Andreas Chiabi

The frequency and magnitude of growth failure in a group of HIV-infected children in Cameroon

Introduction La survenue de l’hypertension artérielle pulmonaire (HTAP) est un tournant dans l’évolution de la sclérodermie. L’objectif de cette étude est de décrire les aspects épidémiologiques et évolutifs de l’HTAP au cours de la sclérodermie systémique. Méthodes Nous avons réalisé une étude descriptive concernant des patients suivis pour sclérodermie systémique, au service de Dermatologie de l’hôpital Aristide Le Dantec entre Janvier 2000 et Août 2009. Ces patients étaient inclus dans l’étude après exploration cardio-vasculaire (ECG, échocardiographie-Doppler). Nous avons étudié les paramètres épidémiologiques, cliniques, paracliniques et évolutifs des patients. Résultats Nous avons enregistré 12 cas d’hypertension artérielle pulmonaire parmi les 83 patients atteints de sclérodermie systémique soit une prévalence de 14,45%. L’âge moyen des patients était de 43,58 ans±12,5 ans et le sex-ratio (H/F) de 0,33. Sur le plan clinique, la dyspnée était quasi constante (75%) et la douleur thoracique présente dans 25% des cas. Le syndrome de Raynaud était observé chez 8 patients soit 66,67% de nos patients. L’électrocardiogramme montrait des signes de surcharge droite chez 4 malades (33,33%) et la radiographie thoracique en faveur d’une fibrose pulmonaire chez 4 patients. L’échocardiographie-Doppler notait une insuffisance tricuspide importante dans 58, 33% des cas (7 patients), une pression artérielle pulmonaire systolique (PAPs) en moyenne de 66,25±29,3 mmHg, une dilatation des cavités cardiaques droites dans 5 cas et un mouvement paradoxal du septum interventriculaire chez 3 malades (33,33%). Il était également noté 3 cas (25%) d’épanchement péricardique. Nous avons déploré 4 décès (33,33%). Conclusion L’hypertension artérielle pulmonaire est une complication fréquente et grave de la sclérodermie. Son dépistage, grâce à l’échocardiographie-Doppler systématique, constitue une étape fondamentale de la prise en charge.Introduction: Some probable mechanisms have been described to the relationship between magnesium (Mg) level and migraine headache attacks. In the study reported here, we sought to determine the total Mg serum status of patients with migraine within and between the headache attacks and compare it with non-migraineurs. Methods: This study was performed on 50 migraineurs patients diagnosed according to the International Headache Society (IHS) criteria for acute migraine headache. Fifty healthy subjects without any family history or evidences of migraine were randomly selected from hospital personnel as the control group. Serum Mg level was measured by Xylidyl blue method. Results: In the group with migraine headache, no significant difference was found in the serum total Mg levels within and between migraine headache attacks (1.86 ± 0.41 mg/dl versus 1.95 ± 0.35 mg/dl, p = 0.224). But, serum total Mg level was notably lower in the group with these attacks compared to the control group (1.86 ± 0.41 mg/dl versus 2.10 ± 0.23 mg/dl, p < 0.001). Conclusion: Serum Mg level is on average significantly reduced in patients with migraine compared to the healthy group. However, the serum total Mg levels in migraineurs remained constant within and between migraine headache attacks.Le kyste hydatique est une parasitose qui sévit à l’état endémique au Maroc. Cependant sa rupture au cours de la grossesse reste rare. Nous rapportons le cas d’une patiente de 23 ans, admise aux urgences en état de choc avec bouffissure du visage sur aménorrhée de 8 semaines, chez laquelle le diagnostic d’hydatidose à la fois hépatique et pelvienne, avec éventuelle rupture de l’un des kystes hépatiques a été posé par la radiologie. Après mesures de réanimation, le traitement chirurgical a été instauré, avec bonne évolution. Nous essayons à partir de ce cas et à travers une revue de littérature, de préciser les difficultés diagnostiques et thérapeutiques rencontrées dans la prise en charge des kystes hydatiques, surtout compliquées, au cours de la grossesse.

Weight-for-Height Z Score and Mid-Upper Arm Circumference as Predictors of Mortality in Children with Severe Acute Malnutrition

Background Mortality associated with severe acute malnutrition (SAM) could be reduced by screening malnourished children for those most vulnerable to death. We compared the weight-for-height Z score (WHZ) and mid-upper arm circumference (MUAC) as predictors of mortality in children with SAM. Methods We conducted a retrospective study spanning over 8 years, using records of children aged 6-59 months, hospitalized for SAM and discharged alive or who died during hospitalization. Results Area under the curve was greater for MUAC [0.809 (95% CI, 0.709-0.911, p = 0.001)] than WHZ [0.649 (95% CI, 0.524-0.774, p = 0.032)]. MUAC predicted death better [sensitivity: 95.5%, specificity: 25.0%, positive likelihood ratio (PLR): 1.27, negative likelihood ratio (NLR): 0.18] than WHZ (sensitivity: 86.4%, specificity: 21.4%, PLR: 1.10, NLR: 0.64). Best MUAC and WHZ cut-offs for predicting death (10.3 cm and -4, respectively) were most accurate in infants aged <12 months, the former being more accurate. Conclusion MUAC predicts death better than WHZ in children with SAM.

Initial treatment of severe malaria in children is inadequate - a study from a referral hospital in Cameroon

Background . Severe malaria, caused by Plasmodium falciparum, is potentially fatal, with a case mortality rate of 15 - 20%, despite treatment. Aim . To document epidemiological and clinical features, including initial treatment, of severe malaria in children referred to a general paediatric unit in Cameroon. Methods . A prospective cross-sectional study investigating characteristics of children admitted for severe malaria, confirmed with a positive thick blood smear. Results . A total of 309 (29.2%) children were identified out of 1 060 admissions, of whom 52% were males and 48% females, and mean age 46.3 (1 - 180) months. Most children were aged artesunate + amodiaquine (18%), and artesunate + mefloquine (6%). Only 16% of the mothers said they had used insecticidetreated bed nets (ITNs). Conclusion . In most cases, there is a delay before consultation, with most children initially self-medicated at home. Initial consultations are at primary local health facilities where less effective drugs are prescribed at inadequate dosages. Recommended ACTs were also often prescribed at inadequate dosages. Education in the use of ITNs, home treatment of simple malaria, and appropriate use of ACTs should be promoted.

Morbidity and Mortality from Measles in Cameroonian Children: Implications for Measles Control

Objective: To investigate the epidemiological trends of measles in the Littoral, North-west, South-west and Western regions of Cameroon in order to improve measles control. Design and Methods: Cross-sectional study of retrolective data collected on cases of measles from January 1997 to April 2003 and stored in registers at regional levels. Child age, immunization and disease status, complications and outcomes were recorded. Results: 33,268 cases of measles were registered. The trend was endemo-epidemic with outbreaks occurring between Feb- ruary and April. The average incidence rate was 4.8‰ per year with 4.1‰ reported in 1998, 5.8‰ in 2001, and 0.9‰ in 2002. Complete data sets for 16,637 cases indicate that 47.4% were children aged 9 to 59 months. Those less than 9 months represented 15.2% of the cases. More than half (415 cases) of the 766 cases with known immunization status (54.2%) representing 2.5% of the 16,637 total cases had received the measles vaccine. Complications were frequent in the Western (53.7%) and the Littoral (33.7%) regions and 53.3% of all complications were bronchopulmonary infections. The global case fatality rate was 1.6%, and 2.1% in children less than 9 months with a significant tendency to decrease with age (p<10 -4 ). The most frequent cause-related disorders of death were malnutrition (34.4%), neurological (35.3%) and di- gestive (26.2%). Conclusion: measles was a public health problem in Cameroon with vaccinated and unvaccinated children both affected within the period of study. Those less than 9 months old, carried the highest burden of the disease in terms of mortality.

Baseline demographic, clinical and immunological profiles of HIV-infected children at the Yaounde Gynaeco-Obstetric and Pediatric hospital, Cameroon.

Introduction Approximately 2.5 million children below 15 years are infected with the HIV virus, with 90% in sub-Saharan Africa. The Yaounde Gynaeco-obstetric and Pediatric hospital has been a treatment center for HIV since 2006. The aim of this study was to analyze the baseline demographic, clinical and immunologic characteristics of the children with the HIV infection in this hospital. Methods It was a retrospective, cross- sectional and analytic study, carried out between January and April 2011 which included 61 HIV positive children aged 0-15 years. The socio-demographic, clinical and immunologic data were obtained from their medical records. Results Most (52.5%) of the children studied were above 60 months of age with a mean age of 71 months. Most (57.4%) were females. Mother-to-child transmission was the principal mode of contamination in 88.5% of cases. More than half of their mothers (55.7%) did not receive antiretroviral prophylaxis during pregnancy and labor. Common clinical findings included prolonged fever (44.6%), malnutrition (37.6%), lymphadenopathy (34.4%), respiratory tract infections (34.4%) and diarrhea (24.5%). Diagnosis was confirmed by HIV serology for most of the patients (93.4%). Polymerase chain reaction served as method of diagnosis in only 6.6% of the cases. HIV 1 was the predominant viral type. More than half of the children (52.5%) were seen at an advanced stage of the disease. Conclusion HIV screening during pregnancy and prevention of mother-to-child transmission should be reinforced in this context, and fathers of HIV-infected children should be encouraged to go for HIV testing.

The clinical spectrum of severe acute malnutrition in children in Cameroon: a hospital-based study in Yaounde, Cameroon

BACKGROUND Severe acute malnutrition (SAM) is a major health problem, and the cause of more than half of childhood deaths in children less than 5 years in developing countries. Globally, 20 million children under 5 years of age are severely malnourished according to the World Health Organization (WHO). In Cameroon, the prevalence of SAM remains high and estimated at 1.9% in 2011 and 1.3% in 2014. The aim of this study was to determine the epidemiology, clinical aspects and outcome of SAM at the Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH). METHODS We retrospectively reviewed the medical records of children hospitalized in the YGOPH for SAM over a period of 8 1/2 years (from September 2006 to March 2015). We included the medical records of children under 15 years of age who were hospitalized in the pediatric unit of the YGOPH for the management of SAM. Data was collected using a data entry form and was analyzed with Epi info version 3.5.4 software. Data was considered statistically significant for P less than 0.05. RESULTS The prevalence of SAM was 2.72%. The median age was 9 months (range, 23 days-112 months). The most represented age group was 6 to 12 months with 34.6% of the children. The most frequent symptoms on admission were: wasting (58.1%) and fever (53.6%). The mean interval between the onset of symptoms and admission was 30.36 days. Marasmus was the most frequent clinical form of SAM observed in 88.8% of the children. Respiratory tract infections were the most common comorbidities and were present in 45 patients (25.1%), followed by malaria in 15.1% of cases. The sero-prevalence of human immuno deficiency virus (HIV) was 43.75% amongst the 32 children whose HIV status was known. Dehydration was the most frequent complication, with an occurrence of 29.6%. A total of 58.7% of patients were discharged following clinical improvement and the mortality rate was 15%. The average duration of hospitalization was 8.25 days. CONCLUSIONS SAM is a frequently encountered pathology in this context with a high mortality, thus the need to step up prevention strategies. Health education during pediatric consultations and vaccination sessions on the appropriate feeding of the young infant and the child should be reinforced.

Profil clinique et bactériologique des infections néonatales bactériennes à l’Hôpital Laquintinie de Douala, Cameroun

INTRODUCTION The World Health Organization has estimated that the global incidence of neonatal deaths was 2,8 million in 2015, of which 47,6% were due to infections. These infections can affect newborns babies ages 0-1 month through 3 months. METHODS This is a prospective study conducted from 1 March to 30 June 2015 in the Neonatology service of the Laquintinie Hospital at Douala. All symptomatic newborns with or without anamnestic criteria and all asymptomatic newborns, with at least an infectious risk and a positive blood culture or an abnormal blood count or positive C-reactive protein were included in the study. RESULTS Of the 310 newborns enrolled in the study, 300 were retained for neonatal infection, corresponding to a total incidence of 96.8%. We performed 104 cultures, of which 25 were positive, corresponding to an incidence of confirmed neonatal infection of 24%. The factors associated with infection were unexplained preterm birth < 35 weeks of amenorrhea (45,1%) and neonatal resuscitation (34,8%). Fever (56%) and neurological disorders (48.8%) were the most frequent clinical symptoms. Gram-negative bacteria were the most frequent germs (56%). Imipenem (95%) and amikacin (66.7%) were the most effective antibiotics. Outcome was favorable in 66,4% of cases and the overall mortality rate was 33,6%. CONCLUSION This study revealed a high prevalence of neonatal bacterial infection in this Hospital. Bacterial ecology was dominated by Gram-negative bacteria. It was recorded a significant resistance to the most widely used antibiotics and a fairly high mortality.

Evaluation of breastfeeding and 30% glucose solution as analgesic measures in indigenous African term neonates

Objectives: To compare the analgesic effect of breastfeeding and 30% glucose on pain induced in term newborns during a single painful procedure. Study Design and Setting: We conducted an open design trial, from January to October 2013, at the maternity of the Yaounde Gynaeco-Obstetric and Paediatric Hospital. Patients and Methods: We included healthy term newborns of at least 24 h of life; a heel prick was done, using a 23-gauge syringe, after an analgesic with breastfeeding or 30% glucose. The newborns were divided into two groups by drawing of lots. The pain was evaluated using the Neonatal Infant Pain Scale. Results: Fifty newborns were recruited per group. The median (interquartile range [IQR]) pain scores, during pricking, were 2 (1.5–3.5) and 3 (2.5–4.5), in the groups of breastfeeding and 30% glucose respectively, with a significant statistical difference ( P P = 0.02). Conclusion: The analgesic effect of breastfeeding is greater than that of 30% glucose solution, in newborns undergoing a single painful procedure. Term newborns weighing between 2500 and 3000 g express pain more than those weighing more than 3000 g.

Risks associated with mother-to-child transmission of hiv infection

Nguefack F, Koki-Ndombo P, Ngoh R, Soh Fru F, Kinkela MN, Chiabi A. Risks associated with mother-to-child transmission of HIV infection. Turk J Pediatr 2017; 59: 426-433. Early infant diagnosis (EID) permits the detection of Human Immunodeficiency Virus (HIV) infection in exposed children from 4-6 weeks by polymerase chain reaction (PCR). The aim of this study was to assess some maternal and infant characteristics associated with HIV infected children in an EID program. A retrospective study was performed using records of HIV exposed children enrolled in the EID program from 2009 to 2013. Patients recruited were from various health structures and at different clinical stages; some for the Prevention of Mother-to-Child Transmission (PMTCT) follow up, others with signs of HIV infection. Data was collected from completed hospital records of children aged 6 weeks to 18 months containing at least two PCR, one PCR and one serologic test, or one PCR test and viral load. HIV infection was considered if one of the of tests was positive. In all, 130 (5.3%) exposed children with only one positive PCR test, and 1,442 (59%) others with information lacking in their record were excluded. A total 107 out of 871 infants enrolled (12.2%) were infected. Only, 32.7% of the mothers were on antiretroviral therapy (ART). Of these, 53.3% had their first PCR performed between 6 weeks and 6 months. Children were less likely to be HIV infected when their mothers received antiretroviral (ARV) (OR=0.15, 95% CI 0.07-0.30, P=0.000). Factors associated with HIV infection in the children were the lack of ARV prophylaxis (OR=2.07, 95%CI 1.05-4.09, P=0.035) and having mixed feeding (OR=3.91, 95% CI 1.66-9.24, P=0.002) in multivariate analysis. The high rate of infection associated with the maternal and infant correlates of HIV infected children would result from the poor implementation of the PMTCT. Systematic screening of pregnant and breastfeeding women should be reinforced and the lifelong ARVs for PMTCT (Option B+) be promoted.

Evaluation of short-term growth in very low birth weight preterm infants at a tertiary hospital in Cameroon

Aim: This retrospective cohort study describes the short-term growth of very low birth weight (VLBW), preterm babies. We hypothesized that catch-up with term infants occurs by 6 months of chronologic age. Patients and Methods: A total of 113 VLBW preterm babies were discharged alive from the neonatology unit of the Yaounde Gyneco-Obstetric and Pediatric Hospital. Sixty-six of the infants respected their monthly appointments for at least 6 months and were included in the study. The weight was taken daily, while the length and head circumference were taken weekly during postnatal hospitalization period and monthly after discharge. Results: The median birth weight was 1390 g. The mean daily weight gain from the 2nd week of hospitalization was 17.35 g/kg/day. By the 6th month of life, the weights of all the infants were comparable to term babies. The median length at birth was 40 cm, an average monthly increase of 3 cm/month for females, and 3.43 cm/month for males. Babies with length at birth above the 85th percentile reached the growth corridor of term infants by 6 months of life. The median head circumference at birth was 28 cm. The head increased at a rate of 2.5 cm/month for males and 2 cm/month for females. Only those with a head circumference above the 50th percentiles were comparable to term infants at 6 months. Conclusions: VLBW preterm infants caught up in weight with term infants by 6 months of age. Growth in length and head circumference lagged behind.