Background:Pneumonia caused by the bacteria Streptococcus pneumoniae is a leading cause of death among children under five years of age, especially in sub-Saharan Africa. Accurate diagnosis remains challenging due to the need for invasive procedures to obtain samples for culture-based diagnostic tests, which are not very sensitive for detecting S.pneumoniae, particularly after antibiotic use.
Serotype-specific urinary antigen detection (ssUAD) assays are a promising, non-invasive alternative for the surveillance and diagnosis of pneumococcal disease. Importantly, they can identify different serotypes of S.pneumoniae, which is crucial for monitoring vaccine impact. However, the ability of the ssUAD to identify invasive disease due to S.pneumoniae has not been studied in children in sub-Saharan Africa, where high rates of asymptomatic carriage may affect diagnostic accuracy.
Aim:
The overall aim of this study is to evaluate the performance of the ssUAD test to detect pneumococcal carriage, and distinguish it from invasive disease, among children under five years old in Blantyre, Malawi.
Methods:This study will test 350 existing urine samples that have already been collected from children as part of the NP Resistome study (Protocol V 5.0, LSTM reference 24-076), including healthy children in the community, children with pneumonia in the community, and children hospitalised with pneumonia. Participants of the NP Resistome study will be recruited from Ndirande Health Centre (NHC), Gateway Primary Care Centre (GPCC) and Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Aliquots from each urine sample will be tested using the ssUAD in the UK, as the assay is not currently available in Malawi. Urinary detection of pneumococcal serotypes will be compared with both culture-based and metagenomic sequencing results from nasopharyngeal swab samples taken as part of the main study.
Who can participate
Age range
12 Months – 24 Months
Sex
ALL
See this in plain English?
AI-rewrites the medical criteria so a patient or caregiver can understand them. Always confirm with the trial site.
Inclusion criteria for healthy children in the community
• Child aged between12-24 months.
Exclusion criteria for healthy children in the community
* Presence of any of the following symptoms: fever, cough, difficulty in breathing or fast breathing.
* Currently taking long-term antibiotic prophylaxis, TB treatment or immunosuppressive medications.
* Diagnosis of an immunosuppressive illness, including HIV infection.
* Hospital admission within the past six months.
Inclusion criteria for children with pneumonia in the community
* Child aged between12-24 months.
* Presence of all of the following symptoms: fever, cough, difficulty in breathing and fast breathing.
* Participant has been prescribed antibiotics for treatment of a lower respiratory tract infection on this presentation.
Exclusion criteria for children with pneumonia in the community
* Severe anaemia, with a recorded haemoglobin level \< 70 grams per Litre.
* Currently taking long-term antibiotic prophylaxis, TB treatment or immunosuppressive medications.
* Diagnosis of an immunosuppressive illness, including HIV infection.
* Hospital admission within the past six months.
Inclusion criteria for children hospitalised with pneumonia
* Child aged between 12-24 months.
* Presence of all of the following symptoms: fever, cough, difficulty in breathing and fast breathing.
* Participant has been prescribed antibiotics for treatment of a lower respiratory tract infection on this presentation.
Exclusion criteria for…
Questions worth asking your doctor
Bring these to your next appointment. They're a starting point for a shared conversation — not a sign you qualify or a recommendation to enrol.
1Based on my diagnosis and history, is this trial worth exploring for me — or is there a standard treatment we should try first?
2What does this trial's phase tell us about how much is already known about its safety and benefit?
3What would taking part actually involve for me — visits, tests, time, and travel?
4What are the known and possible risks or side effects I should weigh, and how would they be monitored?
5If this trial isn't the right fit, what other options or trials would you suggest I look into?
Generated to help you prepare — always confirm anything about your own eligibility and care with the study team and your doctor.
Questions for the trial coordinator
The trial coordinator is the person who runs the study day to day. These cover the practical side — logistics, costs, and what taking part would actually mean for your life. The study team confirms whether you meet the criteria; these are questions to ask, not a sign you qualify.
1What does taking part actually involve week to week — how many visits, where, and how long does each one take?
2What costs are covered by the study, and what might I have to pay for myself, including travel, parking, or time off work?
3What happens during screening, and what happens if the study team confirms I don't meet the criteria after those tests?
4Who pays for the scans, blood work, and other tests the trial requires — the study, my insurance, or me?
5How will being in the trial affect my regular care, and will my own doctor stay informed and involved?
6Can I leave the trial at any point if I change my mind, and what would happen to my care if I do?
A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.
What they're measuring
1
Serotype specific urinary pneumococcal antigen detection
Timeframe: At the time of recruitment/participant enrolment.