Systematic review and meta-analysis on the etiology of bacterial pneumonia in children in sub-Saharan Africa


Published: 29 September 2022
Abstract Views: 430
PDF: 188
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

  • Chukwuemeka Onwuchekwa Barcelona Institute for Global Health, Barcelona, Spain; Institute of Tropical Medicine, Antwerp, Belgium. https://orcid.org/0000-0002-0017-8429
  • Bassey Edem Vaccine and Immunity Theme, Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine. Atlantic Boulevard, Fajara, Gambia.
  • Victor Williams Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
  • Ibiloye Olujuwon Institute of Tropical Medicine, Antwerp, Belgium.
  • Musa Jallow Vaccine and Immunity Theme, Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine. Atlantic Boulevard, Fajara, Gambia.
  • Binta Sanyang Edward Francis Small Teaching Hospital, Banjul, Gambia.
  • Kristien Verdonck Institute of Tropical Medicine, Antwerp, Belgium.

Introduction. Before the introduction of vaccination to protect children from pneumonia, Streptococcus pneumoniae and Haemophilus influenzae type B (HiB) were the most frequent aetiological agents causing bacterial pneumonia in children under five years old. However, the etiology of childhood pneumonia appears to be changing and nonvaccine- type S. pneumoniae, non-typeable H. influenzae, and Staphylococcus aureus are becoming more relevant.
Objective. We conducted a systematic review aimed at identifying the common causes of bacterial pneumonia in children in sub-Saharan Africa.
Methods. We searched PubMed, Web of Science and African Index Medicus and included primary studies conducted since January 2010 that reported on the bacterial causes of pneumonia in children under five from sub-Saharan Africa. We extracted data items (about the study setting, pneumonia diagnosis, sampling, microbiological methods, and etiological agents) as well as study quality indicators.
Results. Streptococcus pneumoniae was the most common bacteria in blood cultures from children with pneumonia (8%, 95% CI: 4- 14%), and H. influenzae was second (3%, 95% CI: 1-17%). Children’s nasopharynx commonly contained S. pneumoniae (66%), Moraxella catarrhalis (62%), and H. influenzae (44%).
Conclusion. S. pneumoniae and H. influenzae cause bacterial pneumonia in sub-Saharan African children. Our review also highlights the prevalence of potentially pathogenic bacteria in the nasopharynx of children under five and calls for more research into how nasopharyngeal colonization causes pneumonia.


Troeger C, Forouzanfar M, Rao PC, Khalil I, Brown A, Swartz S, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis. 2017;17(11):1133–61. DOI: https://doi.org/10.1016/S1473-3099(17)30396-1

Marangu D, Zar HJ. Childhood pneumonia in low-and-middle-income countries: An update. Paediatr Respir Rev. 2019;32:3–9. DOI: https://doi.org/10.1016/j.prrv.2019.06.001

Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Heal Organ. 2008;86(5):408–16. DOI: https://doi.org/10.2471/BLT.07.048769

Howie SRC, Morris GAJ, Tokarz R, Ebruke BE, Machuka EM, Ideh RC, et al. Etiology of severe childhood pneumonia in the Gambia, West Africa, determined by conventional and molecular microbiological analyses of lung and pleural aspirate samples. Vol. 59, Clinical Infectious Diseases. 2014. p. 682–5. DOI: https://doi.org/10.1093/cid/ciu384

Alicino C, Paganino C, Orsi A, Astengo M, Trucchi C, Icardi G, et al. The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis. Vaccine. 2017. DOI: https://doi.org/10.1016/j.vaccine.2017.09.005

Onwuchekwa C, Edem B, Williams V, Oga E. Estimating the impact of pneumococcal conjugate vaccines on childhood pneumonia in sub-Saharan Africa: A systematic review. F1000Research. 2020; DOI: https://doi.org/10.12688/f1000research.25227.1

Mackenzie GA, Hill PC, Sahito SM, Jeffries DJ, Hossain I, Bottomley C, et al. Impact of the introduction of pneumococcal conjugate vaccination on pneumonia in The Gambia: population-based surveillance and case-control studies. Lancet Infect Dis. 2017 Sep;17(9):965–73. DOI: https://doi.org/10.1016/S1473-3099(17)30321-3

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339. DOI: https://doi.org/10.1136/bmj.b2700

Duke T. Neonatal pneumonia in developing countries. Arch Dis Child Fetal Neonatal Ed. 2005;90(3):211–9. DOI: https://doi.org/10.1136/adc.2003.048108

JBI. Critical Appraisal Tools | Joanna Briggs Institute. Joanna Briggs Institute (JBI). 2020.

Hedges L V., Pigott TD. The power of statistical tests in meta-analysis. Psychol Methods. 2001; DOI: https://doi.org/10.1037/1082-989X.6.3.203

Cafri G, Kromrey JD, Brannick MT. A meta-meta-analysis: Empirical review of statistical power, type I error rates, effect sizes, and model selection of meta-analyses published in psychology. Multivariate Behav Res. 2010; DOI: https://doi.org/10.1080/00273171003680187

Nyaga VN, Arbyn M, Aerts M. Metaprop: A Stata command to perform meta-analysis of binomial data. Arch Public Heal. 2014; DOI: https://doi.org/10.1186/2049-3258-72-39

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. Cochrane Handbook for Systematic Reviews of Interventions. 2019. DOI: https://doi.org/10.1002/9781119536604

Bénet T, Sylla M, Messaoudi M, Picot VS, Telles JN, Diakite AA, et al. Etiology and factors associated with pneumonia in children under 5 years of age in Mali: A prospective case-control study. PLoS One. 2015;10(12):1–15. DOI: https://doi.org/10.1371/journal.pone.0145447

Marangu D, Zar HJJ, Levine OSS, O’Brien KLL, Deloria-Knoll M, Murdoch DRR, et al. Authors : Ac c te d us cr ip t Ac c ep te us cr t. Clin Infect Dis [Internet]. 2020 Apr;8(1):1–10. Available from: http://dx.doi.org/10.1016/S2214-109X(18)30247-X DOI: https://doi.org/10.1016/S2214-109X(18)30247-X

Elfving K, Shakely D, Andersson M, Baltzell K, Ali AS, Bachelard M, et al. Acute uncomplicated febrile illness in children aged 2-59 months in Zanzibar - Aetiologies, antibiotic treatment and outcome. PLoS One. 2016;11(1):1–21. DOI: https://doi.org/10.1371/journal.pone.0146054

Negash AA, Asrat D, Abebe W, Hailemariam T, Hailu T, Aseffa A, et al. Bacteremic Community-Acquired Pneumonia in Ethiopian Children : Etiology , Antibiotic Resistance , Risk Factors , and Clinical Outcome. :1–8.

Ngocho JS, Minja L, van der Gaast – de Jongh CE, Rahamat-Langendoen JC, Langereis JD, Mmbaga BT, et al. Viral-bacterial (co-)occurrence in the upper airways and the risk of childhood pneumonia in resource-limited settings. J Infect [Internet]. 2020;81(2):213–20. Available from: https://doi.org/10.1016/j.jinf.2020.06.013 DOI: https://doi.org/10.1016/j.jinf.2020.06.013

Morpeth SC, Knoll MD, Scott JAG, Park DE, Watson NL, Baggett HC, et al. Detection of pneumococcal DNA in blood by polymerase chain reaction for diagnosing pneumococcal pneumonia in young children from low- and middle-income countries. Clin Infect Dis. 2017;64(January):S347–56. DOI: https://doi.org/10.1093/cid/cix145

Bénet T, Sánchez Picot V, Messaoudi M, Chou M, Eap T, Wang J, et al. Microorganisms Associated with Pneumonia in Children <5 Years of Age in Developing and Emerging Countries: The GABRIEL Pneumonia Multicenter, Prospective, Case-Control Study. Clin Infect Dis. 2017;65(4):604–12. DOI: https://doi.org/10.1093/cid/cix378

Pimenta FC, Moiane B, Lessa FC, Venero AKL, Moura I, Larson S, et al. Dried blood spots for Streptococcus pneumoniae and Haemophilus influenzae detection and serotyping among children < 5 years old in rural Mozambique. BMC Pediatr. 2020;20(1):1–8. DOI: https://doi.org/10.1186/s12887-020-02209-3

Zar HJ, Barnett W, Stadler A, Gardner-Lubbe S, Myer L, Nicol MP. Aetiology of childhood pneumonia in a well vaccinated South African birth cohort: A nested case-control study of the Drakenstein Child Health Study. Lancet Respir Med. 2016; DOI: https://doi.org/10.7196/SAMJ.2016.v106i7.11108

O’Brien KL, Baggett HC, Brooks WA, Feikin DR, Hammitt LL, Higdon MM, et al. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet. 2019;

Hammitt LL, Kazungu S, Morpeth SC, Gibson DG, Mvera B, Brent AJ, et al. A preliminary study of pneumonia etiology among hospitalized children in Kenya. Clin Infect Dis. 2012;54(SUPPL. 2). DOI: https://doi.org/10.1093/cid/cir1071

Selva L, Benmessaoud R, Lanaspa M, Jroundi I, Moraleda C, Acacio S, et al. Detection of Streptococcus pneumoniae and Haemophilus influenzae Type B by Real-Time PCR from Dried Blood Spot Samples among Children with Pneumonia: A Useful Approach for Developing Countries. PLoS One. 2013;8(10):6–12. DOI: https://doi.org/10.1371/journal.pone.0076970

Carrim M, Wolter N, Benitez AJ, Tempia S, du Plessis M, Walaza S, et al. Epidemiology and molecular identification and characterization of mycoplasma pneumoniae, South Africa, 2012-2015. Emerg Infect Dis. 2018;24(3):506–13. DOI: https://doi.org/10.3201/eid2403.162052

Adebanjo T, Lessa FC, Mucavele H, Moiane B, Chauque A, Pimenta F, et al. Pneumococcal carriage and serotype distribution among children with and without pneumonia in Mozambique, 2014-2016. PLoS One. 2018;13(6):2014–6. DOI: https://doi.org/10.1371/journal.pone.0199363

Adegbola RA, DeAntonio R, Hill PC, Roca A, Usuf E, Hoet B, et al. Carriage of Streptococcus pneumoniae and other respiratory bacterial pathogens in low and lower-middle income countries: A systematic review and meta-analysis. PLoS One. 2014; DOI: https://doi.org/10.1371/journal.pone.0103293

Roca A, Hill PC, Townend J, Egere U, Antonio M, Bojang A, et al. Effects of community-wide vaccination with PCV-7 on pneumococcal nasopharyngeal carriage in the Gambia: A cluster-randomized trial. PLoS Med. 2011; DOI: https://doi.org/10.1371/journal.pmed.1001107

Usuf, E., Badji, H., Bojang, A., et al. Pneumococcal carriage in rural Gambia prior to the introduction of pneumococcal conjugate vaccine: A population-based survey. Trop Med Int Heal. 2015; DOI: https://doi.org/10.1111/tmi.12505

Usuf E, Bottomley C, Adegbola RA, Hall A. Pneumococcal carriage in sub-Saharan Africa - A systematic review. PLoS One. 2014;9(1). DOI: https://doi.org/10.1371/journal.pone.0085001

DeAntonio R, Yarzabal JP, Cruz JP, Schmidt JE, Kleijnen J. Epidemiology of community-acquired pneumonia and implications for vaccination of children living in developing and newly industrialized countries: A systematic literature review. Human Vaccines and Immunotherapeutics. 2016. DOI: https://doi.org/10.1080/21645515.2016.1174356

Onwuchekwa, C., Edem, B., Williams, V., Olujuwon, I., Jallow, M., Sanyang, B., & Verdonck, K. (2022). Systematic review and meta-analysis on the etiology of bacterial pneumonia in children in sub-Saharan Africa. Journal of Public Health in Africa, 13(3). https://doi.org/10.4081/jphia.2022.2151

Downloads

Download data is not yet available.

Citations