JMIR Publications

ABSTRACT

Background:

In sub-Saharan Africa, where burden of respiratory disease deaths is highest, information on cause of death remains inadequate due to poor access to healthcare and limited availability of diagnostic tools. Postmortem examination can aid in ascertainment of causes of death. This report describes the study protocol for the Pediatric Respiratory Etiology Surveillance Study (PRESS).

Objective:

To identify causes and etiologies associated with respiratory disease deaths among children 1-59 months old hospitalized with respiratory illness admitted to the Kenyatta National Hospital, the largest public hospital in Kenya, through postmortem examination coupled with innovative approaches to laboratory investigation.

Methods:

We prospectively followed children hospitalized with respiratory illness until end of clinical care or death. In case of death, parents/guardians were offered grief counseling and postmortem examination offered. Lung tissue specimens were collected using minimally invasive tissue sampling and conventional autopsy where other tissues were collected. Tissues were tested using histopathology, immunohistochemistry and multiple-pathogen molecular-based assays to identify pathogens. For each case, clinical and laboratory data were reviewed by a team of pathologists, clinicians, laboratorians and epidemiologists to assign a cause of and etiology associated with death.

Results:

We have enrolled 945 pediatric cases of respiratory illness hospitalized in KNH at the time of this submission, of those 140 (15%) died while in hospital. Analysis and interpretation of laboratory results and writing up of findings are expected in 2018/19.

Conclusions:

Postmortem studies can help identify major pathogens contributing to respiratory-associated deaths in children. This information is needed to develop evidence-based prevention and treatment policies that target important causes of pediatric respiratory mortality and assist with prioritization of local resources. PRESS can also provide insights into the interpretation of results using multi-pathogen testing platforms in resource-limited settings.