BACKGROUNDGlobally, very few childhood deaths have been attributed to coronavirus disease 2019 (COVID-19). We evaluated clinical, microbiologic and postmortem histopathologic findings in childhood ...deaths in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified antemortem or postmortem. METHODSSurveillance of childhood deaths was ongoing during the initial COVID-19 outbreak in South Africa from April 14, 2020, to August 31, 2020. All children hospitalized during this time had a SARS-CoV-2 test done as part of standard of care. Postmortem sampling included minimally invasive tissue sampling (MITS) of lung, liver and heart tissue; blood and lung samples for bacterial culture and molecular detection of viruses (including SARS-CoV-2) and bacteria. The cause of death attribution was undertaken by a multidisciplinary team and reported using World Health Organization framework for cause of death attribution. RESULTSSARS-CoV-2 was identified on antemortem and/or postmortem sampling in 11.7% (20/171) of deceased children, including 13.2% (12/91) in whom MITS was done. Eighteen (90%) of 20 deaths with SARS-CoV-2 infection were <12 months age. COVID-19 was attributed in the causal pathway to death in 91.7% (11/12) and 87.5% (7/8) cases with and without MITS, respectively. Lung histopathologic features in COVID-19-related deaths included diffuse alveolar damage (n = 6, 54.5%), type 2 pneumocyte proliferation (n = 6, 54.5%) and hyaline membrane formation (n = 5, 36.4%). Culture-confirmed invasive bacterial disease was evident in 54.5% (6/11) of COVID-19 attributed deaths investigated with MITS. CONCLUSIONSCOVID-19 was in the causal pathway of 10.5% (18/171) of all childhood deaths under surveillance. The postmortem histopathologic features in fatal COVID-19 cases in children were consistent with reports on COVID-19 deaths in adults; although there was a high prevalence of invasive bacterial disease in the children.
Introduction
Globally, childhood poisoning, accounts for a significant proportion of emergency department admissions. There is a paucity of data from low- and middle-income countries on poisoning in ...children.
Objective
To describe the incidence, case fatality rate, and types of poisoning in children admitted to a tertiary-level hospital in Johannesburg, South Africa.
Methods
This was a retrospective descriptive study of children hospitalised with poisoning from January 2016 to December 2021 at Chris Hani Baragwanath Academic Hospital. Children were identified from a discharge summary database using ICD-10 codes that describe poisoning. Trends in incidence of poison exposure were reported.
Results
Of the 60,901 admissions during the study period, 2,652 (4.4%) children were diagnosed with poisoning. Most (71.3%) children were less than 5 years of age and 55% were male. The incidence of poisoning per 100,000 was highest at 108.4 (95% CI: 104.3–112.6) in 2019 and decreased to 77.3 (95% CI: 73.9–80.7) in 2020 and 59.6 (95% CI: 56.3–62.5) in 2021. Main causes of poisoning were organic solvents (37.6%), medications (32.9%), and pesticides (17.5%). The overall case fatality rate was 2.1%. In a multivariate analysis, poisoning secondary to pesticides (aOR: 13.9; 95% CI: 4.52–60.8;
p
< 0.001), and unspecified agents (aOR: 12.7; 95% CI: 3.27–62.8;
p
< 0.001) were associated with an increased odds of death.
Conclusion
We report a high prevalence of poisoning in children hospitalised in this tertiary-level hospital in South Africa. Public health measures to reduce the burden of organic solvents, medications and pesticide poisoning are urgently warranted.
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