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Background <p>Infectious Pathogens (IP) remain a significant contributor to stillbirths and under-five deaths in resource-limited settings. Children with sickle cell disease (SCD) are susceptible due to weakened immunity, influencing infection outcomes. This sub-study, nested within the Kenya Child Health and Mortality Prevention Surveillance (CHAMPS) network, investigated infectious pathogens associated with stillbirths and under-five deaths in Western Kenya, as well as the role of the sickle cell condition.</p> Methods <p>We analysed stillbirths (<i>n</i> = 387) and ≤ 5 child deaths (<i>n</i> = 945) enrolled in CHAMPS in Karemo (Siaya) and Manyatta (Kisumu), both in western Kenya, between May 2017 and Dec 2024. Minimally invasive tissue sampling (MITS) specimens were processed on a TaqMan Array Card using the QuantStudio 7 real-time PCR (TAC qPCR) and cultured. All participants were screened for sickle cell status using the point-of-care Gazelle™ Hb Variant device, and confirmed by High Performance Liquid Chromatography (HPLC) and pathological diagnosis. Statistical analyses were performed using R programming software (version 4.5.1).</p> Findings <p>A total of 1,332 cases were investigated, 499, 37.5% (95% CI:34.9–40.1) had an infectious pathogen (IP), with lower prevalence among stillbirths (4.1%, 95%CI:2.6–6.6) and higher prevalence among under-five deaths (51.1%, 95%CI:47.9–54.3). SCD was identified in 46 cases (3.5%) and sickle cell trait in 256 cases (19.2%), for a total of 302 cases (22.7%) with SCD/trait. IP prevalence was higher in SCD (60.9%, 95%CI: 46.3–73.9) than in sickle cell trait (25.8%, 95%CI: 20.6–31.6). Among SCD and sickle cell trait cases, the most frequently identified pathogens were <i>Plasmodium falciparum</i> (39.3% and 18.2%), <i>Klebsiella pneumoniae</i> (7.1% and 37.9%), and <i>Streptococcus pneumoniae</i> (21.4% and 9.1%), respectively. Overall, the leading pathogens identified in post-mortem specimens in both SCD/trait and non-SCD/trait groups were <i>K. pneumoniae</i> (28.7% vs. 25.5%), <i>P. falciparum</i> (24.5% vs. 35.9%), <i>S. pneumoniae</i> (12.8% vs. 12.1%), HIV (8.5% vs. 8.7%), <i>cytomegalovirus</i> (7.4% vs. 7.4%), and <i>respiratory syncytial virus</i> (3.2% vs. 1.5%).</p> Conclusions <p>Infectious pathogens were significantly associated with stillbirth and under-five mortality in Western Kenya, highlighting the need to strengthen infection prevention, diagnosis, and management during pregnancy and early childhood in line with WHO recommendations and targeted preventive care for vulnerable populations like those with SCD.</p> Clinical trial number <p>Not applicable.</p>

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Infectious pathogens associated with stillbirth and under-five mortality by sickle cell disease in Western Kenya: a cross-sectional study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月30日

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  • Morgan Otundo Wasilwa,
  • Valentine Simiyu,
  • Fredrick Onduru,
  • Edwin Kiplelgo,
  • Maryann Nyanjom,
  • Kephas Otieno,
  • Hellen Muttai,
  • Richard Omore,
  • Victor Akelo,
  • Dorcas Obiri-Yeboah

摘要

Background

Infectious Pathogens (IP) remain a significant contributor to stillbirths and under-five deaths in resource-limited settings. Children with sickle cell disease (SCD) are susceptible due to weakened immunity, influencing infection outcomes. This sub-study, nested within the Kenya Child Health and Mortality Prevention Surveillance (CHAMPS) network, investigated infectious pathogens associated with stillbirths and under-five deaths in Western Kenya, as well as the role of the sickle cell condition.

Methods

We analysed stillbirths (n = 387) and ≤ 5 child deaths (n = 945) enrolled in CHAMPS in Karemo (Siaya) and Manyatta (Kisumu), both in western Kenya, between May 2017 and Dec 2024. Minimally invasive tissue sampling (MITS) specimens were processed on a TaqMan Array Card using the QuantStudio 7 real-time PCR (TAC qPCR) and cultured. All participants were screened for sickle cell status using the point-of-care Gazelle™ Hb Variant device, and confirmed by High Performance Liquid Chromatography (HPLC) and pathological diagnosis. Statistical analyses were performed using R programming software (version 4.5.1).

Findings

A total of 1,332 cases were investigated, 499, 37.5% (95% CI:34.9–40.1) had an infectious pathogen (IP), with lower prevalence among stillbirths (4.1%, 95%CI:2.6–6.6) and higher prevalence among under-five deaths (51.1%, 95%CI:47.9–54.3). SCD was identified in 46 cases (3.5%) and sickle cell trait in 256 cases (19.2%), for a total of 302 cases (22.7%) with SCD/trait. IP prevalence was higher in SCD (60.9%, 95%CI: 46.3–73.9) than in sickle cell trait (25.8%, 95%CI: 20.6–31.6). Among SCD and sickle cell trait cases, the most frequently identified pathogens were Plasmodium falciparum (39.3% and 18.2%), Klebsiella pneumoniae (7.1% and 37.9%), and Streptococcus pneumoniae (21.4% and 9.1%), respectively. Overall, the leading pathogens identified in post-mortem specimens in both SCD/trait and non-SCD/trait groups were K. pneumoniae (28.7% vs. 25.5%), P. falciparum (24.5% vs. 35.9%), S. pneumoniae (12.8% vs. 12.1%), HIV (8.5% vs. 8.7%), cytomegalovirus (7.4% vs. 7.4%), and respiratory syncytial virus (3.2% vs. 1.5%).

Conclusions

Infectious pathogens were significantly associated with stillbirth and under-five mortality in Western Kenya, highlighting the need to strengthen infection prevention, diagnosis, and management during pregnancy and early childhood in line with WHO recommendations and targeted preventive care for vulnerable populations like those with SCD.

Clinical trial number

Not applicable.