ArticlePLOS global public health2024
Risk and rates of hospitalisation in young children: A prospective study of a South African birth cohort.
Article in PLOS global public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Respiratory Syncytial Virus among People Living with HIV: Is There a Case for Rolling Out Prophylaxis? A Viewpoint Based on a Systematic Review.Pathogens (Basel, Switzerland) · 2024Pooled it
- Alternative approaches to phase III clinical trials for vaccine efficacy and licensure: the role of real-world evidence - a meeting report.Biologicals : journal of the International Association of Biological Standardization · 2026Article
- Infectious-cause hospitalisation in a province-wide cohort of children with antenatal HIV exposure compared to children without HIV exposure.AIDS (London, England) · 2026Article
- Maternal Inflammation Likely Drives Impaired Immune Responses to Respiratory Syncytial Virus in HIV-Exposed Uninfected Infants.The Journal of infectious diseases · 2026Article
- Infectious morbidity among children HIV-exposed uninfected in South Africa.AIDS (London, England) · 2026Article
- Assessing inequalities in paediatric emergency department admissions in the Northwest of England: a retrospective cohort study.BMJ public health · 2026Article
- Growth, infection, and humoral immunity in children who are HIV exposed and uninfected.Frontiers in cellular and infection microbiology · 2026Article
- Epidemiology, Distinct Seasonal Dynamics, and Age-Specific Characteristics of Eight Respiratory Viruses in Thailand, 2025.Journal of tropical medicine · 2026Article
- Review
- Maternal and early-life longitudinal cytokine profiles in a South African birth cohort: the impact of HIV.bioRxiv : the preprint server for biology · 2025Article
- New advances in RSV: Is prevention attainable?Pediatric pulmonology · 2025Review
- Residency as a determinant of oral health disparities in primary dentition among HIV-infected, HIV-exposed, and unexposed children in Kenya - findings from a cohort study.Critical public health · 2025Article
- Associations of maternal alcohol and non-prescribed substance use with early child growth.The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa · 2025Article
- Care of the Child Perinatally Exposed to Human Immunodeficiency Virus.Clinics in perinatology · 2024Review
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8 authors at 4 institutions in 5 countries.
Funding
Abstract
Children in sub-Saharan Africa (SSA) are disproportionately affected by morbidity and mortality. There is also a growing vulnerable population of children who are HIV-exposed uninfected (HEU). Understanding reasons and risk factors for early-life child hospitalisation will help optimise interventions to improve health outcomes. We investigated hospitalisations from birth to two years in a South African birth cohort study. Mother-child pairs in the Drakenstein Child Health Study were followed from birth to two years with active surveillance for hospital admission and investigation of aetiology and outcome. Incidence, duration, cause, and factors associated with child hospitalisation were investigated, and compared between HEU and HIV-unexposed uninfected (HUU) children. Of 1136 children (247 HEU; 889 HUU), 314 (28%) children were hospitalised in 430 episodes despite >98% childhood vaccination coverage. The highest hospitalisation rate was from 0-6 months, decreasing thereafter; 20% (84/430) of hospitalisations occurred in neonates at birth. Amongst hospitalisations subsequent to discharge after birth, 83% (288/346) had an infectious cause; lower respiratory tract infection (LRTI) was the most common cause (49%;169/346) with respiratory syncytial virus (RSV) responsible for 31% of LRTIs; from 0-6 months, RSV-LRTI accounted for 22% (36/164) of all-cause hospitalisations. HIV exposure was associated with increased incidence rates of hospitalisation in infants (IRR 1.63 [95% CI 1.29-2.05]) and longer hospital admission (p = 0.004). Prematurity (HR 2.82 [95% CI 2.28-3.49]), delayed infant vaccinations (HR 1.43 [95% CI 1.12-1.82]), or raised maternal HIV viral load in HEU infants were risk factors for hospitalisation; breastfeeding was protective (HR 0.69 [95% CI 0.53-0.90]). In conclusion, children in SSA experience high rates of hospitalisation in early life. Infectious causes, especially RSV-LRTI, underly most hospital admissions. HEU children are at greater risk of hospitalisation in infancy compared to HUU children. Available strategies such as promoting breastfeeding, timely vaccination, and optimising antenatal maternal HIV care should be strengthened. New interventions to prevent RSV may have additional impact in reducing hospitalisation.
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