title: Etiology and Factors Associated with Pneumonia in Children under 5 Years of Age in Mali: A Prospective Case-Control Study.
abstract: BACKGROUND
  There are very limited data on children with pneumonia in Mali. The objective was to assess the etiology and factors associated with community-acquired pneumonia in hospitalized children <5 years of age in Mali.
  
  
  METHODS
  A prospective hospital-based case-control study was implemented in the Pediatric department of Gabriel Touré University Hospital at Bamako, Mali, between July 2011-December 2012. Cases were children with radiologically-confirmed pneumonia; Controls were hospitalized children without respiratory features, matched for age and period. Respiratory specimens, were collected to identify 19 viruses and 5 bacteria. Whole blood was collected from cases only. Factors associated with pneumonia were assessed by multivariate logistic regression.
  
  
  RESULTS
  Overall, 118 cases and 98 controls were analyzed; 44.1% were female, median age was 11 months. Among pneumonia cases, 30.5% were hypoxemic at admission, mortality was 4.2%. Pneumonia cases differed from the controls regarding clinical signs and symptoms but not in terms of past medical history. Multivariate analysis of nasal swab findings disclosed that S. pneumoniae (adjusted odds ratio [aOR] = 3.4, 95% confidence interval [95% CI]: 1.6-7.0), human metapneumovirus (aOR = 17.2, 95% CI: 2.0-151.4), respiratory syncytial virus [RSV] (aOR = 7.4, 95% CI: 2.3-23.3), and influenza A virus (aOR = 10.7, 95% CI: 1.0-112.2) were associated with pneumonia, independently of patient age, gender, period, and other pathogens. Distribution of S. pneumoniae and RSV differed by season with higher rates of S. pneumoniae in January-June and of RSV in July-September. Pneumococcal serotypes 1 and 5 were more frequent in pneumonia cases than in the controls (P = 0.009, and P = 0.04, respectively).
  
  
  CONCLUSIONS
  In this non-PCV population from Mali, pneumonia in children was mainly attributed to S. pneumoniae, RSV, human metapneumovirus, and influenza A virus. Increased pneumococcal conjugate vaccine coverage in children could significantly reduce the burden of pneumonia in sub-Saharan African countries.
authors.affiliation: Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.|University of Lyon 1, Lyon, France.|International Center for Infectiology Research (CIRI), Lyon, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bénet
authors.affiliation: Pediatrics department, Gabriel Touré Hospital, Bamako, Mali.
authors.forename: Mariam
authors.initials: M
authors.lastname: Sylla
authors.affiliation: International Center for Infectiology Research (CIRI), Lyon, France.|Emerging Pathogens Laboratory, Fondation Mérieux, Lyon, France.
authors.forename: Mélina
authors.initials: M
authors.lastname: Messaoudi
authors.affiliation: International Center for Infectiology Research (CIRI), Lyon, France.|Emerging Pathogens Laboratory, Fondation Mérieux, Lyon, France.
authors.forename: Valentina
authors.initials: V
authors.lastname: Sánchez Picot
authors.affiliation: International Center for Infectiology Research (CIRI), Lyon, France.|Emerging Pathogens Laboratory, Fondation Mérieux, Lyon, France.
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Telles
authors.affiliation: Pediatrics department, Gabriel Touré Hospital, Bamako, Mali.
authors.forename: Abdoul-Aziz
authors.initials: AA
authors.lastname: Diakite
authors.affiliation: International Center for Infectiology Research (CIRI), Lyon, France.|Emerging Pathogens Laboratory, Fondation Mérieux, Lyon, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Komurian-Pradel
authors.affiliation: International Center for Infectiology Research (CIRI), Lyon, France.|Emerging Pathogens Laboratory, Fondation Mérieux, Lyon, France.|Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Hubert
authors.initials: H
authors.lastname: Endtz
authors.affiliation: Centre d'Infectiologie Charles Mérieux, Bamako, Mali.
authors.forename: Souleymane
authors.initials: S
authors.lastname: Diallo
authors.affiliation: International Center for Infectiology Research (CIRI), Lyon, France.|Emerging Pathogens Laboratory, Fondation Mérieux, Lyon, France.
authors.forename: Gláucia
authors.initials: G
authors.lastname: Paranhos-Baccalà
authors.affiliation: Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.|University of Lyon 1, Lyon, France.|International Center for Infectiology Research (CIRI), Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Vanhems
mesh_terms: D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D016022:Case-Control Studies; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008302:Mali; D009666:Nose / Q000382:microbiology*; D011014:Pneumonia / Q000209:etiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D014780:Viruses / Q000145:classification / Q000302:isolation & purification*