Emotional and behavioural outcomes in childhood for survivors of Group B Streptococcus invasive disease in infancy: findings from five low and middle-income countries

Background: Survivors of invasive Group B streptococcus (iGBS) disease, notably meningitis, are at increased risk of neurodevelopment impairment (NDI). However, the limited studies to date have a median follow-up to 18 months and mainly focused on moderate/severe NDI, with no previous studies on emotional-behavioural problems among iGBS survivors. Methods: In this multi-country, 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 iGBS history were matched to iGBS survivors on sex and age. Our primary outcomes were emotional-behavioural problems and psychopathologies as measured with the Child Behaviour Checklist (CBCL). The CBCL was completed by the child’s primary caregiver. Results: Between October 2019 and April 2021, 573 children (mean age of 7.18 years old) were assessed: 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 DSM-5 defined, clinically significant psychopathologies. Conclusions: Our findings suggested that school age iGBS survivors experienced increased mild emotional behavioural problems which may impact children and families. At-risk neonates including iGBS survivors need long-term follow-up with integrated emotional-behavioural assessments and appropriate care. Scale-up will require simplified assessments that are free and culturally adapted