Invasive salmonellosis among children admitted to a Rural Tanzanian Hospital and a comparison with previous studies

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Study Justification:
– The study aimed to address the lack of information on invasive salmonellosis in African children.
– It aimed to estimate the case fraction of invasive salmonellosis among pediatric admissions in a rural Tanzanian hospital.
– The study also aimed to examine associations between invasive salmonellosis and common co-morbidities, as well as describe its clinical features.
– By comparing the findings with previous studies, the study aimed to contribute to the understanding of invasive salmonellosis in sub-Saharan Africa.
Study Highlights:
– The study enrolled 1,502 children from March 2008 to February 2009.
– Pathogenic bacteria were isolated from the blood of 156 (10%) children, with 38% of them having invasive salmonellosis.
– Salmonella typhi accounted for 9% of the bacteremic children, non-typhoidal Salmonella (NTS) accounted for 29%, and other pathogenic bacteria accounted for 62%.
– Children with typhoid fever were older and had a longer duration of fever, while NTS infections were associated with prior antimalarial treatment, malarial complications, and a high risk of death.
– The study concluded that invasive salmonellosis, particularly NTS infection, is an important cause of febrile disease among hospitalized children in rural Tanzania.
– Certain clinical features can be used to distinguish invasive salmonellosis from other severe febrile illnesses.
Recommendations for Lay Reader and Policy Maker:
– Increase awareness and knowledge about invasive salmonellosis among healthcare providers, parents, and caregivers.
– Strengthen surveillance and diagnostic capabilities in rural healthcare settings to improve early detection and management of invasive salmonellosis.
– Implement strategies to prevent and control invasive salmonellosis, such as improving sanitation and hygiene practices, promoting vaccination against Salmonella typhi, and ensuring access to appropriate antimicrobial treatment.
– Conduct further research to better understand the epidemiology, risk factors, and outcomes of invasive salmonellosis in different populations.
Key Role Players:
– Healthcare providers: Doctors, nurses, and laboratory technicians involved in diagnosing and treating invasive salmonellosis.
– Public health officials: Responsible for implementing surveillance systems, developing prevention strategies, and coordinating response efforts.
– Researchers: Conducting further studies to expand knowledge on invasive salmonellosis and evaluate the effectiveness of interventions.
– Policy makers: Developing and implementing policies to address invasive salmonellosis, including vaccination programs and guidelines for diagnosis and treatment.
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers on invasive salmonellosis diagnosis and management.
– Laboratory equipment and supplies for bacterial culture and diagnostic tests.
– Surveillance systems and data management infrastructure.
– Public health campaigns to raise awareness and promote preventive measures.
– Vaccine procurement and distribution.
– Research funding for further studies on invasive salmonellosis.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides detailed information on the methodology, including the study population, data collection, and analysis methods. The findings are supported by laboratory-confirmed diagnoses and comparisons with previous studies. However, the abstract lacks information on the sample size and generalizability of the results. To improve the evidence, the abstract could include the sample size and information on the representativeness of the study population, as well as any limitations or potential biases in the study design.

Background: The importance of invasive salmonellosis in African children is well recognized but there is inadequate information on these infections. We conducted a fever surveillance study in a Tanzanian rural hospital to estimate the case fraction of invasive salmonellosis among pediatric admissions, examine associations with common co-morbidities and describe its clinical features. We compared our main findings with those from previous studies among children in sub-Saharan Africa. Methodology/Principal Findings: From 1 March 2008 to 28 Feb 2009, 1,502 children were enrolled into the study. We collected clinical information and blood for point of care tests, culture, and diagnosis of malaria and HIV. We analyzed the clinical features on admission and outcome by laboratory-confirmed diagnosis. Pathogenic bacteria were isolated from the blood of 156 (10%) children, of which 14 (9%) were S. typhi, 45 (29%) were NTS and 97 (62%) were other pathogenic bacteria. Invasive salmonellosis accounted for 59/156 (38%) bacteremic children. Children with typhoid fever were significantly older and presented with a longer duration of fever. NTS infections were significantly associated with prior antimalarial treatment, malarial complications and with a high risk for death. Conclusions/Significance: Invasive salmonellosis, particularly NTS infection, is an important cause of febrile disease among hospitalized children in our rural Tanzanian setting. Previous studies showed considerable variation in the case fraction of S. typhi and NTS infections. Certain suggestive clinical features (such as older age and long duration of fever for typhoid whereas concomitant malaria, anemia, jaundice and hypoglycemia for NTS infection) may be used to distinguish invasive salmonellosis from other severe febrile illness. © 2010 Mtove et al.

The study was conducted at Teule Hospital, which is the designated district hospital of Muheza in north-eastern Tanzania. The hospital serves a catchment population of about 277,000 of whom 17% are aged less than five years. Child mortality in the area is 165/1000 [5]. The majority of inhabitants reside in rural settings, mainly practicing subsistence farming and informal trade. The area is highly endemic for Plasmodium falciparum malaria with perennial transmission and two seasonal peaks coinciding with the short and long rains [6]. HIV sero-prevalence among antenatal clinic attendees was about 7% in 2007 [7]. The Tanzanian Expanded Programme of Immunization includes the following: Bacille Calmette-Guérin, live oral polio, diphtheria-whole cell pertussis-tetanus-hepatitis B and monovalent measles vaccines for children, as well as supplemental tetanus toxoid vaccine for women of child-bearing age. Tanzania had just started immunization against Haemophilus influenzae type b in March 2009 and hopes to introduce pneumococcal vaccine in 2010 [8]. Typhoid vaccine is not routinely administered in the country. Prior to the start and during the course of the study, emergency triage and hospital care guidelines were implemented in the ward [9]. On admission, children aged 2 months to 14 years were screened for eligibility during the study hours from 7am to 7pm, Monday-Sunday. Children with fever of 3 or more days prior to admission or fever of less than 3 days but with at least one severity criteria (respiratory distress, deep breathing, severe pallor with respiratory distress, prostration, capillary refill ≥3 seconds, temperature gradient, systolic blood pressure <70 mm Hg, coma, severe jaundice, history of 2 or more convulsions in last 24 hours, hypoglycemia, neck stiffness, bulging fontanel or desaturation) were recruited into the study. All clinical information was recorded in a standard case record form. Treatment was provided as per national guidelines. Outcome was recorded at discharge or death in a discharge form. Surveillance procedures were supervised by experienced study physicians (GM, IH, JD). We collected 1 to 10 millilitres of blood (depending on body weight) from each eligible child. Immediate bedside testing included those for hemoglobin concentration (Hemocue™, Anglholm, Sweden) and blood glucose level (Accu-check™, Roche Diagnostics GmbH, Germany). We performed two types of rapid diagnostic test (RDT) for P. falciparum malaria: HRP-2 based (Paracheck™, Orchid Biomedical, Mumbai, India or Parahit™, Span Diagnostics, Surat, India) and LDH based (OptiMAL-IT, DiaMed AG, Switzerland). From each child, thin and thick blood films were prepared, Giemsa-stained and read by experienced laboratory technicians. At least 100 high power microscopic fields of the thin film were examined to exclude the diagnosis of malaria. Blood for culture was inoculated into a BactALERT™ Pediatric-fan bottle (bioMérieux, Marcy l'Etoile, France) and incubated in the BacT/ALERT 3D automated microbial detection system. Blood cultures were processed according to standard methods. Colonies with biochemical reactions on API20E suggestive of Salmonellae were confirmed serologically by slide and tube agglutination testing using specific O and H antisera (Becton Dickinson, NJ, USA). Sera were tested for the presence of HIV-1 and HIV-2 antibodies according to the National HIV rapid testing algorithm [10] using Capillus HIV-1, HIV-2 test (Trinity Biotech, Bray, Ireland) or SD Bioline (Standard Diagnostics, Kyonggi-do, Korea) followed by Determine HIV-1/2 test (Abbott Laboratories, IL, USA) if the first test was positive. Discordant results were resolved by a third antibody test, Unigold (Trinity Biotech, Bray, Ireland), which if positive rendered the sample as positive and if negative, the sample was considered as negative. Children aged less than 18 months with positive results were not tested by polymerase chain reaction for viral antigen and for that reason were excluded in the final analysis. Data were double-entered into custom-made data entry programs using MS-Access (Microsoft Corp, VA, USA). Data management programs included error, range and consistency check programs. Fever was defined as history of a rise in body temperature as recalled by a care-giver or presence of axillary temperature ≥37.5°C on presentation. Bacteremia was defined as fever with isolation of pathogenic bacteria from blood culture, further classified as those caused by S. typhi (typhoid fever), NTS, and other (non-Salmonellae) pathogenic bacteria. Malaria was defined as fever with a positive RDT or blood film. HIV infection was defined as a positive Capillus test or SD bioline, confirmed either by a positive Determine HIV-1/2 or a positive Unigold test. Low maternal education was considered as schooling to less than the National Curriculum standard 7. Diarrhea was defined as loose or watery stools ≥3 times per day. A seizure was regarded as abnormal movements with altered consciousness. Desaturation was defined as oxygen saturation less than 90% measured by pulse oximetry. Acute severe malnutrition was defined as the presence of bilateral pedal edema or severe wasting. We also assessed the mid-upper arm circumference (MUAC) of children between 12 to 59 months of age. Signs of shock were temperature gradient in the lower extremities and delayed capillary refill of ≥3 seconds or systolic blood pressure 2 seconds or sunken eyes. Prostration was defined as inability to sit unsupported (for children over 9 months of age) or to drink/breastfeed. Coma was defined as Blantyre coma score ≤2 for children less than 2 years of age or a Glasgow coma score ≤10 for older children. Hypoglycemia was defined as blood glucose level of <2.5 mmol/litre. Anemia was defined as hemoglobin of <8 g/dl and severe anemia <5 g/dl. To assess potentially important distinguishing factors, we classified the cases into 5 non-mutually-exclusive groups: typhoid fever, invasive NTS infection, other pathogenic bacteremia, malaria, and those without bacteremia and malaria. Comparisons of categorical data were made using the Chi square or Fishers' Exact test, as appropriate. Comparisons of continuous data were made using student's t-test for data with equal variance or Welch's t-test for those with unequal variance. All analyses were performed using Stata™ v 10.0 (Stata Corp., Tx, USA). We conducted a literature review to compare our main findings with those from previous studies. Potential articles for inclusion were identified by direct searches of the MEDLINE database through PubMed. We included facility-based studies of children ≤16 years in sub-Saharan Africa that reported case fractions of S. typhi and NTS infection from sterile-site specimen (blood, CSF, lung or joint aspirate) bacterial cultures. The searches were restricted to publications from 1987 to date. For study sites with several publications generated from the same study population, only one citation was included unless the time period varied. We also conducted supplementary searches of the references in retrieved articles. Abstracts were reviewed and if relevant, the article was included. The fever surveillance was conducted following the principles governing biomedical research involving human subjects. Prior written informed consent was obtained from the parent or guardian of each eligible child. Pre-test counseling was provided before HIV testing in accordance with local guidelines. The study was approved by the National Institute for Medical Research, Tanzania (NIMR/HQ/R.8a/Vol.IX/666) and the International Vaccine Institute – Institutional Review Boards, South Korea (IRB# 2007-017).

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Based on the provided description, it seems that the request is for innovations or recommendations to improve access to maternal health. However, the description provided is about a study on invasive salmonellosis among children in a Tanzanian hospital. There is no specific information related to maternal health or innovations in the description.

To provide recommendations for improving access to maternal health, it would be helpful to have more information or context related to the topic.
AI Innovations Description
The study mentioned in the description focuses on invasive salmonellosis among children admitted to a rural Tanzanian hospital. While the study provides valuable insights into the prevalence and clinical features of invasive salmonellosis, it does not directly address improving access to maternal health.

To develop an innovation to improve access to maternal health, it is important to consider the specific challenges and barriers faced by pregnant women in accessing healthcare services. Some recommendations that can be used to develop an innovation in this area include:

1. Mobile health clinics: Implementing mobile health clinics that travel to remote areas or underserved communities can help bring maternal healthcare services closer to pregnant women. These clinics can provide prenatal care, vaccinations, and other essential services.

2. Telemedicine: Utilizing telemedicine technology can enable pregnant women to access healthcare services remotely. This can include virtual consultations with healthcare providers, remote monitoring of vital signs, and access to educational resources.

3. Community health workers: Training and deploying community health workers who are knowledgeable about maternal health can help bridge the gap between healthcare facilities and pregnant women in rural areas. These workers can provide education, support, and referrals to appropriate healthcare services.

4. Transportation support: Lack of transportation is a significant barrier to accessing maternal healthcare in remote areas. Providing transportation support, such as subsidized or free transportation services, can help pregnant women reach healthcare facilities for prenatal care, delivery, and postnatal care.

5. Health education and awareness: Conducting targeted health education campaigns to raise awareness about the importance of maternal health and available healthcare services can help empower pregnant women to seek appropriate care. This can include community workshops, radio programs, and informational materials.

6. Strengthening healthcare infrastructure: Investing in improving healthcare infrastructure in rural areas, including the construction and staffing of healthcare facilities, can enhance access to maternal health services. This can involve building or upgrading maternity wards, ensuring the availability of essential medical equipment and supplies, and training healthcare providers.

It is important to tailor the innovation to the specific context and needs of the community. Engaging with local stakeholders, including healthcare providers, community leaders, and pregnant women themselves, can help identify the most effective strategies for improving access to maternal health.
AI Innovations Methodology
Based on the provided information, it seems that you are looking for recommendations to improve access to maternal health. However, the description you provided is about a study on invasive salmonellosis among children in a rural Tanzanian hospital. It does not directly relate to maternal health. If you could provide more specific information or clarify your request, I would be happy to assist you with recommendations and methodologies related to improving access to maternal health.

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