Etiology of Pediatric Fever in Western Kenya: A Case–Control Study of Falciparum Malaria, Respiratory Viruses, and Streptococcal Pharyngitis

Background: It is unclear whether smoking increases the risk of COVID-19 hospitalisation. We first examined the association of smoking status with hospitalisation for COVID-19 compared with hospitalisation for other respiratory viral infections a year previous. Second, we examined the concordance between smoking status recorded on the electronic health record (EHR) and the contemporaneous medical notes. Methods: This case-control study enrolled adult patients (446 cases and 211 controls) at a single National Health Service trust in London, UK. The outcome variable was type of hospitalisation (COVID-19 vs. another respiratory virus a year previous). The exposure variable was smoking status (never/former/current smoker). Logistic regression analyses adjusted for age, sex, socioeconomic position and comorbidities were performed. The study protocol and analyses were pre-registered in April 2020 on the Open Science Framework. Results: Current smokers had lower odds of being hospitalised with COVID-19 compared with other respiratory viruses a year previous (ORadj=0.55, 95% CI=0.31-0.96, p=.04). There was no significant association among former smokers (ORadj=1.08, 95% CI=0.72-1.65, p=.70). Smoking status recorded on the EHR (compared with the contemporaneous medical notes) was incorrectly recorded for 168 (79.6%) controls (χ2(3)=256.5, p=<0.001) and 60 cases (13.5%) (χ2(3)=34.2, p=<0.001). Conclusions: In a single UK hospital trust, current smokers had reduced odds of being hospitalised with COVID-19 compared with other respiratory viruses a year previous, although it is unclear whether this association is causal. Targeted post-discharge recording of smoking status may account for the greater EHR-medical notes concordance observed in cases compared with controls.

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Factors associated with malnutrition in children <5 years in western Kenya: A hospital-based unmatched case control study

10.21203/rs.2.11617/v5 ◽

2020 ◽

Author(s):

Edwin Gudu ◽

Mark Obonyo ◽

Victor Omballa ◽

Elvis Oyugi ◽

Cecilia Kiilu ◽

...

Keyword(s):

Formal Education ◽

Case Control Study ◽

Case Control ◽

Child Feeding ◽

Western Kenya ◽

Factors Associated ◽

Under Nutrition ◽

Child Feeding Practices ◽

Clinical Records ◽

Control Study

Abstract Background: Globally, under-nutrition accounts for >3 million deaths annually among children <5 years, with Kenya having ~35,000 deaths. This study aimed to identify factors associated with malnutrition in children aged <5 years in western Kenya. Methods: We conducted a hospital-based unmatched case-control study between May and June 2017. Cases were defined as children aged 6-59 months with either z-score for weight-for-height ≤-2SD or ≥+2SD; weight-for-age ≤-2SD or ≥+2SD; or height-for-age ≤-2SD. Controls were children aged 6-59 months with age-appropriate anthropometric measurements. Cases were consecutively recruited while systematic random sampling was used to select controls. Data from interviews and clinical records were collected and entered into Epi-Info, which was used to run unconditional logistic regression analyses. Results: A total of 94 cases and 281 controls were recruited. Of the cases, 84% (79/94) were under-nourished. Mother not having attended ante-natal clinic (OR=7.9; 95% CI: 1.5-41.2), deworming (OR=0.8; 95% CI: 0.4-1.2), and pre-lacteal feeding (OR=1.8; 95% CI: 1.1-3.0) were associated with under-nutrition. Delayed developmental milestones (AOR=13.9; 95% CI: 2.8-68.6); low birth weight (AOR=3.3; 95% CI: 1.4-7.6), and paternal lack of formal education (AOR=4.9; 95% CI: 1.3-18.9) were independently associated with under-nutrition. Conclusion: Proper pre-natal care, child feeding practices and deworming programs should be enhanced to reduce pediatric malnutrition.

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