{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:40:55Z","timestamp":1772163655808,"version":"3.50.1"},"reference-count":19,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T00:00:00Z","timestamp":1644192000000},"content-version":"unspecified","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MLW Programme Core Award","award":["206454"],"award-info":[{"award-number":["206454"]}]},{"DOI":"10.13039\/100010269","name":"Wellcome","doi-asserted-by":"publisher","award":["091909\/Z\/10\/Z"],"award-info":[{"award-number":["091909\/Z\/10\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CDC"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,1,26]]},"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Assess characteristics of clinical pneumonia after introduction of pneumococcal conjugate vaccine (PCV), by HIV exposure status, in children hospitalised in a governmental hospital in Malawi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We evaluated 1139 children \u22645 years old hospitalised with clinical pneumonia: 101 HIV-exposed, uninfected (HEU) and 1038 HIV-unexposed, uninfected (HUU). Median age was 11 months (IQR 6\u201320), 59% were male, median mid-upper arm circumference (MUAC) was 14 cm (IQR 13\u201315) and mean weight-for-height z score was \u22120.7 (\u00b12.5). The highest Respiratory Index of Severity in Children (RISC) scores were allocated to 10.4% of the overall cohort. Only 45.7% had fever, and 37.2% had at least one danger sign at presentation. The most common clinical features were crackles (54.7%), nasal flaring (53.5%) and lower chest wall indrawing (53.2%). Compared with HUU, HEU children were significantly younger (9 months vs 11 months), with lower mean birth weight (2.8 kg vs 3.0 kg) and MUAC (13.6 cm vs 14.0 cm), had higher prevalence of vomiting (32.7% vs 22.0%), tachypnoea (68.4% vs 49.8%) and highest RISC scores (20.0% vs 9.4%). Five children died (0.4%). However, clinical outcomes were similar for both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this post-PCV setting where prevalence of HIV and malnutrition is high, children hospitalised fulfilling the WHO Integrated Management of Childhood Illness criteria for clinical pneumonia present with heterogeneous features. These vary by HIV exposure status but this does not influence either the frequency of danger signs or mortality. The poor performance of available severity scores in this population and the absence of more specific diagnostics hinder appropriate antimicrobial stewardship and the rational application of other interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-050188","type":"journal-article","created":{"date-parts":[[2022,2,8]],"date-time":"2022-02-08T12:17:28Z","timestamp":1644322648000},"page":"e050188","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical pneumonia in the hospitalised child in Malawi in the post-pneumococcal conjugate vaccine era: a prospective hospital-based observational study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3682-8892","authenticated-orcid":false,"given":"Pui-Ying","family":"Iroh Tam","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi"},{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"},{"name":"Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Chirombo","sequence":"additional","affiliation":[{"name":"Statistical Support Unit, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Henrion","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"},{"name":"Statistical Support Unit, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Newberry","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Mambule","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi"},{"name":"Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dean","family":"Everett","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi"},{"name":"Pathology and Infectious Diseases, Khalifa University, Abu Dhabi, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Mwansambo","sequence":"additional","affiliation":[{"name":"Government of Malawi Ministry of Health, Lilongwe, Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nigel","family":"Cunliffe","sequence":"additional","affiliation":[{"name":"Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"French","sequence":"additional","affiliation":[{"name":"Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S","family":"Heyderman","sequence":"additional","affiliation":[{"name":"Division of Infection and Immunity, University College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naor","family":"Bar-Zeev","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi"},{"name":"Paediatrics and Child Health Research Group, Malawi-Liverpool Wellcome Programme, Blantyre, Malawi"},{"name":"Division of Infection and Immunity, University College London, London, UK"},{"name":"Global Disease Epidemiology and Control, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,2,8]]},"reference":[{"key":"2025101811372334000_12.2.e050188.1","unstructured":"UNAIDS . Malawi factsheet, 2019."},{"key":"2025101811372334000_12.2.e050188.2","unstructured":"World Bank . Prevalence of stunting - Malawi, 2018."},{"key":"2025101811372334000_12.2.e050188.3","unstructured":"WHO . Malawi maternal and child health data. Geneva, Switzerland: WHO, 2015."},{"key":"2025101811372334000_12.2.e050188.4","unstructured":"WHO . Revised who classification and treatment of childhood pneumonia at health facilities. Geneva, Switzerland: WHO, 2014."},{"key":"2025101811372334000_12.2.e050188.5","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/cid\/ciy834","article-title":"Emerging resistance to empiric antimicrobial regimens for pediatric bloodstream infections in Malawi (1998-2017)","volume":"69","author":"Iroh Tam","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2025101811372334000_12.2.e050188.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0047337"},{"key":"2025101811372334000_12.2.e050188.7","doi-asserted-by":"publisher","DOI":"10.1093\/tropej\/fms019"},{"key":"2025101811372334000_12.2.e050188.8","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2016.00164"},{"key":"2025101811372334000_12.2.e050188.9","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/S2213-2600(16)00096-5","article-title":"Aetiology of childhood pneumonia in a well vaccinated South African birth cohort: a nested case-control study of the Drakenstein child health study","volume":"4","author":"Zar","year":"2016","journal-title":"Lancet Respir Med"},{"key":"2025101811372334000_12.2.e050188.10","unstructured":"Malawi Ministry of Health . Clinical management of HIV in adults and children. Malawi, 2011."},{"key":"2025101811372334000_12.2.e050188.11","unstructured":"WHO . Handbook IMCI. Integrated management of childhood illness. Geneva, Switzerland: World Health Organization, 2000."},{"key":"2025101811372334000_12.2.e050188.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0092968","article-title":"Predicting mortality among hospitalized children with respiratory illness in Western Kenya, 2009-2012","volume":"9","author":"Emukule","year":"2014","journal-title":"PLoS One"},{"key":"2025101811372334000_12.2.e050188.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0168126","article-title":"Predicting hospitalised paediatric pneumonia mortality risk: an external validation of RISC and mRISC, and local tool development (RISC-Malawi) from Malawi","volume":"11","author":"Hooli","year":"2016","journal-title":"PLoS One"},{"key":"2025101811372334000_12.2.e050188.14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0027793"},{"key":"2025101811372334000_12.2.e050188.15","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1097\/INF.0000000000001883","article-title":"Pneumonia risk stratification scores for children in low-resource settings: a systematic literature review","volume":"37","author":"Deardorff","year":"2018","journal-title":"Pediatr Infect Dis J"},{"key":"2025101811372334000_12.2.e050188.16","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz350"},{"key":"2025101811372334000_12.2.e050188.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0157665","article-title":"Development and validation of a new clinical scale for infants with acute respiratory infection: the ReSVinet scale","volume":"11","author":"Justicia-Grande","year":"2016","journal-title":"PLoS One"},{"key":"2025101811372334000_12.2.e050188.18","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/20469047.2017.1298700","article-title":"A meta-analysis of antimicrobial susceptibility profiles for pneumococcal pneumonia in sub-Saharan Africa","volume":"38","author":"Iroh Tam","year":"2018","journal-title":"Paediatr Int Child Health"},{"key":"2025101811372334000_12.2.e050188.19","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/tropej\/fmz079","article-title":"The challenge and opportunity of pediatric antimicrobial stewardship in low resource settings","volume":"66","author":"Iroh Tam","year":"2020","journal-title":"J Trop Pediatr"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-050188","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T18:37:30Z","timestamp":1760812650000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-050188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,8]]},"published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1136\/bmjopen-2021-050188"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-050188","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.08.06.21261706","asserted-by":"object"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2]]}}}