{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:57:13Z","timestamp":1787684233165,"version":"build-2784847793"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T00:00:00Z","timestamp":1708646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007866","name":"College of Medicine and Health Sciences, University of Gondar","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007866","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nTraditional herbal medicine (THM) is frequently used in pediatric populations in many low-income countries as a form of healthcare and has been associated with a range of adverse events, including liver toxicity, renal failure, and allergic reactions. Despite these concerns, its impact on multi-organ dysfunction syndrome (MODS) risk has not been thoroughly investigated.<\/jats:p>\n<\/jats:sec>\n\nObjective<\/jats:title>\nThis study aimed to investigate the incidence and predictors of MODS in a pediatric intensive care unit (PICU) in Ethiopia, with a focus on the association between THM use and the risk of MODS.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nThis was a single-center prospective cohort study conducted at a PICU in the university of Gondar Comprehensive Specialized hospital, Northwest Ethiopia. The study enrolled eligible patients aged one month to 18 years admitted to the PICU during the study period. Data on demographic characteristics, medical history, clinical and laboratory data, and outcome measures using standard case record forms, physical examination, and patient document reviews. The predictors of MODS were assessed using Cox proportional hazards models, with a focus on the association between traditional herbal medicine use and the risk of MODS.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nA total of 310 patients were included in the final analysis, with a median age of 48 months and a male-to-female ratio of 1.5:1. The proportion and incidence of MODS were 30.96% (95% CI:25.8, 36.6) and 7.71(95% CI: 6.10, 9.40) per 100-person-day observation respectively. Renal failure (17.74%), neurologic failure (15.16%), and heart failure (14.52%) were the leading organ failures identified. Nearly one-third of patients (32.9%) died in the PICU, of which 59.8% had MODS. The rate of mortality was higher in patients with MODS than in those without. The Cox proportional hazards model identified renal disease (AHR = 6.32 (95%CI: 3.17,12.61)), intake of traditional herbal medication (AHR = 2.45, 95% CI:1.29,4.65), modified Pediatric Index of Mortality 2 (mPIM 2) score (AHR = 1.54 (95% CI: 1.38,1.71), and critical illness diagnoses (AHR = 2.68 (95% CI: 1.77,4.07)) as predictors of MODS.<\/jats:p>\n<\/jats:sec>\n\nConclusion<\/jats:title>\nThe incidence of MODS was high. Renal disease, THM use, mPIM 2 scores, and critical illness diagnoses were independent predictors of MODS. A more than twofold increase in the risk of MODS was seen in patients who used TMH. Healthcare providers should be aware of risks associated with THM, and educate caregivers about the potential harms of these products. Future studies with larger sample sizes and more comprehensive outcome measures are needed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0286233","type":"journal-article","created":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T18:45:24Z","timestamp":1708713924000},"page":"e0286233","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Traditional herbal medicine use doubled the risk of multi-organ dysfunction syndrome in children: A prospective cohort study"],"prefix":"10.1371","volume":"19","author":[{"given":"Nahom Worku","family":"Teshager","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashenafi Tazebew","family":"Amare","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koku Sisay","family":"Tamirat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mulualem Endeshaw","family":"Zeleke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asefa Adimasu","family":"Taddese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,2,23]]},"reference":[{"key":"pone.0286233.ref001","article-title":"International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics.","author":"B Goldstein","year":"2005","journal-title":"In: Pediatric Critical Care Medicine"},{"issue":"4","key":"pone.0286233.ref002","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1378\/chest.109.4.1033","article-title":"Epidemiology of sepsis and multiple organ dysfunction syndrome in children","volume":"109","author":"F Proulx","year":"1996","journal-title":"Chest"},{"issue":"2","key":"pone.0286233.ref003","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/01.PCC.0000059421.13161.88","article-title":"Multiple organ dysfunction syndrome in children.","volume":"4","author":"JA Tantale\u00e1n","year":"2003","journal-title":"Pediatr Crit Care Med"},{"key":"pone.0286233.ref004","article-title":"Multiple Organ Dysfunction in the Pediatric Intensive Care Unit","author":"E Rossetti","year":"2017","journal-title":"Critical Care Nephrology: Third Edition"},{"key":"pone.0286233.ref005","article-title":"Day one MODS is associated with poor functional outcome and mortality in the pediatric intensive care unit.","author":"KV Typpo","year":"2009","journal-title":"Pediatr Crit Care Med"},{"key":"pone.0286233.ref006","article-title":"Multiple Organ Dysfunction and Critically Ill Children With Acute Myeloid Leukemia: Single-Center Retrospective Cohort Study.","author":"M Gaugler","year":"2022","journal-title":"Pediatr Crit Care Med"},{"key":"pone.0286233.ref007","article-title":"Outcomes of critically ill children requiring continuous renal replacement therapy.","author":"LW Hayes","year":"2009","journal-title":"J Crit Care"},{"key":"pone.0286233.ref008","article-title":"Epidemiology and outcomes of pediatric multiple organ dysfunction syndrome","author":"RS Watson","year":"2017","journal-title":"Pediatr Crit Care Med"},{"key":"pone.0286233.ref009","article-title":"The Triple Burden Disease in Developing Nations","author":"J Frenk","year":"2011","journal-title":"Harvard Int Rev"},{"key":"pone.0286233.ref010","article-title":"Quality of private and public ambulatory health care in low and middle income countries: Systematic review of comparative studies.","author":"S Berendes","year":"2011","journal-title":"PLoS Med"},{"key":"pone.0286233.ref011","article-title":"1218 Differences in Organ Dysfunctions Between Neonates and Other Children","author":"S Leteurtre","year":"2010","journal-title":"Pediatr Res"},{"key":"pone.0286233.ref012","article-title":"Pediatric multiple organ dysfunction in resource limited settings","author":"EL Fink","year":"2017","journal-title":"Pediatric Critical Care Medicine"},{"key":"pone.0286233.ref013","article-title":"PRISM III: An updated pediatric risk of mortality score.","author":"MM Pollack","year":"1996","journal-title":"Crit Care Med"},{"key":"pone.0286233.ref014","first-page":"1","article-title":"Pediatric critical care medicine: Volume 1: Care of the critically ill or injured child, second edition.","author":"DS Wheeler","year":"2014","journal-title":"Pediatr Crit Care Med Vol 1 Care Crit Ill or Inj Child"},{"key":"pone.0286233.ref015","article-title":"Pediatric Sepsis Update: How Are Children Different?","author":"BM Emr","year":"2018","journal-title":"Surg Infect (Larchmt)"},{"key":"pone.0286233.ref016","article-title":"The growing use of herbal medicines: Issues relating to adverse reactions and challenges in monitoring safety.","author":"M. 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