Volume 22, Number 10—October 2016
CME ACTIVITY - Research
Ebola Virus Disease in Children, Sierra Leone, 2014–2015
, Asad Naveed, Kevin Wing, Musa Gbessay, J.C.G. Ross, Francesco Checchi, Daniel Youkee, Mohammed Boie Jalloh, David E. Baion, Ayeshatu Mustapha, Hawanatu Jah, Sandra Lako, Shefali Oza, Sabah Boufkhed, Reynold Feury, Julia Bielicki, Diana M. Gibb, Nigel Klein, Foday Sahr, and Shunmay Yeung
Table 1
Descriptive, univariable, and multivariable analysis of 282 Ebola-positive children who attended an EHU and for whom outcome was recorded, Western Area, Sierra Leone, August 2014–March 2015*
| Variable | Total, no. (%) | Survived, no. (%) | Died, no. (%) | Crude OR† (95% CI) | Multivariable adjusted OR‡ |
|---|---|---|---|---|---|
| Total§ |
282 (100) |
122 (43) |
160 (57) |
– |
– |
| Sex | |||||
| F | 146 (52) | 70 (48) | 76 (52) | 1 | 1 |
| M |
136 (48) |
52 (38) |
84 (62) |
1.49 (0.93–2.39¶ |
1.42 (0.86–2.36) |
| Age, y | |||||
| Mean (SD) | 6.6 (3.9) | 7.4 (3.6) | 6.0 (4.0) | OR per +1 y | |
| Median (IQR) |
7 (3–10) |
8 (4–10) |
5 (2–10) |
0.91 (0.85–0.97) |
0.92 (0.86–0.98) |
| Age group, y | |||||
| 5 to <12 | 178 (63) | 87 (49) | 91 (51) | 1 | – |
| 0 to <5 |
104 (37) |
35 (34) |
69 (66) |
1.88 (1.14–3.11)¶ |
– |
| Days from symptom onset to EHU presentation | |||||
| Mean (SD) | 3.6 (3.0) | 3.6 (3.1) | 3.5 (3.0) | 1.16 (0.59–2.29) | – |
| Median (IQR) |
3 (2–4) |
3 (2–4) |
3 (2–4) |
OR per +1 d |
|
| Signs and symptoms | |||||
| Fever,# n = 204 | |||||
| No | 9 (4) | 6 (67) | 3 (33) | 1** | – |
| Yes | 195 (96) | 83 (43) | 112 (57) | 2.70 (0.66–11.11) | – |
| Fatigue/weakness, n = 163 | |||||
| No | 4 (2) | 1 (25) | 3 (75) | 15 | – |
| Yes | 159 (98) | 65 (41) | 94 (59) | 0.48 (0.05–4.74) | – |
| Common symptoms, n = 160 | |||||
| Fever or fatigue | 8 (5) | 3 (37) | 5 (63) | 1 | – |
| Both | 152 (95) | 63 (41) | 89 (59) | 1.07 (0.58–1.97) | – |
| Vomiting/nausea, n = 205 | |||||
| No | 83 (40) | 37 (45) | 46 (55) | 1 | – |
| Yes | 122 (60) | 51 (42) | 71 (58) | 1.13 (0.64–2.00) | – |
| Diarrhea, n = 198 | |||||
| No | 108 (55) | 56 (52) | 52 (48) | 1 | 1 |
| Yes | 90 (45) | 31 (34) | 59 (66) | 1.94 (1.11–3.39)¶ | 1.91 (1.08–3.39) |
| Anorexia, n = 201 | |||||
| No | 44 (22) | 21 (48) | 23 (52) | 1 | – |
| Yes | 157 (78) | 64 (41) | 93 (59) | 1.30 (0.66–2.55) | – |
| Abdominal pain, n = 188 | |||||
| No | 78 (41) | 32 (41) | 46 (59) | 1 | – |
| Yes | 110 (59) | 51 (46) | 59 (54) | 0.82 (0.49–1.4) | – |
| Hiccups,†† n = 188 | |||||
| No | 179 (95) | 79 (44) | 100 (56) | 1 | – |
| Yes | 9 (5) | 3 (33) | 6 (67) | 1.58 (0.38–6.52)†† | – |
| Difficulty swallowing, n = 191 | |||||
| No | 147 (77) | 64 (44) | 83 (56) | 1 | – |
| Yes | 44 (23) | 19 (43) | 25 (57) | 0.98 (0.44–2.17) | – |
| Difficulty breathing, n = 190 | |||||
| No | 164 (86) | 72 (44) | 92 (56) | 1 | – |
| Yes | 26 (14) | 8 (31) | 18 (69) | 1.74 (0.69–4.55) | – |
| Muscle pain, n = 185 | |||||
| No | 104 (56) | 45 (43) | 59 (57) | 1 | – |
| Yes | 81 (44) | 37 (46) | 44 (54) | 0.93 (0.53–1.64) | – |
| Joint pain, n = 186 | |||||
| No | 99 (53) | 44 (44) | 55 (56) | 1 | – |
| Yes | 87 (47) | 39 (45) | 48 (55) | 1.00 (0.57–1.77) | – |
| Headache, n = 185 | |||||
| No | 77 (42) | 29 (38) | 48 (62) | 1 | 1 |
| Yes | 108 (58) | 53 (49) | 55 (51) | 0.64 (0.34–1.19)¶ | 0.60 (0.32–1.13) |
| Conjunctivitis, n = 190 | |||||
| No | 118 (62) | 54 (46) | 64 (54) | 1 | – |
| Yes | 72 (38) | 30 (42) | 42 (58) | 1.18 (0.63–1.90) | – |
| Rash, missing n = 190 | |||||
| No | 181 (95) | 79 (44) | 102 (56) | 1 | – |
| Yes | 9 (5) | 3 (33) | 6 (67) | 1.55 (0.38–6.39)†† | – |
| Unexplained bleeding,†† n = 192 | |||||
| No | 189 (98) | 81 (43) | 108 (57) | 1 | – |
| Yes | 3 (2) | 1 (33) | 2 (67) | 1.50 (0.13–16.83)†† | – |
| Rare symptoms,†† n = 189 | |||||
| No | 169 (89) | 75 (44) | 94 (56) | 1 | – |
| Yes | 20 (11) | 7 (35) | 13 (65) | 2.04 (0.84–4.97)¶ | – |
| Malaria positive by RDT, n = 16 | |||||
| No | 14 (88) | 9 (64) | 5 (36) | –‡‡ | – |
| Yes | 2 (13) | 0 | 2 (100) | – | – |
| Admitted accompanied, n = 181 | |||||
| No | 69 (38) | 32 (46) | 37 (54) | 1 | – |
| Yes | 112 (62) | 44 (39) | 68 (61) | 1.22 (0.65–2.28) | – |
| Date of presentation, n = 282 | |||||
| Before Jan 9 | 256 (91) | 114 (45) | 142 (55) | 1 | – |
| On/after Jan 9 |
26 (9) |
8 (31) |
18 (69) |
1.81 (0.76–4.31)¶ |
– |
| Common medications,§§ n = 149 | |||||
| Antimicrobial or antimalarial drug at EHU | 22 (15) | 7 (32) | 15 (68) | 1 | – |
| Antimicrobial and antimalarial drug at EHU | 127 (85) | 53 (42) | 74 (58) | 0.64 (0.32–.30) | – |
| Intravenous fluids at EHU | |||||
| No | 270 (96) | 117 (43) | 153 (57) | 1 | – |
| Yes |
12 (4) |
5 (42) |
7 (58) |
1.07 (0.33–3.46) |
– |
| EHU | |||||
| Ola During Children’s Hospital | 112 (40) | 41 (37) | 71 (63) | 1 | – |
| Connaught | 57 (20) | 20 (35) | 37 (65) | 1.06 (0.55–2.08) | – |
| Lumley | 13 (5) | 7 (54) | 6 (46) | 0.49 (0.16–1.57) | – |
| Rokupa | 24 (9) | 15 (63) | 9 (38) | 0.35 (0.14–0.86) | – |
| Macauley | 16 (6) | 5 (31) | 11 (69) | 1.27 (0.41–3.91) | – |
| Newton | 20 (7) | 10 (50) | 10 (50) | 0.58 (0.22–1.50) | – |
| Kerry Town Suspect Ward | 5 (2) | 3 (60) | 2 (40) | 0.38 (0.06–2.40) | – |
| Police Training Schools 1 and 2 | 14 (5) | 9 (64) | 5 (36) | 0.32 (0.10–1.02) | – |
| 34 Military Hospital | 10 (4) | 5 (50) | 5 (50) | 0.58 (0.16–2.11) | – |
| Aspen | 4 (1) | 2 (50) | 2 (50) | 0.58 (0.08–4.36) | – |
| Kuntorloh | 1 (0) | 1 (100) | 0 | – | – |
| Jui | 6 (2) | 4 (67) | 2 (33) | 0.29 (0.05–1.65) | – |
*EHU, Ebola holding unit; IQR, interquartile range; OR, odds ratio; –, omission of variables according to p value as described in the footnotes that follow.
†Multiple imputation used to account for missing data for all estimates with missing data. Multiple imputation model included all variables in this table with missing data (unless specified) plus the complete variables: outcome status, sex, age, date of admission, and EHU. For comparison of multiple imputation with a complete records analysis, see Technical Appendix Table 2.
‡Multivariable regression model included age, sex, diarrhea, and headache (selected for inclusion using a backward stepwise approach) with multiple imputation applied as explained in the previous footnote.
§Total children admitted to EHUs for whom complete outcome information was available.
¶p<0.20 (Wald test); therefore, variable was included in an initial multivariable model from which the final multivariable presented in this table was obtained through a backward stepwise approach (online Technical Appendix, “Statistical Analysis” section and Technical Appendix Table 2).
#All symptoms in this table: recorded upon presentation at EHU.
**Fever and fatigue/weakness: insufficient numbers of children recorded as “No” for these variables to include in multiple imputation model; therefore, the OR for a complete records analysis is shown here. A “common symptoms” variable was created to enable inclusion of data related to these symptoms in multiple imputation and multivariable regression models.
††Rash, hiccups, and unexplained bleeding: insufficient numbers of children recorded as “Yes” for these variables to include in multiple imputation model. A “rare symptoms” variable was created to enable inclusion of data related to these symptoms in multiple imputation and multivariable regression models.
‡‡Insufficient numbers for regression analysis.
§§Combined variable created because of the low numbers of children recorded as not having received either medication.