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Pneumococcal Disease in Angolan Children Under Five: Epidemiology and Antimicrobial Resistance Patterns
Israel C Avelino1, Joaquim Van-Dúnem2, Sílvia Maria Mendes da Conceição Silvestre3
1From the Global Health and Tropical Medicine (GHTM), LA-REAL, Institute of Hygiene and Tropical Medicine (IHMT), NOVA University Lisbon, Lisbon, Portugal.
Insights
Pneumococcal disease in Angolan children is often fatal due to severe illness, poverty, and drug-resistant bacteria. Improving immunization, diagnosis, nutrition, and care access is crucial for reducing child mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Streptococcus pneumoniae causes significant under-5 mortality globally, especially in low- and middle-income countries.
- Angola faces a disproportionate burden of pneumococcal disease in young children.
Purpose of the Study:
- To identify clinical, sociodemographic, and microbiological predictors of mortality in Angolan children with pneumococcal disease.
Main Methods:
- A cross-sectional observational study was conducted at a national referral pediatric hospital in Luanda, Angola.
- Clinical, demographic, and microbiological data were collected.
- Multivariate logistic regression was used to determine independent predictors of in-hospital mortality.
Main Results:
- Of 463 children, 19.4% died. Predictors of mortality included young age (<12 months), rural residence, low maternal education, household crowding, severe disease (meningitis/sepsis), malnutrition, unvaccinated status, prolonged symptoms (≥14 days), extended hospital stay (≥48 hours), and multidrug-resistant pneumococcal infections.
- Pneumonia was the most common diagnosis (68.0%), followed by meningitis (21.8%) and sepsis (10.2%).
Conclusions:
- Pediatric pneumococcal disease mortality in Luanda results from combined clinical severity, socioeconomic vulnerability, and antimicrobial resistance.
- Urgent interventions including targeted immunization, prompt diagnosis, nutritional support, and enhanced healthcare access are needed for high-risk populations.
Background:
Streptococcus pneumoniae remains a leading cause of under-5 mortality worldwide, with a disproportionate impact in low- and middle-income countries. This study examined clinical, sociodemographic and microbiological predictors of mortality among Angolan children with pneumococcal disease.
Methods:
A hospital-based, cross-sectional observational study was conducted at a national referral pediatric hospital in Luanda, Angola. Clinical, demographic and microbiological data were systematically collected. Multivariate logistic regression identified independent predictors of in-hospital mortality, adjusting for potential confounders.
Results:
A total of 463 children under 5 years of age with suspected or confirmed pneumococcal disease were enrolled. The median age was 24 months (interquartile range: 12-36); 315 (68.0%) had pneumonia, 101 (21.8%) meningitis and 47 (10.2%) sepsis. Of the total cases, 347 (74.9%) were clinically diagnosed and 116 (25.1%) were bacteriologically confirmed. Ninety children (19.4%) died during hospitalization. In multivariate analysis, independent predictors of in-hospital mortality included age <12 months, rural residence, maternal primary education, household crowding, meningitis or sepsis, malnutrition, unvaccinated status, symptom duration ≥14 days, hospital stay ≥48 hours and multidrug-resistant pneumococcal infection.
Conclusions:
Mortality from pediatric pneumococcal disease in Luanda is driven by a convergence of clinical severity, sociodemographic vulnerability and antimicrobial resistance. These findings underscore the urgent need for targeted immunization strategies, early diagnostic intervention, nutritional support and improved access to care in high-risk settings.
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