Ekoe Tetanye

Management of neural tube defects in a Sub-Saharan African country: the situation in Yaounde, Cameroon.

BACKGROUND Neural tube defect is a serious disabling but preventable congenital malformation with an incidence of 1.99 per 1000 births in Yaounde [A.K. Njamnshi, V. d e P. Djientcheu, A. Lekoubou, M. Guemse, M.T. Obama, R. Mbu, S. Takongmo, I. Kago. Neural tube defects are rare among black Americans but not in Sub-Saharan black Africans: The case of Yaounde-Cameroon. Journal of the Neurological Sciences 2008; 270: 13-17]. The management requires highly qualified personnel and a significant social cost. The aim of this study was to evaluate the management of neural tube defect in a resource-limited developing Sub-Saharan nation like Cameroon. METHODS We reviewed all patients with neural tube defects admitted in the neonatology unit of the Mother and Child Center (Chantal Biya Foundation Yaounde) between January 1st 2000 and December 31st 2006. RESULTS Sixty-nine (69) patients were enrolled. There was a male predominance (69.57%) in the sample. Myelomeningomecele represented 68.11% of cases, followed by encephalocele (27.54%) and meningocele (4.35%). Antenatal ultrasound examinations were done in 27 cases (32.8%). The prenatal diagnosis was made only in 8 cases. No medical abortion was performed in any of these cases. Medical abortion is illegal in Cameroon (except in certain specific situations) as well as other Sub-Saharan African countries. Hydrocephalus was diagnosed in 40.02% of cases. As most of the patients (62.32%) could not afford modern treatment, only 26.09% of them were operated at birth. The rest sought traditional and other forms of treatment, due to poverty or cultural beliefs. Eight patients (11.59%) died before surgery. Surgery consisted of local closure alone (40%) or local closure associated to CSF shunting (60%). The complications were wound dehiscence (13.69%), shunt infection (1.37%), meningitis (1.37%) and iatrogenic pulmonary oedema (1.37%). CONCLUSION Neural tube defects are the most frequent and disabling malformations in neonates in the Sub-Saharan African paediatric environment. Prenatal management and outcome at birth are limited by poverty and cultural beliefs. Prevention is possible and may be better than palliative care in developing countries.

Anthropometric measurements in a newborn population in West Africa: A reliable and simple tool for the identification of infants at risk for early postnatal morbidity

The predictive value of anthropometric measurements in the identification of infants at risk for early postnatal morbidity was assessed in a cohort of 490 neonates born in Yaoundé, Cameroon. Mid-arm circumference (MAC), head circumference, weight, and length were measured within 6 hours of birth, and the gestational age, individual MAC/head circumference ratio, and individual ponderal index were calculated. A detailed questionnaire on gestational medical history was also obtained from the mothers. All infants were then closely monitored during the first 72 hours after delivery for the appearance of symptoms requiring medical intervention and treated accordingly. Low birth weight (LBW) was observed in 37.75%, prematurity in 25.5%, and small size for gestational age in 14.1% of the neonates. Gestational medical problems were reported by 44.3% of the mothers; malaria was the most frequent. Early postnatal morbidity was observed in 26% of the infants; infection (53%), respiratory distress (26%), hypoglycemia (26%), and convulsions (11.7%) accounted for most of the problems. The MAC correlated best of all variables with birth weight (r = 0.91); a value of less than or equal to 9.5 cm had a 93% sensitivity and a 90.5% specificity in the prediction of LBW. An MAC cutoff value of less than or equal to 9.5 cm was also the best of all variables in the prediction of early postnatal morbidity, and 85.2% sensitivity and 74.3% specificity were achieved. We conclude that in developing countries, where scales are not always available and the overburdened maternity wards cannot allow for medical surveillance of every infant, the MAC can be used in the estimation of birth weight. Moreover, an appropriately calculated cutoff value of MAC may serve as a reliable indicator of LBW and of infants at risk for early postnatal morbidity.

Trace elements in foods of children from Cameroon: A focus on zinc and phytate content

In developing countries, complementary foods are based on local cereal porridges. These foods are poor in trace elements, with a high risk of inducing micronutrient deficiencies-the primary cause of mortality in children under the age of five. Inappropriate feeding of complementary foods is the major factor creating malnutrition and micronutrients deficiencies in Cameroon children, as well as in other developing countries. This study determined the zinc and phytate content of 30 complementary foods that were based on maize or Irish potatoes. The foods were blended or treated by dehusking, fermentation and germination. Zinc was measured by flame atomic absorption spectrophotometry and phytates by high pressure-liquid chromatography; then phytates/zinc molar ratios were calculated. Concentrations (mg/100g dry matter) ranged, respectively, from 0.20 to 2.58 (0.12 ± 0.67) for zinc and from 0.00 to 6.04 (1.87 ± 1.7) for phytates. The phytate/zinc ratio varied from 0.00 to 51.62 (11.12 ± 11.53). It appears that germination and fermentation reduced the level of phytates: however, zinc levels in the samples did not change significantly. The traditional, local complementary foods were not only poor in zinc, but contained very high levels of phytates. These phytates have the potential to considerately reduce the acid extraction of zinc, and could impair its bioavailability.