Childhood very severe pneumonia and meningitis-related hospitalization and death in Yemen, before and after introduction of H. influenzae type b (Hib) vaccine.

Haemophilus influenzae type b (Hib) vaccine was included in the Yemen immunization programme in 2005. This study compared the rates of very severe pneumonia and all-cause meningitis hospitalization and death, before and after introduction of conjugate Hib vaccine, and reports the results of the 2010 bacterial meningitis surveillance. A retrospective analysis was made of data collected for 2000-2010 for all children aged 2-60 months in the main children's hospital in Sana'a. Compared with the pre-Hib vaccination period, the post-Hib period showed significant and impressive reductions in the rates of hospitalization and death for all-cause meningitis. However, hospitalization and death for very severe pneumonia improved only modestly, and there was evidence of a decreasing but non-significant trend indicting that very severe pneumonia was a non-specific endpoint with multi-etiologies (both viral and bacterial). Very severe pneumonia remains the leading cause of severe morbidity and death for young children, particularly those aged < 12 months.

Childhood very severe pneumonia and meningitisrelated hospitalization and death in Yemen, before and after introduction of H. influenzae type b (Hib)vaccine

لقد أدرج لقاح المستدمية المنزلية من النمط "بي" في البرنامج اليمني للتمنيع في عام 2005 . وتقارن هذه الدراسة بين معدلات الإدخال في المستشفيات والوفيات ذات الصلة بالالتهاب الرئوي الشديد جدا والالتهاب السحائي الناجم عن جميع الأسباب قبل وبعد إدخال لقاح المستدمية النزلية المتقارن من النمط "بي"، وتعرض نتائج الترصد لالتهاب السحايا الجرثومي في عام 2010 . وهي دراسة استعادية أجريت على البيانات التي جمعت في الفترة 2000 - 2010 وشملت جميع الأطفال الذين تراوحت أعمارهم بين شهرين و 60 شهرا في المستشفى الرئيسي لطب الأطفال في صنعاء. وقد اتضح وجود انخفاضات يعتد بها إحصائيا ومثيرة للاهتمام في معدلات الإدخال إلى المستشفى والموت الناجم عن جميع أسباب التهابات السحايا في الفترة التي سبقت إدخال اللقاح مقارنة بالفترة التي تلت إدخال اللقاح. إلا أن معدل الإدخال إلى المستشفى والوفيات بسبب الالتهاب الرئوي الشديد جدا لم يتحسن إلا قليلا، وكانت هناك بينات على تناقص، ولكن دون أن يكون له ميل يعتد به إحصائيا، مما يدل على أن الالتهاب الرئوي الشديد جدا كان بمثابة نقطة نهائية غير نوعية تترافق بأسباب متعددة للأمراض [منها جرثومي ومنها فيروسي]. ولايزال الالتهاب الرئوي الشديد جدا هو السبب الأكثر انتشارا للأمراض الشديدة وللموت بين صغار الأطفال، ولاسيما من يقل عمره عن 12 شهرا

ABSTRACT Haemophilus influenzae type b (Hib) vaccine was included in the Yemen immunization programme in 2005. Thisstudy compared the rates of very severe pneumonia and all-cause meningitis hospitalization and death, before and afterintroduction of conjugate Hib vaccine, and reports the results of the 2010 bacterial meningitis surveillance. A retrospectiveanalysis was made of data collected for 2000–2010 for all children aged 2–60 months in the main children’s hospital inSana’a. Compared with the pre-Hib vaccination period, the post-Hib period showed significant and impressive reductionsin the rates of hospitalization and death for all-cause meningitis. However, hospitalization and death for very severepneumonia improved only modestly, and there was evidence of a decreasing but non-significant trend indicting that verysevere pneumonia was a non-specific endpoint with multi-etiologies (both viral and bacterial). Very severe pneumoniaremains the leading cause of severe morbidity and death for young children, particularly those aged < 12 months.

RÉSUMÉ Le vaccin contre Haemophilus influenzae type b (Hib) a été inclus dans le programme de vaccination duYémen en 2005. La présente étude a comparé les taux d'hospitalisation et de décès dus à une pneumonie trèssévère et à une méningite toutes causes confondues, avant et après l'introduction du vaccin Hib conjugué ; elle apar ailleurs présenté les résultats de la surveillance de la méningite bactérienne de 2010. Une analyse rétrospectivea été menée afin de recueillir des données sur la période de 2000 à 2010 pour tous les enfants âgés de 2 à 60 moisdans le grand hôpital pour enfants de Sanaa. Par rapport à la période précédant la vaccination par le Hib, la périodesuivant cette dernière a présenté des réductions significatives et remarquables dans les taux d'hospitalisation et dedécès pour méningite toutes causes confondues. Toutefois, les taux d'hospitalisation et de décès pour pneumonietrès sévère n'ont diminué que modestement. Des éléments montrent certes une tendance à la baisse, mais nonsignificative, et indiquent que la pneumonie très sévère n'était pas un critère d'évaluation spécifique lorsque lesétiologies étaient multiples (à la fois virale et bactérienne). La pneumonie très sévère reste la cause principale demorbidité sévère et de décès chez le jeune enfant, notamment chez l'enfant de moins de 12 mois.

Burden of perinatal conditions in Yemen: a 12-year hospital-based study.

We conducted a 12-year retrospective analysis of perinatal characteristics at Al-Sabeen Hospital, Sana'a. There were 62168 births, 2936 stillbirths and 5434 perinatal deaths. There were 14 576 (24.6%) preterm low-birth-weight (LBW) babies. Early neonatal death (ENND) rate was 42.2/1000 live births. Of the 10 546 neonates admitted to the special baby care unit (SBCU), 40.1% were preterm LBW and 2147 (20.4%) died (80.6% were preterm LBW). The last 4 years showed a 17.2% increase in stillbirths and a 40.5% reduction in ENND compared with the first 4 years. In the SBCU, reduction in ENND was > 70%. Respiratory distress accounted for 63.8% of deaths in the SBCU and birth asphyxia 15.0%. Our results reflect the poor antenatal and delivery care services in Yemen.

Burden of perinatal conditions in Yemen: a 12-year hospital-based study

We conducted a 12-year retrospective analysis of perinatal characteristics at Al-Sabeen Hospital, Sana'a. There were 62168 births, 2936 stillbirths and 5434 perinatal deaths. There were 14 576 [24.6%] preterm low-birth-weight [LBW] babies. Early neonatal death [ENND] rate was 42.2/1000 live births. Of the 10 546 neonates admitted to the special baby care unit [SBCU], 40.1% were preterm LBW and 2147 [20.4%] died [80.6% were preterm LBW]. The last 4 years showed a 17.2% increase in stillbirths and a 40.5% reduction in ENND compared with the first 4 years. In the SBCU, reduction in ENND was > 70%. Respiratory distress accounted for 63.8% of deaths in the SBCU and birth asphyxia 15.0%. Our results reflect the poor antenatal and delivery care services in Yemen

Bacterial aetiology and anti-microbial resistance of childhood diarrhoea in Yemen.

In a 12-month period, 561 stool cultures from Yemeni children aged 1-60 months and presenting with diarrhoea, were analysed to identify the bacterial aetiology and their anti-microbial resistance to the commonly used antibiotics. A total of 190 (33.9 per cent) were positive for bacterial culture. Most of the positive cultures (58 per cent) were from children aged 1-12 months. The majority of the positive cultures were enteropathogenic Escherichia coli (58.4 per cent) Salmonella spp., and Shigella spp. (20 per cent each). Campylobacter were found to be an extremely uncommon agent of childhood diarrhoea making only 1.6 per cent of the positive cultures. The majority of the Salmonella were group C (60.5 per cent) and group B (29 per cent). Of the Shigella isolates, 13 (34 per cent) were S. flexneri, and seven (18 per cent) S. dysentrea. More than two-thirds of the Salmonella isolates were resistant to nalidixic acid, chloramphenicol, co-trimoxazole, gentamicin, and amoxycillin, while 42 per cent were resistant to cefotaxime. Most of the Shigella isolates were susceptible to nalidixic acid and cefotaxime, and resistant to the other antibiotics. All the tested enteropathogenic E. coli isolates were resistant to amoxycillin, 83 per cent were resistant to co-trimoxazole, 62 per cent to chloramphenicol, and 54 per cent to gentamicin, while only 16 and 6 per cent were resistant to nalidixic acid and cefotaxime, respectively. This study, the first in Yemen, draws attention to the urgent need of a national surveillance system, essential for the containment of anti-microbial resistance.

The impact of breastfeeding on serum electrolytes in infants hospitalized with severe dehydrating diarrhoea in Yemen.

The effect of breastfeeding on serum electrolytes and case fatality was studied in a group of 430 children admitted with severe dehydrating diarrhoea. Hyponatraemia and hypokalaemia were significantly more prevalent in infants who were exclusively bottle-fed (37.3% and 46.3%) compared with exclusively breastfed (12.2% and 16.7%) and among bottle-fed weaning children (46.3% and 62.6%) compared with weaning children who continued to breastfeed (24.7% and 36.7%, respectively). Mortality was lower in exclusively breastfed children (4.4%) than in those receiving formula feeds (16.4%); it was also lower in weaning children who continued to receive breast-milk (6%) than in bottle-fed weaning children (13.8%). Breastfeeding significantly reduces case fatality and the likelihood of electrolyte disturbances among infants hospitalized with severe dehydrating diarrhoea.

Outcome for children under 5 years hospitalized with severe acute lower respiratory tract infections in Yemen: a 5 year experience.

Between 1991 and 1995, 2554 children under 5 years old hospitalized with severe acute lower respiratory tract infection in Al-Sabe'en, Sana'a, Yemen were studied. 47.7 per cent (1218) were under 6 months of age and 74.1 per cent (1893) were in their first 12 months. Sixty-four per cent (1633) were males. Of the 2554 cases, 221 died (overall, a case fatality rate of 8.7 per cent). 118 of the deaths (53.4 per cent) were in the under 6 months age group and 188 (85 per cent) were in the first 12 months age group. During 1995 the hospital started adopting the WHO standard case-management guidelines for treating severe acute lower respiratory tract infections. There were no significant reductions in case fatality rates in 1995 (CFR 9.8 per cent) compared with those of 1991 (CFR 7.9 per cent), 1992 (CFR 9.4 per cent), 1993 (CFR 7 per cent), or 1994 (CFR 8.5 per cent). Factors such as late hospital admission with cyanosis, malnutrition, rickets as well as increased resistance of the common causative organisms (pneumococci and H. influenzae) to antibiotics recommended by the WHO may have contributed to such a high case fatality rate remaining unchanged. In addition to reducing the risk of developing pneumonia and dying from pneumonia by improving maternal nutrition, health education, promoting breastfeeding, and preventing rickets and nutritional anaemia among the vulnerable age groups, vaccination against pneumococci and H. influenzae type b should be seriously considered as one of the strategies to reduce lower respiratory tract infection-related mortality.

Clinical characteristics and outcome of children aged under 5 years hospitalized with severe pneumonia in Yemen.

A 1-year study of 529 Yemeni children under 5 years of age hospitalized for severe pneumonia was undertaken to define their clinical characteristics and to identify risk factors associated with death from pneumonia. There were 354 (66.9%) boys, 270 of the 529 (51%) were under 6 months of age and 457 (86.4%) were aged < or = 12 months. The clinical characteristics of the group were as follows. Boys constituted 70% of the group and under-1-year-olds 86%, weight-for-age was under 60% in 23%, clinical rickets was present in 50% and anaemia in 30% (30.1%). On admission, cyanosis was detected in 56%, heart failure in 21% and isolated hepatomegaly in 14%. Fifty-two children died (CFR 9.8%), of whom 25 (48%) were under 6 months of age and 20 (38.5%) were aged between 6 and 12 months. Only seven children aged over 1 year died from pneumonia. Weight-for-age less than 60%, rickets, haemoglobin < 10 g/dl, cyanosis and heart failure were associated with an increased risk of dying from severe pneumonia.