Emotional and Behavioral Outcomes in Childhood for Survivors of Invasive Group B Streptococcus Disease in Infancy: Findings From 5 Low- and Middle-Income Countries

Author:

Chandna Jaya1,Liu Wan-Hsin12,Dangor Ziyaad3,Leahy Shannon3,Sridhar Santhanam4,John Hima B4,Mucasse Humberto5,Bassat Quique56789,Bardaji Azucena56,Abubakar Amina1011,Nasambu Carophine10,Newton Charles R1012,Sánchez Yanotti Clara13,Libster Romina13,Milner Kate14,Paul Proma1,Lawn Joy E1,Madhi Shabir A,D Z,L S,Harden Lois,Ghoor Azra,Mbatha Sibongile,Lowick Sarah,Jaye Tamara,Lala Sanjay G,Sithole Pamela,Msayi Jacqueline,Kumalo Ntombifuthi,Msibi Tshepiso Nompumelelo,S S,J H B,Arumugam Asha,Murugesan Nandhini,Rajendraprasad Nandhini,Priya Mohana,A A,N C,Adan Adam Mabrouk,Katana Patrick Vidzo,Mwangome Eva,N C R,B Q,Bardají Azucena,Bramugy Justina,M H,Massora Sergio,L R,Y C S,Medina Valeria,Rojas Andrea,Amado Daniel,Llapur Conrado J,M A K,

Affiliation:

1. Maternal, Adolescent, Repr oductive & Child Health Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom

2. Division of General Paediatrics, Department of Paediatrics, Taipei Veterans General Hospital, Taipei, Taiwan

3. Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

4. Neonatology Department, Christian Medical College, Vellore, India

5. Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique

6. ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

7. Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain

8. Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain

9. Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain

10. Neuroscience Research Group, Department of Clinical Sciences, KEMRI Wellcome Trust, Kilifi, Kenya

11. Institute of Human Development, Aga Khan University, Nairobi, Kenya

12. Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom

13. Fundación INFANT, Buenos Aires, Argentina

14. Neurodisability & Rehabilitation Research Group, Murdoch Children’s Research Institute 2, Department of Paediatrics, University of Melbourne, Melbourne, Australia

Abstract

Abstract Background Survivors of invasive group B Streptococcus (iGBS) disease, notably meningitis, are at increased risk of neurodevelopmental impairment. However, the limited studies to date have a median follow-up to 18 months and have mainly focused on moderate or severe neurodevelopmental impairment, with no previous studies on emotional-behavioral problems among iGBS survivors. Methods In this multicountry, matched cohort study, we included children aged 18 months to 17 years with infant iGBS sepsis and meningitis from health demographic surveillance systems, or hospital records in Argentina, India, Kenya, Mozambique, and South Africa. Children without an iGBS history were matched to iGBS survivors for sex and age. Our primary outcomes were emotional-behavioral problems and psychopathological conditions as measured with the Child Behavior Checklist (CBCL). The CBCL was completed by the child’s primary caregiver. Results Between October 2019 and April 2021, 573 children (mean age, 7.18 years) were assessed, including 156 iGBS survivors and 417 non-iGBS comparison children. On average, we observed more total problems and more anxiety, attention, and conduct problems for school-aged iGBS survivors compared with the non-iGBS group. No differences were found in the proportion of clinically significant psychopathological conditions defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Conclusions Our findings suggested that school-aged iGBS survivors experienced increased mild emotional behavioral problems that may affect children and families. At-risk neonates including iGBS survivors need long-term follow-up with integrated emotional-behavioral assessments and appropriate care. Scale-up will require simplified assessments that are free and culturally adapted.

Funder

Bill and Melinda Gates Foundation

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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