of children aged >6 months to 14 years from June 2022 to December 2024, identified from pediatric admission and discharge registers, were screened. Children satisfying the criteria for elevated transaminases were included in this study. Those with chronic liver disease/chronic hepatitis were excluded. A total of 165 children were included, with the majority belonging to the 5-14 years age group (70.3%) and being male (53.9%). The median age of the children enrolled was 8 (5-10) years. Infectious etiologies accounted for 83.03% of cases, with dengue (23%), HAV (21.2%), and enteric fever (13.3%) being the most common causes. Non-infectious causes accounted for 9.09% of cases, while 7.88% were idiopathic. Multivariate analysis identified younger age (adjusted OR: 0.79, 95% CI: 0.67-0.91; P-value .002), fever (adjusted OR: 9.13, 95% CI: 2.1-55.9; P-value .007), lethargy at presentation (adjusted OR: 3.1, 95% CI: 1.0-9.61, P-value .047), ascites (adjusted OR: 8.12, 95% CI: 2.44-30, P-value <.001), and hypoalbuminemia (adjusted OR: 0.3, 95% CI: 0.11-0.76, P-value <.014) as significant risk factors for adverse outcomes. Younger age, fever, lethargy, ascites, and hypoalbuminemia were identified as independent risk factors for adverse outcomes. Early recognition of these predictors and targeted management strategies may improve clinical outcomes in hospitalized children with AH.

We aimed to evaluate the therapeutic efficacy of pulmonary surfactant (PS) in neonatal respiratory distress syndrome (NRDS) when guided by lung ultrasound (LUS) score. A prospective cohort of 121 surfactant-treated NRDS infants was included. After 1:1 propensity score matching, 99 matched pairs (NRDS vs. healthy controls) were established. Clinical baseline characteristics, chest X-ray (CXR) grading, LUS, arterial blood gas indices, and adverse events were collected. Comparisons were made between pretreatment (within 4 h of birth) and post-treatment (12 h after PS) findings in the NRDS group. Correlations between LUS and CXR grading were assessed, and receiver operating characteristic curves were used to examine the predictive value of early CXR grading and bilateral LUS scores for post-treatment improvement. After PS administration, NRDS infants showed significant reductions in partial pressure of carbon dioxide, CXR grading, LUS score, and clinical signs, accompanied by increased partial pressure of oxygen and potential of hydrogen (P < .001). The overall improvement rate was 90.91%. Both pre- and post-treatment LUS scores correlated positively with CXR grading (|r| > 0.5). Early CXR grading and bilateral LUS scores were strong predictors of treatment response, with LUS showing superior performance (P = .006). Adverse reactions occurred in only 8.08% of treated infants, indicating acceptable safety. PS therapy improves arterial blood gas parameters and clinical symptoms in NRDS infants with good safety. LUS scoring not only facilitates treatment guidance but also provides predictive value for therapeutic efficacy, offering a practical basis for clinical management of NRDS.