Risk and rates of hospitalisation in young children: a prospective study of a South African birth cohort.

The Sustainable Development Goals highlight the need to prevent child morbidity and mortality. However, there are limited recent data on hospitalisation rates and determinants in sub-Saharan Africa (SSA), including in children who are HIV-exposed and uninfected (HEU), despite this region having the highest under-5 mortality rate.Children who are HEU represent a growing vulnerable population in SSA. Early-life hospitalisation occurred in 28% of children in our cohort, most frequently in the first 6 months of life, despite high vaccination coverage including the 13-valent pneumococcal conjugate vaccine (PCV) and excluding paediatric HIV infection.Infectious causes represented 83% of hospital admissions after birth; lower respiratory tract infection (LRTI) caused most hospitalisations (49%), with RSV accounting for 31% of episodes. In the first 6 months of life RSV-LRTI was responsible for 22% of all-cause hospitalisations and for 41% of LRTI hospitalisations.Children who are HEU had higher rates of hospitalisation in infancy through 12 months, compared to HIV-unexposed and uninfected children (HUU), as well as longer hospital stay.Prematurity or delayed vaccination were associated with higher risk of hospitalisation; detectable maternal HIV viral load was associated with higher hospitalisation rates in HEU children; breastfeeding was protective against hospitalisation, particularly from gastrointestinal causes. Young children in SSA continue to experience high rates of hospitalisation and infectious causes underly most hospital admissions.Renewed focus on measures to prevent hospitalisation in young children is needed, including interventions to encourage breastfeeding practices, timely vaccinations, optimal maternal health, and targeting at-risk children including those who are HEU or premature.New interventions against RSV-LRTI may substantially reduce hospitalisation in LMICs.