Excess risk of subsequent infection in hospitalized children from a community cohort study in Cambodia and Madagascar. (25th March 2022)

• Record Type: Journal Article
• Authors: Rambliere, Lison; Kermorvant-Duchemin, Elsa; de Lauzanne, Agathe; Collard, Jean-Marc; Herindrainy, Perlinot; Vray, Muriel; Garin, Benoit; Zo, Andrianirina Zafitsara; Rasoanaivo, Fanjalalaina; Rakotoarimanana Feno Manitra, Jacob; Raheliarivao, Tanjona Bodonirina; Diouf, Jean-Baptiste Niokhhor; Ngo, Véronique; Lach, Siyin; Long, Pring; Borand, Laurence; Sok, Touch; Abdou, Armiya Youssouf; Padget, Michael; Madec, Yoann; Guillemot, Didier; Delarocque-Astagneau, Elisabeth; Huynh, Bich-Tram
• Is Part Of: International journal of epidemiology. Volume 51:Number 5(2022)
• Page Start: 1421
• Page End: 1431
• Publication Date: 2022-03-25
• Subjects: Children -- cohort -- low- and middle-income countries -- hospital -- infection -- post-hospital syndrome -- care pathway -- global health -- diarrhoea -- lower-respiratory infection -- sepsis; Epidemiology -- Periodicals; 614.4
• DOI: 10.1093/ije/dyac048
• Languages: English
• ISSNs: 0300-5771

Abstract

Abstract: Background: Children in low- and middle-income countries are particularly vulnerable in the months following an initial health event (IHE), with increased risk of mortality caused mostly by infectious diseases. Due to exposure to a wide range of environmental stressors, hospitalization in itself might increase child vulnerability at discharge. The goal of this study was to disentangle the role of hospitalization on the risk of subsequent infection. Methods: Data from a prospective, longitudinal, international, multicenter mother-and-child cohort were analysed. The main outcome assessed was the risk of subsequent infection within 3 months of initial care at hospital or primary healthcare facilities. First, risk factors for being hospitalized for the IHE (Step 1) and for having a subsequent infection (Step 2) were identified. Then, inpatients were matched with outpatients using propensity scores, considering the risk factors identified in Step 1. Finally, adjusted on the risk factors identified in Step 2, Cox regression models were performed on the matched data set to estimate the effect of hospitalization at the IHE on the risk of subsequent infection. Results: Among the 1312 children presenting an IHE, 210 (16%) had a subsequent infection, mainly lower-respiratory infections. Although hospitalization did not increase the risk of subsequent diarrhoea or unspecified sepsis, inpatients were 1.7 (95% Confidence Intervals [1.0–2.8]) times more likely to develop a subsequent lower-respiratory infection than comparable outpatients. Conclusion: For the first time, our findings suggest that hospitalization might increase the risk of subsequent lower-respiratory infection adjusted on severity and symptoms at IHE. This highlights the need for robust longitudinal follow-up of at-risk children and the importance of investigating underlying mechanisms driving vulnerability to infection.